Interest in oncology physical therapy practice as an option among career choices has paralleled the tremendous growth in the field of cancer rehabilitation. It has been more than 4 decades since the seeds of cancer rehabilitation were planted rather synchronously in the fertile grounds of MD Anderson Cancer Center in Houston and Memorial Sloan-Kettering Cancer Center in New York. At around the same time, Reach to Recovery was initiated, postlaryngectomy and postcolostomy groups were introduced, and the concept of employing real rehabilitation efforts had become engendered in those who observed and documented the disabilities and sequalae of cancer and its treatment. Cancer rehabilitation was born.
Nicole Stout, dynamic past American Physical Therapy Association (APTA) Oncology Section president, has come to take her deserved place among our professional leaders as a member of APTA's board of directors. Now, as guest editor of this issue, she displays her superb organizational skills in garnering a group of remarkably fresh and exceptionally talented authors to further the body of cancer rehabilitation knowledge that has virtually exploded in just recent years.
Stout's choice of topics demonstrates her wide view of the cancer rehabilitation milieu and portrays the breadth and diversity of themes that have come under the cancer rehabilitation umbrella.
Kathie Hummel-Berry, current APTA Oncology Section president, offers a detailed and comprehensive overview of the epidemiology of cancer as it relates to physical therapy practice. The development of cancer determines its incidence and prevalence, and this in turn drives the associated problems of disability that are observed. A thorough familiarity with the origins and causes of the rehabilitation problems opens the road to better evaluation and treatment techniques on the part of the physical therapist practicing in oncology. Garret and Kirchner (1995, Rehabilitation Oncology) first depicted oncologic emergencies and stressed their importance to physical therapists working with the cancer patient; G. Stephen Morris, Director of research in the Department of Rehabilitation Medicine at MD Anderson Cancer Center gives this subject a fresh look and imparts a new significance to its primacy. The intense significance of central nervous system tumors and their far-reaching consequences are exhibited in an excellent, representative delineation of the evaluation and treatment of patients with brain tumors.
Prescribing exercises for patients with cancer is a wide topic, and this comprehensive and extensive subject is summarized beautifully by Andrea Lieserowitz, a key member of the APTA Oncology Section's specialization committee. Her impressive article affords the therapist thoughtful concepts on which to base exercise choices in the cancer patient. Pelvic floor dysfunction is not limited to females with gynecological cancers, but can also occur in males with tumors of the prostate or bladder. Pelvic floor rehabilitation is a relatively new area in the cancer rehabilitation family, but one where the importance of the many ensuing psychological and physical problems that are encountered can far outweigh their incidence. Physical therapists who concentrate their practice in pelvic floor rehabilitation will find that cancer patients can make up a considerable percentage of their clients. Lisa Massa in her admirable article outlines this heretofore little discussed issue and brings it to the clinical significance that it merits.
It is somewhat surprising that the lymphedema management techniques developed in the 1930s in Europe took so long in becoming mainstream approaches in the United States. Now, certification and training in complex lymphedema therapy is perhaps the most popular and pervasive choice of specialized care in the cancer rehabilitation arena. Support groups, listserve sharing of ideas, research, and education in evaluation and treatment of this all too common problem have increased beyond most therapist's expectations, and Tammy Mondry proffers a most commendable manuscript summarizing and diagramming the salient features of lymphedema care and confers and assigns the needed relevance of this area to the reader.
Cindy Pfalzer, a renowned and prolific researcher, teacher, clinician, and visionary in the field of cancer rehabilitation, teams up with Stout and Ellen Levy to portray the musculoskeletal impairments identified in the upper quadrant. Dr Pfalzer and Ms Stout have both presented extensively on this topic, and their depiction in this issue underscores the vast extensions of these impairments to many types of cancer. The late effects of chemotherapy are just beginning to be addressed in the literature in a meaningful manner; Mary Lou Galantino, chair of the research effort in APTA's oncology section, presented on this pertinent topic at the seventh MCV Massey Cancer Center's biennial conference and now employs her superlative writing skills to bestow a definitive story of this multifaceted problem. The issue closes with a look into gait and balance disturbances during and after cancer treatment, areas needing special attention by the oncology physical therapist.
Kudos to all the authors in this superb effort, which has given us a detailed, elaborate picture of really just the surface of the multitude of disabilities encountered in the cancer patient, and in particular, the geriatric cancer patient. As we enter the second decade of the 21st century, we can be assured that the full richness of approaches to cancer rehabilitation is yet to be realized. The sheer number of therapists now involved in oncology rehabilitation is amazing, and knowledge dissemination is paramount. The cancer rehabilitation parameters first developed and engendered back in the 1950s and 1960s, and developed and matured up to the present time, have borne marvelous fruit. This special issue of Topics in Geriatric Rehabilitation gives us one of the first harvests.
—Stephen A. Gudas, PhD, PT
Department of Anatomy and Neurobiology
VCU/Medical College of Virginia
Editor, Rehabilitation Oncology