Prostate Cancer Treatment cannot be Enhanced without including Comprehensive Cancer Rehabilitation

By Farooq Azam Rathore

Affiliations

1. Department of Rehabilitation Medicine, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan

doi: 10.29271/jcpsp.2024.11.1400

Sir,

I read the editorial, “Prostate Brachytherapy: Advancing Prostate Cancer Treatment in the Region”,¹ by Pervez and Alrashidi with interest. I commend the authors for their comprehensive overview of prostate brachytherapy and its potential to improve prostate cancer (PCa) treatment in our region. Their work highlights the critical need for advanced and accessible treatment options in the face of rising PCa incidence. 

While the editorial provides valuable insights into the technical aspects and benefits of brachytherapy, I believe it is crucial to address a significant aspect of PCa care that was not discussed: The integration of cancer rehabilitation services. I would like to suggest that the discussion of PCa management remains incomplete without the early integration of cancer rehabilitation services. While technological advancements such as brachytherapy are undoubtedly important and lifesaving, addressing the physical, functional, and psychosocial consequences of PCa and its treatment are equally vital for holistic  patient  care.

Cancer rehabilitation is a specialised and rapidly upcoming field in the realm of Physical Medicine and Rehabilitation (PMR) that aims to optimise patients' quality of life (QOL) by addressing the impairments, activity limitations, and participation restrictions that can arise from cancer and its treatment.² In the context of PCa, rehabilitation can play a pivotal role in managing urinary incontinence, erectile dysfunction, fatigue, pain, and psychological distress – all of which can significantly impact a patient's well-being and overall outcome. The management of PCa is incomplete without the early integration of cancer rehabilitation services. Zopf et al. in a 15-month supervised exercise programme demonstrated significant improvement in physical fitness, urinary incontinence, physical role, emotional and social functioning, and reduced treatment-related side effects (dyspnoea, urinary, and bowel symptoms) in PCa patients.³ A meta-analysis found that preoperative pelvic floor muscle exercise can improve postoperative urinary incontinence in the short-term at 3 months, after radical prostatectomy.⁴ A comprehensive systematic review by Santa Mina et al. concluded that prehabilitation and rehabilitation interventions across various domains (including exercise, psychosocial support, and symptom management) consistently showed benefits in functional outcomes and QOL for PCa patients.⁵

The integration of cancer rehabilitation services alongside PCa management is not just beneficial; it is essential for optimal patient outcomes. An early integration of rehabilitation can potentially reduce both direct and indirect healthcare costs by preventing complications and reducing hospital readmissions, as shown by Silver et al. in their review of cancer rehabilitation models.⁶

However, significant challenges hinder the implementation of comprehensive cancer rehabilitation services in Pakistan. Despite growing evidences and recommendations for better integration of rehabilitation into oncology care, rehabilitation services in oncology are relatively underutilised.⁷ Other challenges include:

1. Lack of resources: Limited funding and inadequate infrastructure for rehabilitation services in many healthcare facilities.
2. Knowledge gap: Insufficient awareness among oncologists and patients about the benefits of cancer rehabilitation.
3. Lack of referrals: Absence of standardised referral pathways from oncology to rehabilitation services.
4. Shortage of trained professionals: Limited number of rehabilitation specialists with expertise in cancer care.
5. Geographical disparities: Uneven distribution of rehabilitation services, particularly in rural areas.
6. Financial constraints: High out-of-pocket expenses for patients seeking rehabilitation services.
7. Lack of research: Limited local data on the effec-tiveness of rehabilitation interventions in our popu-lation.

To address these challenges and improve PCa care in our region, healthcare policymakers, oncologists, and rehabilitation specialists need to take collaborative action. Some suggestions are as follows:

1. Develop and implement national guidelines for integrating rehabilitation services in cancer care pathways.
2. Increase funding for cancer rehabilitation research and service development.
3. Enhance education and training programmes for healthcare professionals (particularly oncologists in training) in cancer rehabilitation.
4. Establish multidisciplinary teams that include PMR (Physical Medicine Rehabilitation) specialists in cancer treatment centres.
   
    
5. Create public awareness campaigns about the importance of cancer rehabilitation.

In conclusion, while I appreciate the authors for their valuable contribution to advancing PCa treatment through brachy-therapy, I urge our medical community to recognise that optimal care extends beyond the primary treatment. By integrating comprehensive rehabilitation services, we can significantly enhance the QOL and functional outcomes for PCa survivors in our region. I hope that this letter will spark a broader discussion on the critical role of rehabilitation in PCa care and lead to tangible improvements in our healthcare systems.

COMPETING  INTEREST:
The author declared no conflict of interest.

AUTHORS’ CONTRIBUTION:
FAR: Design of the work, acquisition, analysis and interpretation of the data, drafting of the manuscript, clinical analysis, revision, and approval of the final draft.
 

REFERENCES

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2. Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil 2020; 42(1):8-13. doi: 10.1080/09638288.2018. 1514662.
3. Zopf EM, Bloch W, Machtens S, Zumbe J, Rubben H, Marschner S, et al. Effects of a 15-month supervised exercise program on physical and psychological outcomes in prostate cancer patients following prostatectomy: The ProRehab study. Integr Cancer Ther 2015; 14(5):409-18. doi: 10.1177/1534735415583552.
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