{"slug":"rehabilitation","tag":"rehabilitation","variants":["rehabilitation"],"description":"Services and operations that put function back after cancer treatment: physiotherapy, occupational therapy, speech and language therapy, prehabilitation, reconstruction and the devices that go with them.","count":25,"kinds":{"section":1,"technology":20,"bottleneck":1,"idea":1,"trial":2},"related":[{"slug":"rejuvenation","tag":"rejuvenation","shared":25},{"slug":"survivorship","tag":"survivorship","shared":25},{"slug":"open-problem","tag":"open-problem","shared":4},{"slug":"commissioning","tag":"commissioning","shared":2},{"slug":"exercise","tag":"exercise","shared":2},{"slug":"fertility","tag":"fertility","shared":1},{"slug":"hair","tag":"hair","shared":1},{"slug":"late-effects","tag":"late-effects","shared":1},{"slug":"neuropathy","tag":"neuropathy","shared":1},{"slug":"recovery","tag":"recovery","shared":1},{"slug":"return-to-work","tag":"return-to-work","shared":1},{"slug":"use-it-or-lose-it","tag":"use-it-or-lose-it","shared":1}],"records":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/","tldr":"What cancer treatment took, and whether it comes back: hair, hearing, fertility, bone, muscle, nerves, memory, the heart, skin, sexual function and the years afterwards. Recovery begins during treatment rather than after it, and structured exercise has more evidence behind it than everything sold as rejuvenation put together."},{"id":"rejuv-rehab-cancer-rehabilitation","kind":"technology","name":"Cancer rehabilitation: the discipline that puts function back","route":"/technologies/rejuv-rehab-cancer-rehabilitation/","status":"established","tldr":"Cancer rehabilitation is the medical speciality that treats what treatment leaves behind: weakness, a stiff shoulder, a swallow that no longer works, a bladder that leaks, a limb that swells. It is delivered by a named set of professions, it has randomised evidence behind several of its parts, and in the largest study to measure it only three in ten of the impairments that needed it were treated."},{"id":"rejuv-rehab-prospective-surveillance","kind":"technology","name":"Prospective surveillance: looking for the problem before it becomes a disability","route":"/technologies/rejuv-rehab-prospective-surveillance/","status":"emerging","tldr":"The usual model waits for a patient to complain, by which time an arm has been swollen for a year. The prospective surveillance model measures function before treatment starts and again at set points afterwards, so a small problem is found while it is still small. One costing study put the price of managing early arm swelling at 636 dollars a year against 3,125 dollars for late swelling."},{"id":"rejuv-rehab-provision-gap","kind":"technology","name":"The gap between the rehabilitation people need and the rehabilitation they are offered","route":"/technologies/rejuv-rehab-provision-gap/","status":"established","tldr":"This is the measured part. Among 163 women with advanced breast cancer, 92 per cent had at least one physical impairment and 530 impairments were found; 30 per cent of those needing rehabilitation got it. In an Irish cancer centre in 2025, 71 per cent of 660 patients reported at least one specialist rehabilitation need and 36 per cent of those with a need had seen the relevant professional."},{"id":"rejuv-rehab-prehabilitation-evidence","kind":"technology","name":"What the randomised trials of prehabilitation found, operation by operation","route":"/technologies/rejuv-rehab-prehabilitation-evidence/","status":"established","tldr":"Training before an operation reliably makes people fitter for it. Whether it cuts complications depends on the operation and on who was recruited: a trial in high-risk abdominal surgery halved the proportion with complications, the largest colorectal trial cut severe complications from 29.7 to 17.1 per cent, and pooled home-based programmes improved the walking test and nothing else."},{"id":"rejuv-rehab-prehabilitation-programme","kind":"technology","name":"What a prehabilitation programme actually contains, and how long it needs","route":"/technologies/rejuv-rehab-prehabilitation-programme/","status":"established","tldr":"The programme behind the best colorectal result was four weeks long, supervised in hospital, and had four parts: high-intensity exercise three times a week, a nutritional intervention, psychological support, and smoking cessation where it applied. Supervision is the ingredient the trials keep separating out, and the window is what the pathway leaves."},{"id":"rejuv-recon-breast","kind":"technology","name":"Breast reconstruction: implant and autologous, immediate and delayed, and what women report afterwards","route":"/technologies/rejuv-recon-breast/","status":"standard-of-care","tldr":"Two years after surgery, women reconstructed from their own tissue reported more satisfaction with their breasts than women with implants, by about 8 points on a 100-point scale. After radiotherapy the gap widens and so does the complication rate: 38.9 per cent of irradiated implant reconstructions had a complication within two years against 25.6 per cent of tissue ones."