Chapter 63: Pediatric Oncology Rehabilitation

INTRODUCTION AND EPIDEMIOLOGY

Over 75,000 children (ages 0–19 years) were diagnosed with cancer between 2010 and 2014 in the United States. Of these, leukemias and lymphomas were the most common, accounting for over 40% of cases. Central nervous system (CNS) tumors accounted for another 17%. Over the same time period, nearly 10,000 children died from cancer¹ (Fig. 63–1). Childhood cancer survival rates are improving, leading to an increasing population of adolescent and young-adult survivors. As the children age, the long-term effects of cancer and its treatment intermingle with comorbidities seen in any aging population.² Many physical and psychological sequelae of cancer and its treatment are amenable to rehabilitation interventions.

GOALS OF REHABILITATION

The appropriate rehabilitation treatment strategy will vary depending on a child's tumor, treatments, and prognosis. Rehabilitative management strategies may require dynamic problem solving as a child ages and grows, even into adulthood. One framework for goal setting in cancer rehabilitation is the Dietz classification.³ It defines goals across four types of interventions: preventative, restorative, supportive, and palliative. For example, a child who has received curative treatment may benefit primarily from preventative and restorative interventions, whereas one with terminal disease would be more appropriate for supportive and palliative management. Preventing immobility-related complications is of paramount importance. Children should also be screened for attainment of age-appropriate developmental milestones, and their cognitive, psychological, and social/emotional well-being should be optimized. Members of rehabilitation team (including physiatrists; physical, occupational, speech, and recreational therapists; child life specialists; psychologists, social workers, and case managers) need to work together and communicate with oncology teams to create the most appropriate and uniform rehabilitation plan. Young children should be considered for early intervention services and preschool special education programs. School-aged children may need individualized education plans (IEPs) or other accommodations, including home schooling. Children with CNS tumors or those exposed to neurotoxic chemotherapy may need formalized neuropsychological testing. The importance of family and community support cannot be overstated, and available resources should be offered to caregivers to help prevent burnout and fatigue. Survivorship care and management of the long-term psychosocial sequelae of surviving childhood cancer become increasingly important.

SPECIFIC CANCER DIAGNOSES AND RELATED SIDE EFFECTS