Rehabilitation and Its Key Role in Childhood Cancer

By Abu Sidhanee, Children’s Physiotherapist and Clinical Lead, University College Hospital London, UK.

At the 2021 Congress, Pia Delano, a physiotherapist from Chile, Annie Brochu, a physiotherapist from Canada, and I talked about rehabilitation in paediatric cancer at the SIOP Supportive Care education session. As the 2022 Congress in Barcelona approaches, I’d like to reflect on what we said, and how the SIOP community can help take rehabilitation forward. 

The WHO defines rehabilitation as ‘a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment’ (for further information see: https://www.who.int/news-room/fact-sheets/detail/rehabilitation). For children and adolescents with cancer this means many things, including getting them back walking again, helping them to talk or regaining their independence with tasks such as holding a pencil and writing. 

Over 90% of children and adolescents with cancer present with symptoms like pain and fatigue, and over 80% of survivors have at least one late effect related to their cancer or treatment. Therefore, almost all will require rehabilitation of some kind.

We know that the relative burden of childhood cancer will increase and global survival for children's cancer is improving (WHO GICC). Hence, there will be more survivors of childhood cancer. Rehabilitation will be key to optimising their quality of life. 

Unfortunately, many countries are not equipped with sufficient rehabilitation infrastructure. In some Low & Middle-Income Countries, over half of people do not receive rehabilitation services they require. We used data from the SIOP Global Mapping Programme to understand the state of paediatric oncology rehabilitation services across Africa (for further information see: https://siop-online.org/globalmapping/) Rehabilitation is often not prioritized & continues to be under-resourced in many settings globally, including high-income ones. 

It is important to recognise at local level, the provision of rehabilitation can be cheap and doesn’t require expensive equipment, and that simple play and everyday household objects can be used effectively to facilitate rehabilitation. See this video for some ideas.

Investing in rehabilitation at national level can bring productivity and economic benefits, so it can be cost effective. However, we must remember the greatest impact of rehabilitation is to the child, their family, and their communities. We all want to see children and adolescents living their lives to the fullest, being active and engaging with their friends and communities. Rehabilitation should be considered an essential service.

Although major gains in treatment have been made in recent decades, cure is no longer good enough. We didn’t come this far only to get this far. Rehabilitation will take children with cancer further. 

Through rehabilitation, there is the potential to optimise the function, quality of life and physical & psychosocial outcomes of millions of children and adolescents globally. Amongst many other things, rehabilitation can have hugely positive impacts on the lives of millions of families, the burden on health resources, and socio-economic productivity.

So, if you are not already doing so, please start talking about rehabilitation. Please advocate for it locally in your settings and encourage those in positions of power to invest in rehabilitation. In addition, please support Pia, Annie, and I in the work we are doing with SIOP and ask your colleagues to come forward and join our Rehabilitation task force. 

If you are interested in joining SIOP’s Rehabilitation task force or would like to find out more, please contact us by email: PaedsCancerRehab@outlook.com 

Abu Sidhanee is a Clinical Lead Physiotherapist working in Children’s & Teenage Cancer services at University College Hospital London, UK. He is a member of SIOP and the Children’s Cancer & Leukaemia Group (UK). Abu is the lead of World Physiotherapy’s IPT-HOPE Paediatric Oncology specialist interest group and a co-lead of SIOPs Rehabilitation task force. He was also part of the peer review group for the WHO Cancer Package of Intervention for Rehabilitation. Abu works as part of a comprehensive multi-professional team in the care of children and teenagers with a wide range of cancer diagnoses. He has a special interest in neuro-oncology, bone tumours and on-treatment rehabilitation and physical activity.




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