End-stage cancer is a challenging journey, both physically and emotionally, for patients and their families. Palliative care, with its focus on improving the quality of life and managing symptoms, plays a crucial role in supporting these individuals. Within palliative care, physiotherapy emerges as a gentle yet powerful tool that aims to enhance mobility, alleviate pain, and promote overall well-being.
I recall Manjunath, a middle-aged man diagnosed with prostate cancer that had metastasized into multiple bone cancers, with lytic and sclerotic lesions spreading to all major bones in his body. He was bedridden and struggling with severe pain, fatigue and bed-soreness. After two weeks of gait training, he felt confident enough to walk in the corridors of Karunashraya with the help of a walker. He was introduced to balance and coordination exercises that improved his functional limitations. Kinesio taping also helped reduce his neck pain. Manjunath found comfort and relief and experienced positive emotions.
Physiotherapy in palliative care goes beyond traditional rehabilitation and exercise. It not only focuses on preserving the quality of life but also facilitates independence and comfort for patients in their final stages of life.
As I was passing by the Kadamba ward, a cheerful laughter drew me to Asha Bai’s bed. A vivacious, 64 years old lady who was admitted to BHT- Karunashraya with multiple myeloma and vertebral compression due to cancer. Since she was bedridden and overweight, the physiotherapist started with assisted ambulation and wheelchair mobilization. Given her weak muscles and limbs, manual therapies like soft tissue mobilization were part of her daily treatment. Electrotherapy modalities like TENS (Transcutaneous Electrical Nerve Stimulation) were also used to reduce pain, along with crepe bandaging to reduce edema in parts of her body. Since Asha Bai did not have any open wounds, physiotherapy provided her with immense comfort.
Physiotherapy in palliative care for end-stage cancer patients differs significantly from therapy for regular patients in several key aspects. While traditional physiotherapy for regular patients may emphasize setting goals, regaining movements after injury and pushing boundaries, physiotherapy in palliative care prioritizes comfort, symptom management, and overall well-being. Physiotherapists tailor their approaches to meet the specific needs and limitations of terminally ill cancer patients, ensuring that therapy is gentle, supportive, and aligned with the patient’s goals of pain management and quality of life.
Being the terminally ill breast cancer and lymphoma patient, Catherine was treated with multiple physiotherapy techniques. She was started with therapeutic technique-range of motion (ROM) for her arms mobility. Her lymphedema was managed by manual lymphatic drainage (MLD) and compression bandaging. Our physiotherapist incorporated soft tissue massage into Catherine daily sessions that improved blood circulation and reduced pain and muscle tension in her arms. With the progression of her cancer, doctors included Activities of Daily Living therapy (ADL’s) that empowered her independence and introduced her to breathing techniques that brought sense of calmness in the midst of uncertainty and pain.
In this blog, I have delved into the significance of physiotherapy in palliative care with life examples from BHT- Karunashraya, explored the medical techniques employed, and shed light on how this form of therapy differs for end-stage cancer patients compared to regular patients. For families and caregivers, understand that physiotherapy provides more comfort to the patient and allows you to have more meaningful moments together. For healthcare professionals, let’s champion the early integration of physiotherapy into palliative care that can make a profound difference in patients’ quality of life.
The message to people, stemming from this understanding is of hope and proactive support. Even in the final stages of cancer, there is much we can do to improve a person’s quality of life. Physiotherapy is a vital piece of that puzzle, offering comfort, maintaining function, and fostering a sense of control when so much else feels out of reach. Let’s ensure that this valuable resource is accessible to all who can benefit from it.
Author
Annapurna Ram, Physiotherapist at BHT- Karunashraya
Sunaina, Physiotherapist at BHT- Karunashraya
Shilpi Agrawal, Volunteer at BHT – Karunashraya