Over the past three decades, the number of cancer survivors has increased. That trend is expected to continue. The numbers indicate progress in the treatment of cancer, but they also underscore the importance of quality of life after cancer.
“We want people to lead healthy, productive, enjoyable lives, and mobility is such an important piece of that,” says Larissa Nekhlyudov, MD, MPH, internal medicine clinical director in the Adult Survivorship Program at Dana-Farber.
What are the most common causes of limited mobility during and after cancer treatment?
Mobility can be limited in a range of ways during and after cancer treatment. Care teams, such as those at Dana-Farber Brigham Cancer Center, can help you manage the physical and emotional effects of any mobility issues that arise, which can include:
- General side effects from cancer treatment medicines such as fatigue, dizziness, and general deconditioning, all of which should lessen after treatment, especially with exercise, quality sleep, and good nutrition.
- Damage to nerves, called peripheral neuropathy, can cause numbness or tingling in the hands and feet and a persistent feeling of walking on pins and needles. While neuropathy is often temporary, it can be permanent but might be lessened with light exercise and mobility work.
- Tightening of muscles and connective tissue, called fibrosis, due to radiation. Mobility exercises started early may help prevent fibrosis, but the tightness becomes harder to manage and can worsen significantly if allowed to persist.
- Muscle loss or atrophy, called sarcopenia, can cause weakness and frailty. Good nutrition and exercising at an appropriate level can help.
- Surgery can result in loss of function, for example affecting the shoulder after mastectomy. Much more rarely, amputation due to specific forms of cancer, such as osteosarcoma, can require rehabilitation to adjust to moving with an aid or prosthetic.
Can I do anything to prepare for cancer therapy and avoid mobility issues?
Prehabilitation is becoming more recognized in cancer therapy. Patients who do not need to start treatment immediately can focus on improving wellness and conditioning prior to treatment.
Quitting smoking, attaining an optimal weight for you, and starting a regular exercise program to improve fitness can all help. “Being in good physical condition during cancer treatment can lead to better outcomes,” says Nekhlyudov.
Is there anything I can do to prevent mobility limitations during treatment?
Often when patients undergo treatment, the focus — both for the patient and the oncologist — is on the cancer. Is it shrinking? Is it progressing? But it’s important to also monitor side effects.
Some side effects, like neuropathy, could become permanent conditions. A sense of tingling or numbness in the hands and feet could be the beginning of neuropathy. Tell your care team if you are experiencing these symptoms as soon as possible so they can find a way to help. For example, changing the chemotherapy or reducing the dose might be possible without sacrificing the effects of treatment.
Other side effects, like stiffness and fibrosis that can develop from radiation, is harder to counteract the longer it persists. Patients undergoing radiation therapy might want to incorporate mobility exercises into their course of treatment to prevent fibrosis.
It is important to understand that physical abilities vary from person to person, as do treatment effects. If you or your clinicians have any concerns, seek the guidance of an exercise physiologist. Dana-Farber patients can access helpful services at the Leonard P. Zakim Center for Integrative Therapies and Healthy Living.
How are mobility issues diagnosed after treatment is complete?
Mobility concerns should be a priority topic during follow-up visits. Sounds easy, but it takes some effort.
Doctors often see patients after they have already been seated in an exam room. They don’t have an opportunity to see if a patient struggled to get to the room. Further, patients might have preset expectations that cancer will have negative effects on their function, or be depressed, anxious, or experiencing cognitive problems that limit their ability to recognize their limits or mention things like falls.
A team effort will help bring mobility to the forefront of the conversation. Family members, caregivers, nurses, and staff should mention mobility issues, including those observed during the walk into the office. Doctors should ask about day-to-day activities, falls, fatigue, and nutrition.
A consultation with a physiatrist — if possible, someone specifically trained in mobility issues after cancer — and referral to physical therapy may be needed.
Are there specific tests that can measure mobility?
The Get Up and Go Test evaluates a person’s ability to rise from sitting, walk 10 feet, return, and sit back down. Doctors use it when needed, for instance to determine if a patient is ready to be more independent or is at an increased risk of falling.
Doctors may also ask whether the patient can get themselves dressed, take a shower, or if the patient has had any recent falls. Even patients who are in good condition and appear mobile should mention any concerns they might have, especially if they might not be obvious to the physician.
“The key is to have the conversation,” says Nekhlyudov. “At Dana-Farber, we do our best to treat the whole patient, including their overall wellness and mobility.”
How can I deal with the emotional effects of mobility issues or changes in my body?
Physical changes that limit mobility take a toll on overall quality of life. For some patients, the changes are hard to manage and can lead to depression or anxiety.
Dana-Farber’s Psychosocial Oncology team can help Dana-Farber patients cope, especially if depression, anxiety, or changes in thinking or behavior are affecting mobility or overall quality of life.
What can I do to improve mobility during and after cancer treatment?
Exercise is essential, and there is evidence to support it. An entire field of study called exercise oncology focuses on tailoring exercise and activity to individual patients with cancer. Every patient has unique needs depending on their condition prior to their diagnosis, their illness, and their treatment.
The Leonard P. Zakim Center for Integrated Therapies and Healthy Living offers in-person and virtual exercise classes and exercise consultations. They also offer massage and acupuncture services, which can also help with mobility.
People looking for options in their local community might look for Livestrong at the YMCA, which offers low-cost access to personal trainers who specialize in cancer. The American College of Sports Medicine also has a search tool to help you find trainers who specialize in cancer.
What are my limits? How do I know if a certain form of exercise is okay for me?
If you are in doubt or new to exercise, the best bet is to work with a physical therapist or certified trainer who can do an assessment and help you avoid getting hurt. There are many ways to adjust exercise to an individual’s needs. For example, a patient experiencing neuropathy in the feet might be better off on an exercise bike rather than walking. A patient struggling with balance might start with chair yoga rather than mat yoga.
Dana-Farber’s Zakim Center YouTube master playlist has many videos to help you get started.
If you are not new to exercise, talk to your care team to plan your return to activities like running, mountain climbing, and hiking during and after treatment.
“Many people go on to do the things that bring them joy and happiness,” says Nekhlyudov.
What can I do on my own to help with mobility?
Getting sufficient, high-quality sleep and maintaining a healthy diet are important to maintain overall health. Dana-Farber has several resources that can help you learn more about sleeping, exercising, and eating well during and after cancer therapy:
About the Medical Reviewer
Dr. Nekhlyudov received her MD from the Mount Sinai School of Medicine in 1995. She completed her residency in internal medicine at the Yale-New Haven Hospital and the Yale Primary Care Residency Program. She then pursued a research fellowship focusing on cancer and received an MPH from the Harvard School of Public Health. She is a general internist with extensive clinical and research expertise in cancer survivorship. She leads numerous educational efforts aimed at improving the care of cancer survivors in both oncology and primary care settings.