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Report on the rehabilitation of cancer patients Cancer rehabilitation helps a person with cancer obtaining the best physical, social, psychological, and work-related functioning during and after cancer treatment. The goal of rehabilitation is to help a person regain control over many aspects of their lives and remain as independent and productive as possible. Rehabilitation can be valuable to anyone with cancer and those recovering from cancer treatment. Rehabilitation can improve the quality of life for people with cancer and their families, including: Improving physical strength to help offset any limitations from cancer and cancer treatment Helping the person with cancer become more independent and less reliant on caregivers Helping the person with cancer adjust to actual, perceived, and potential losses due to cancer and cancer treatment Reducing sleep problems Lowering the number of hospitalizations The Department of Radiation Oncology in Debrecen offers a variety of cancer rehabilitation services to their Hungarian and Romanian patients, or are willing to help them identify local resources to assist with rehabilitation. Patients and family members are encouraged to be active, informed partners in the rehabilitation process and seek out the services they need. Talk with a nurse or social worker about the services you are interested in: Patient and family education and counseling Pain management techniques and medications Nutritional counseling Exercise programs to help to build strength, endurance, and mobility Smoking cessation education and support programs Assistance with activities of daily living (ADLs) such as eating, drinking, dressing, bathing and using the toilet, Nutritionist at the Department of Radiation Oncology, University Debrecen evaluates the patient’s nutritional condition, assesses the additional metabolic demands that the cancer places on the body, and recommends the optimal diet with respect to specific clinical condition, caloric intake, food ingredients of choice, optimal consistency for easy swallowing, and the individual’s tastes. The nutritionist judges 1 total food intake by closely monitoring the patient’s weight and counting calories and, if nutrition is inadequate, may recommend interventions to facilitate adequate intake in the presence of poor appetite and swallowing disorders. The nutritionist should teach the patient and family general and specific dietary principles and consult with the clinical staff on the optimal parenteral nutrition when the need for that arises. Psychologist at the Department of Radiation Oncology, University Debrecen assesses the patient’s cognition and behavior, including intelligence, personality (i.e., ideational, emotional, behavioral, and character patterns), personal history, motivation, reaction to the illness, and coping skills. Following the diagnosis of cancer and the development of a disability, both the patient and family members may experience reactive depression or grief, which often is expressed in diverse ways, including denial, anger, anxiety, panic, fear, dependent behavior, depression, and the unmasking of previously controlled psychopathology. The primary role of the psychologist is to assist the patient and the family in coping, as well as to counsel and consult with the rehabilitation team members in managing the emotional reactions. The effectiveness of psychosocial intervention has been successfully demonstrated with cancer patients. Physical therapist at the Department of Radiation Oncology, University Debrecen teaches the patient to perform specific exercises to strengthen muscles, to increase stamina, and to maintain or improve joint range of motion and trunk flexibility. When indicated, training is provided to improve balance and coordination, as well as functional skills: transfers into and out of bed, wheelchair locomotion, and ambulation with or without assistive devices. Instructions are provided on how to normalize gait patterns and to safely ascend and descend stairs and curbs. Various physical modalities may be used by the therapist to reduce pain, such as superficial and deep heat, cold, transcutaneous electrostimulation (TENS), and massage, but the clinician needs to stipulate that heat modalities and massage should not be applied directly over or immediately adjacent to a site of cancer. Physical exercise is perhaps the most important therapeutic modality in the rehabilitation management of physical disabilities. Muscle-strengthening exercises may be either isometric, isotonic, or isokinetic. Isometric exercise does not involve joint motion, and so is prescribed for painful or unstable body parts, whereas isotonic exercise involves joint motion against variable resistance. Isokinetic exercise, a most effective strengthening exercise, involves the use of specific devices to maintain constant speed of motion independent of the force applied. Passive stretching exercises are done by the therapist without the patient’s direct participation to maintain or increase joint mobility. Task-oriented exercises, such as ambulation or training in self-care, may improve function and safety by repetition and prolonged therapy. Highly trained physical therapist at the department is also specialized on the treatment for lymphoedema affecting an arm or leg. This treatment involves: skin care to prevent injury and infection positioning and moving the limb to help drain fluid compressing the area using compression garments such as sleeves, stockings, special bras, or compression bandages exercising and keeping active to improve the flow of lymph specialised massage, called manual lymphatic drainage (MLD), or self-massage, called simple lymphatic drainage (SLD), to help drain fluid deep breathing exercises built into daily routines 2 radiation therapists: after appropriate radiation treatment indication follow the status of their patients during the treatment. Provide the adequate pain relief, refer to blood tests and diagnostic imaging tests Manage the side effects of the radiotherapy as: • radiodermatitis of the skin • radiomucositis of the oral cavity • xerostomy, decreased sense of taste • tracheitis, oesophagitis, pneumonitis, cough • hair loss, weight loss • diarrhea, cystitis, nausea, anaemia Recognize and manage the late side effects of the radiotherapy, provide the regular medical follow-up after the treatment. The complex work of these specialists and professionals provides in the Department of Radiation Oncology, University Debrecen the improvement of rehabilitation of patients with different types of cancer. The content of this report does not necessarily represent the official standpoint of the European Union. 3