},{"id":"rejuv-recon-head-neck","kind":"technology","name":"Head and neck reconstruction: the free flap, and what it gives back","route":"/technologies/rejuv-recon-head-neck/","status":"standard-of-care","tldr":"Removing a tongue, a jaw or a pharynx leaves a hole that will not close, so tissue is moved from the forearm, thigh or lower leg with its own artery and vein and joined under a microscope. In a series of 843 flaps the overall failure rate was 4.0 per cent, and in an older series of 1,000 flaps 7.6 per cent failed wholly or partly. Donor site disability measured years later is small."},{"id":"rejuv-recon-voice-after-laryngectomy","kind":"technology","name":"Voice after the larynx is removed","route":"/technologies/rejuv-recon-voice-after-laryngectomy/","status":"standard-of-care","tldr":"Removing the larynx removes the voice and separates the airway from the mouth permanently. Speech is restored in most people by a one-way valve set in a small hole between the windpipe and the gullet, which lets breath out through the throat so the throat can vibrate. The valve is a consumable that needs replacing, and people who lose contact with the service stop using it."},{"id":"rejuv-recon-stoma-reversal","kind":"technology","name":"Stoma reversal after rectal cancer surgery: who gets the bowel joined up again","route":"/technologies/rejuv-recon-stoma-reversal/","status":"standard-of-care","tldr":"Most temporary stomas made to protect a join in the bowel are reversed, and a meaningful minority are not. In a series of 639 patients having sphincter-sparing surgery, 11.9 per cent still had a stoma two years later; the main reasons were the cancer progressing (52.4 per cent) and the patient deciding against it (19.0 per cent)."},{"id":"rejuv-recon-limb","kind":"technology","name":"Limb salvage, amputation, and the rehabilitation that follows either","route":"/technologies/rejuv-recon-limb/","status":"standard-of-care","tldr":"Saving a limb with a metal endoprosthesis gives better walking efficiency and better return to normal living than an above-knee amputation, and studies that asked patients about overall quality of life found the two closer than expected. On the Toronto Extremity Salvage Score, lower limb amputees scored 72.2 against 85.5 after extended resection."},{"id":"rejuv-recon-facial-prosthetics","kind":"technology","name":"Facial reconstruction and facial prostheses: ears, orbits and noses","route":"/technologies/rejuv-recon-facial-prosthetics/","status":"standard-of-care","tldr":"Where an ear, an eye socket or a nose cannot be rebuilt from the patient's own tissue, a silicone prosthesis is made and held by adhesive or by titanium implants in bone. Implant failure differs sharply by site: across 3,630 implants, 3.5 per cent failed at the ear, 8.8 per cent at the nose and 18.7 per cent at the orbit."},{"id":"rejuv-recon-pelvic-exenteration","kind":"technology","name":"Recovery after pelvic exenteration","route":"/technologies/rejuv-recon-pelvic-exenteration/","status":"standard-of-care","tldr":"Removing the pelvic organs together can cure a recurrence that nothing else will, at the cost of one or two stomas and a long recovery. About half of patients have a major complication within 90 days. Overall quality of life scores recover by six to twelve months in most published series, while sexual function, body image and distress do not, and there are no randomised trials of any of it."},{"id":"rejuv-rehab-swallowing","kind":"technology","name":"Swallowing therapy around head and neck radiotherapy","route":"/technologies/rejuv-rehab-swallowing/","status":"established","tldr":"Keeping food going down the throat during radiotherapy, and doing swallowing exercises through it, both independently predict being back on a normal diet afterwards. In 595 patients, those who kept eating were twice as likely to be on solid food at three to six months and those who exercised were 2.9 times as likely."},{"id":"rejuv-rehab-pelvic-floor","kind":"technology","name":"Pelvic floor rehabilitation after prostate and rectal surgery and after pelvic radiotherapy","route":"/technologies/rejuv-rehab-pelvic-floor/","status":"established","tldr":"Pelvic floor exercises are offered to almost every man after prostate surgery, and the largest randomised trial found formal one-to-one training made no difference at twelve months: 76 per cent of treated men were still leaking against 77 per cent of controls. Training before the operation does speed early recovery."