4.5.2 Rehabilitation

Rehabilitation may be required at any point of the care pathway. If it is required before treatment, it is referred to as prehabilitation (see section 3.6.1).

Patients being treated for acute leukaemia benefit from exercise, nutrition and psychological strategies. Early referral to a clinical psychologist, exercise physiologist, physiotherapist and dietitian should be considered.

All patients should be weighed at each clinic appointment, or daily during inpatient admissions, and screened for malnutrition using a tool that has been validated in CAYA. Obese or malnourished patients should be referred to a dietitian.

Rehabilitation may be required at any point of the care pathway. Exercise in older adults with cancer is associated with improved cardiorespiratory function and, in some studies, better quality of life and less fatigue (Cormie et al. 2017; Silver 2015). There is emerging data showing that participating in an exercise program during cancer treatment is safe, feasible and beneficial (Atkinson et al. 2021).

All members of the multidisciplinary team have an important role in promoting rehabilitation. Team members may include occupational therapists, speech pathologists, dietitians, social workers, psychologists, physiotherapists, exercise physiologists and rehabilitation specialists.

To maximise the safety and therapeutic effect of exercise for people with cancer, all team members should recommend that people with cancer work towards achieving, and then maintaining, recommended levels of exercise and physical activity as per relevant guidelines. Exercise should be prescribed and delivered under the direction of an accredited exercise physiologist or physiotherapist with experience in cancer care (Vardy et al. 2019). The focus of intervention from these health professionals is tailoring evidence-based exercise recommendations to the individual patient’s needs and abilities, with a focus on the patient transitioning to ongoing self-managed exercise.

Other issues that may need to be dealt with include managing cancer-related fatigue, improving physical endurance, achieving independence in daily tasks, optimising nutritional intake, returning to work and ongoing adjustment to cancer and its consequences. Referrals to dietitians, psychosocial support, return-to-work, educational and vocational programs and community support organisations can help in managing these issues.