Holly Flynn didn’t exactly feel like jogging or taking aerobics class after she finished chemotherapy and radiation treatment for breast cancer earlier this year.
“The thought of going to one more appointment, one more class, one more anything — it seems so incredibly overwhelming,” said Flynn, 38, of Savage.
Trouble is, inactivity often ends up harming cancer patients. While seven in 10 patients with common cancers survive long-term, treatment leaves the majority with physical limitations — fatigue, limited mobility in their arms and legs, or other problems — and those often lead to depression and stress as well.
But Flynn took advantage of a new therapy called cancer rehabilitation, adopted by Allina Health and a handful of other Minnesota medical providers, designed to help people overcome the mental and physical aftereffects of cancer and its harsh treatments. Minneapolis-based Allina has trained 100 caregivers at clinics around the metro area on how to detect patients who could benefit from cancer rehab and what kinds of services to offer them.
“People think you sort of revert back to fine after cancer treatment. ‘You’re done! Congratulations!,’ ” said Dr. Nancy Hutchison, who directs Allina’s cancer rehab program. “The truth is, that is when you are at your worst, because … cancer treatment makes you sick.”
Research also has found lower recurrences of cancer in people who stay fit after their treatment.
Rehab is a familiar concept in orthopedics — when patients need to rebuild ankles, knees or other joints — and is commonly used to help patients regain strength after strokes or heart attacks. But it has been a novelty in cancer care until recently, sometimes because of “nihilism,” Hutchison said — the sense that can develop in both cancer patients and doctors that nothing will help.
Studies suggest that at least six of every 10 cancer survivors could benefit from post-treatment rehab services, but that only one in 10 receives them.
A new model of care
Cancer rehab has gained popularity since 2009, when Dr. Julie Silver at Harvard University created “STAR,” the nation’s first hospital certification program in the specialty.
The concept emerged after Silver completed treatment for her own breast cancer and found, to her surprise, that she was unable to resume her usual activities as a mother and doctor. She entered cancer care in her mid-30s and exited, she says, as if she were a woman in her mid-60s.
In the past, Silver said, many cancer survivors had to identify their own disabilities.
“ ‘Gee, I can’t lift my arm over my head’ or ‘I can’t go back to work because I’m in so much pain,’ ” Silver said.
“Imagine if we had stroke survivors and [doctors] just sent them home to figure it out on their own. That’s not a very good model of care, and that’s what was happening with cancer.”
It wasn’t that long ago that Flynn was in that place — finished with cancer treatment but exhausted and wondering if this was the best she was ever going to feel.
She was pregnant with her youngest child when she underwent chemotherapy in 2012, and then after the birth in September that year, she underwent more chemo and radiation, along with a double mastectomy when the cancer returned. The surgery left her unable to raise one arm above her head, but physical therapy helped her regain that mobility within two weeks. Since then, she has worked out on her own and participated in a Pilates class designed for cancer survivors. She returns for additional cancer rehab from Hutchison’s team when other physical problems surface.
Slowly, ordinary tasks are becoming manageable again, like hefting a double stroller out of the back of her SUV or folding and carrying baskets of laundry.
“It feels good,” she said, “to feel like you are taking charge of yourself again.”
In addition to Allina, Duluth-based Essentia has expanded its number of workers with STAR certification. Fairview Health Services started a formal program two years ago and offers rehab in clinics around the metro area.
Rehab can also benefit patients with ongoing and terminal cancers, said Megan Webster, a physical therapist with the Fairview program. She recalled one man who was despondent because cancer was robbing him of the retirement plans he had with his wife; rehab exercises at least gave him the strength for family activities and to attend his grandkids’ sporting events.
Research is also making a case for “prehab” — exercise before cancer treatment that gives patients a better chance at favorable outcomes and fewer complications.
Hutchison said her program emphasizes persuading cancer patients to remain physically active even after physical therapy sessions are over, and to defy the societal messages that cancer patients should just take it easy and rest. This week she encouraged a reluctant patient during a follow-up appointment to stop by the YMCA on the way home and enroll in a class. A nurse followed up with a call to her home to make sure she did it.
“Motivation is hard to sustain when you feel like crap,” Hutchison said.
Jackie Fischer, 66, of Minneapolis, had her first physical therapy appointment on Wednesday — having completed chemo and radiation this fall for breast cancer — and simply hopes it will help her build up the strength to take walks and garden by next spring.
“I’m just glad this is over,” she said of cancer treatment. “I’m just hoping the next step will make it so I’m nice and strong and don’t have to go through that again.”
For Flynn, simultaneous pregnancy and cancer was taxing, and the hormones of the pregnancy probably fueled the growth of a second tumor in her breast that required a second round of cancer treatment. But giving birth amid cancer treatment gave her motivation because she wanted to be strong enough to care of her newborn.
Flynn still isn’t where she wants to be; lifting her 5-year-old up stairs is like “climbing Mount Everest.” But she is making steady progress and training for a 5K run.
“It was really motivating,” she said. “The better I felt, the more I wanted to do.”