},{"id":"rejuv-rehab-respiratory","kind":"technology","name":"Breathing and exercise capacity after lung resection","route":"/technologies/rejuv-rehab-respiratory/","status":"established","tldr":"Taking out a lobe takes away lung, and breathlessness on stairs is what people notice. Across 18 randomised trials and 1,795 patients, pulmonary rehabilitation after lung resection improved lung function, six-minute walk distance and physical quality of life, with bigger gains from programmes of twelve weeks or more."},{"id":"rejuv-rehab-balance-vestibular","kind":"technology","name":"Balance, dizziness and falls after cancer treatment","route":"/technologies/rejuv-rehab-balance-vestibular/","status":"emerging","tldr":"Surgery for a vestibular schwannoma removes the balance nerve on one side, and the brain has to learn to work without it. Vestibular rehabilitation is the physiotherapy that teaches it, and a systematic review of 23 studies graded every outcome as very low certainty. Referral is also the problem: in one centre 42 per cent of patients were referred and 36 per cent of those completed the programme."},{"id":"rejuv-rehab-scar-contracture","kind":"technology","name":"Scars, stiffness and contracture: shoulders, necks and jaws","route":"/technologies/rejuv-rehab-scar-contracture/","status":"established","tldr":"Scar tissue shortens as it matures, and across a joint that means lost movement: a shoulder that will not reach a shelf, a neck that will not turn, a mouth that will not open. Silicone gel flattens and softens the scar itself in randomised trials, and stretching is what holds the joint."},{"id":"rejuv-rehab-driving-and-exercise-return","kind":"technology","name":"Going back to driving, lifting and exercise","route":"/technologies/rejuv-rehab-driving-and-exercise-return/","status":"established","tldr":"These are the two questions people ask most often after an operation and the two with the least evidence behind the answers. No trial establishes when it is safe to drive after cancer surgery, and in the United Kingdom the licence holder must notify the DVLA of an illness affecting safe driving. For exercise the dose is published."},{"id":"rejuv-rehab-assistive-devices","kind":"technology","name":"The devices that do the restoring, and who pays for them","route":"/technologies/rejuv-rehab-assistive-devices/","status":"standard-of-care","tldr":"A breast prosthesis, a limb prosthesis, a compression garment, a voice valve, a dental implant and a hearing aid are each the difference between a function working and not working, and each is funded differently. In the United States a federal law requires plans that cover mastectomy to cover prostheses and lymphoedema treatment."},{"id":"rejuv-rehab-commissioning-inequity","kind":"technology","name":"Where rehabilitation is commissioned, and who misses out","route":"/technologies/rejuv-rehab-commissioning-inequity/","status":"established","tldr":"Whether a person gets rehabilitation after cancer depends on where the problem was noticed, how far they live from the service, how much money they have and what they were treated for. In the benchmark study a problem found in hospital was 88 times more likely to be treated than the same problem found in clinic."},{"id":"rejuv-agenda-rehabilitation-not-commissioned","kind":"bottleneck","name":"Rehabilitation is recommended everywhere and commissioned almost nowhere","route":"/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/","tldr":"The interventions with the best evidence after cancer are supervised exercise, psychological therapy and specialist rehabilitation. The commonest finding across this whole front is that the evidence exists and the service does not."},{"id":"idea-rejuv-rehabilitation-prescription-at-discharge","kind":"idea","name":"Write a rehabilitation prescription at the end of treatment, and fund it like a drug","route":"/ideas/idea-rejuv-rehabilitation-prescription-at-discharge/","tldr":"Exercise after colon cancer has a hazard ratio a drug would be licensed on. It is in the guidelines and in almost no budgets, because it is a staffed service rather than a product."},{"id":"rejuv-trial-ex-cipn","kind":"trial","name":"EX-CIPN: virtual exercise-based rehabilitation for persistent chemotherapy nerve damage","route":"/trials/rejuv-trial-ex-cipn/","status":"recruiting","tldr":"Nothing prevents chemotherapy nerve damage and the only drug with guideline support for the established painful form has a benefit the guideline itself calls limited. This pragmatic trial tests ten weeks of individualised remote exercise against usual care."},{"id":"rejuv-trial-canwork","kind":"trial","name":"CanWork: an occupational therapy programme to help women return to work after breast cancer","route":"/trials/rejuv-trial-canwork/","status":"recruiting","tldr":"Return to work is one of the outcomes most affected by cancer treatment and least provided for. This cluster-randomised trial tests a five-module occupational therapy programme and costs it, so that a commissioner could act on the result."}]}