Symposium Explores Latest Advances in Cancer Rehabilitation

Yazmin Odia, MD

Rehabilitation is vital in improving the quality of life for patients with cancer, including those with brain tumors. Ongoing research and collaboration are essential to address the unmet needs that still exist in this space and to optimize rehabilitation strategies.

To further the discussion of rehabilitation in the field of oncology, the Miami Cancer Institute Oncology Rehabilitation Symposium, 3rd Annual: Restoring Function and Improving Quality of Life for Cancer Survivors brought together experts from a variety of fields, including oncology, rehabilitation medicine, psychology, and neurology. At the symposium, they delved into latest advances and evidence-based strategies for treating the unique challenges faced patients with cancer.

Experts discussed practical, evidence-based rehabilitation strategies, including ways to accurately treat patients with various types of cancer. Further, clinicians evaluated different modes of assessment, treatment, and rehabilitation of patients with brain tumors and patients with skeletal metastasis, functional and lifestyle medicine, the role of acupuncture, nutrition and palliative care in the treatment of cancer patients, and more.

“Our colleagues covered aspects perfectly to the types of rehabilitation or the indications or the timing of rehabilitation for brain tumor patients. Then there were other topics, things like what types of modalities are available and rehabilitation, cognitive rehabilitation, mobility swallowing, all different aspects of the oncology patient,” Yazmin Odia, MD, told Targeted Oncology^TM, in an interview.

In the interview, Odia, chief of neuro-oncology at Miami Cancer Institute, Baptist Health South Florida, discussed the 3rd Annual Miami Cancer Institute Oncology Rehabilitation Symposium, including her discussion on incorporating rehabilitation into the course of treatment for patients with brain cancer.

Targeted Oncology: Can you provide background of the symposium and discuss its importance?

Odia: Annually for the last few years, the rehabilitation group here has sponsored a symposium where they cover all topics having to do with rehabilitation in the oncology setting. Besides the fact that rehabilitation impacts the great majority of my patients specifically, it is something that spreads throughout all the different disease sites. They cover topics to do with the incorporation of rehabilitation from things like lymphedema associated with breast cancer, any of the neurologic deficits that patients with brain metastases or primary brain tumors also have, but also the complications of systemic chemotherapy that often lead to, for example, peripheral neuropathy. This is a widespread problem, and therefore, a highly valued service in our department.

What are some of the topics that were discussed this year?

Some of the topics covered in the symposium this year included some brain- or spine-centric things. For example, just the standard-of-care treatments in terms of radiation or surgery for spine metastasis, which is a common complication of some of the metastatic, lung, breast, and other types of cancers. Our colleagues covered aspects perfectly to the types of rehabilitation or the indications or the timing of rehabilitation for brain tumor patients. Then there were other topics, things like what types of modalities are available and rehabilitation, cognitive rehabilitation, mobility swallowing, all different aspects of the oncology patient.

What can you discuss about the trial you discussed at the symposium?

I was tasked to discuss how to incorporate rehabilitation in the course of treatment for a patient with brain cancer. I divided it into patients that have metastatic cancer, as well as primary brain tumors. Of these, [there are] benign tumors, so called cancerous but in fact, often our patients have multiple recurrences, and they behave quite terribly. Then, the malignant ones, things like glioblastoma. Some of the topics we highlighted were the fact that our patients often have ebbs and flows in their courses. In other words, they don't have a steady decline or a steady recovery. They have moments of peak function, and they have moments of deterioration, and how essentially, rehabilitation must pivot based on that course and the fact that it is not linear, but it's ebb and flow.

For the idiosyncrasies of the patients with brain tumors, I also highlighted that even patients with malignant brain tumors, who supposedly have the worst prognosis can still benefit from rehabilitation. This is not something we know anecdotally. There's great meta-analysis and many numerous clinical trials that have compared even the most aggressive primary brain tumors like glioblastoma to a stroke patient, where it's well-established. Rehabilitation is beneficial. They've shown that just like those patients, even patients with dismal prognosis can benefit. There are such things as rehabilitation that are intended to improve the quality and the function of a patient, no matter how long their expectation of living is.

How does prognosis and quality of life play a role in this?

Neuro-oncology specifically poses the main goal. The reason I say that is that if I put into perspective our field, about 90% of our patients will eventually die of the cancer that they're diagnosed with. I deal with primary brain tumors, many of which are not curable. I deal with stage IV cancers which have a percentage of curable rates. Then I see benign tumors, but I usually see the ones that are behaving badly. We do have patients with poor prognosis, but they are in high need of rehabilitation, because throughout their course again ebbs and flows and have different lifespans, but I still have a lot of need for functional, walking, cognitive, just being maximally independent for as long as humanly possible. That plays heavily into quality of life. Some of the things that patients report are not only pain, which is obviously a huge component of quality, but independence. You'll find that patients link to that as an identity to self. Allowing patients to regain that independence or maintain that independence is part and parcel to their quality.

What are the goals of care overall?

It's highly variable. The trick for goals of care is to make sure we delineate it specifically to the patient in front of us. In other words, we can't just use a cookie cutter approach. We have to be able to understand the individual patient, their individual needs, their individual prognosis, what other treatments they have. As time goes on, that list of tools that we have to attack their cancer in different places and stages is expanding. We have new radiation tools, we have new chemotherapies that penetrate the brain, we have new surgical techniques. That is an evolving field. If a patient still has therapeutic options, we try very aggressively to maintain their quality and their function, because that's what allows us to implement those new and evolving therapeutics.

What are the key takeaways?

I think what I would highlight from our neuro-oncology group is that we are highly involved in investigational therapeutics. We're always studying new cases and new therapies that involve brain tumors, but some of our research actually is focused predominantly on rehabilitation and neurologic function, whether it be preservation or restoration. Some of the trials that we're doing are longitudinally monitoring cognitive function before and after any intervention, whether it be radiation surgery are chemotherapies. That's a way where clinical trials are also being incorporated in aspects that are more focused on quality of life and function. Not just, can we attack the cancer aggressively, but how can we improve the patient? There's also the focus of some of our clinical research.

What unmet needs still must be addressed?

In terms of unmet needs at a rehabilitation, it's always understanding of what new technologies, what new studies, what new techniques can be implemented. I think it has an iterative process. There must be a lot of dialogue between the rehab team and our team in order to understand the goals of care for that patient, the prognosis for that patient, what the goals of rehabilitation are intended to be, and to make sure that we're in sync. I think that having a group of clinicians who could present these rehabilitation topics to the whole gamut of providers, from rehabilitation specialists to American colleges, to radiation therapists and surgery allows us to get in sync and understand how we can work together.