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Physiotherapy services for cancer
patients in South India: A survey
Karthikeyan Guru, Udayakumar Manoor1, Sanjay S. Supe2

Website:
Abstract:
www.pjiap.org BACKGROUND AND AIM: Cancer is a major cause of adult deaths in India and cancer incidence
is projected to grow in the coming decades because of improved life expectancy. The importance of
DOI:
10.4103/PJIAP.PJIAP_36_17 rehabilitation in cancer care received increasing recognition in medical settings; however, very little
has been documented about the involvement of physiotherapists in cancer care and rehabilitation.
This exploratory paper assesses the availability of physical therapy services for cancer patients and
cancer survivors in South India.
METHODOLOGY: In this explorative study, 1410 cancer patients from 15 cancer centers in three
South Indian states were administered a valid questionnaire presented in their native languages.
Descriptive statistics were used to analyze their responses.
RESULTS: More than half of the cancer patients (54.1%) did not know that physiotherapy treatment is
required in symptom management and only one‑third (31%) were advised or referred to physiotherapy
treatment. Two‑thirds of the respondents (68.8%) were benefited by the recommended exercises.
The recommended exercises were stretching (42.9%), breathing (28.6%), and strengthening (16.9%).
The most commonly used evaluation method was visual analog scale for pain (29.9%).
CONCLUSION: It is found that the number of qualified physiotherapists working in the cancer centers
is not sufficient to meet the demand.
Keywords:
Cancer, physiotherapy, referral pattern, rehabilitation

Introduction and type of treatment. The patients who

experienced fatigue reported greater use of

C ancer is a major cause of adult deaths in

India, with more than 70% of fatal cancers
occurring during the productive ages of
healthcare services and of complementary
therapies.[8] Pain can have a large impact on
mobility. Deficits in range of motion (ROM)
Srinivas College of
Physiotherapy and 30–69 years.[1] Cancer incidence will continue or mobility may be present in patients who
Research Center, to grow in the country as a result of increase have undergone surgery, chemotherapy,
Mangalore, 1Department in life expectancy and the proportion of or radiation therapy resulting from the
of Radiation Oncology,
Medical Director, Portea
elderly population, and the absence of cancer formation of scar tissue, disuse, or fibrosis
Medical, 2Department screening programs.[2] Impairments commonly caused by treatments.[9]
of Radiation Physics, associated with cancer and its treatments
KIDWAI Memorial Institute Rehabilitation in relation to cancer can
include fatigue, pain, general deconditioning,
of Oncology, Bengaluru,
Karnataka, India neuropathy, and lymphedema [3-5]  and be preventative, restorative, supportive,
increased levels of disability among cancer and palliative.[10] Cancer patients who are
Address for patients and cancer survivors.[6,7] referred to rehabilitation service perform
correspondence: poorly on tests of physical performance
Prof. Karthikeyan Guru,
Srinivas College of Fatigue is the most common cancer‑related compared to those in control groups.[11,12]
Physiotherapy and symptom, regardless of the stage of illness Thorsen et  al. reported that 63% cancer
Research Center, survivors reported the need for at least one
Pandeshwara, This is an open access journal, and articles are distributed
Mangalore ‑ 575 001, under the terms of the Creative Commons Attribution-
rehabilitation service, with physical therapy
Karnataka, India. NonCommercial-ShareAlike 4.0 License, which allows others to
E‑mail: gkarthispt@yahoo. remix, tweak, and build upon the work non-commercially, as How to cite this article: Guru K, Manoor U, Supe SS.
co.in long as appropriate credit is given and the new creations are Physiotherapy services for cancer patients in South
licensed under the identical terms. India: A survey. Physiother - J Indian Assoc Physiother
Submission: 03‑12‑2017 2018;12:22-9.
Accepted: 16-03-2018 For reprints contact: reprints@medknow.com

22 © 2018 Physiotherapy - The Journal of Indian Association of Physiotherapists | Published by Wolters Kluwer - Medknow
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Guru, et al.: Physiotherapy practice in cancer rehabilitation
being the most frequently requested need (43%), while
40% of the participants reported that their rehabilitation
needs were unmet.[13] Some patients did not encounter
physiotherapy services before cancer treatment and may
have met the physiotherapist only after surgery.[14]
The role of the physiotherapist in palliative care covers
the respiratory, neurologic, lymphatic, orthopedic,
musculoskeletal, and hematologic conditions
and complications. [15] Physiotherapy may include
therapeutic exercises, active or passive mobilization
techniques, graded and purposeful activity, relaxation,
distraction, postural reeducation, positioning, mobility,
transcutaneous electrical nerve stimulation, heat or cold,
and massage therapy.[16]
Cancer patients comprise 51% of those who enter hospice
and palliative care settings where physical therapy
treatments such as transfer and mobility training,
caregiver education, pain management, and assistive
device recommendations are provided to promote and
maintain function. [17] The exercise training appears
to be safe for most patients and improvements in
physiological, psychological, and functional parameters
can be attained with regular participation in moderate
intensity exercise.[18] A 12‑week exercise program is
helpful for improving fatigue, blood pressure, insomnia,
physical function, overall musculoskeletal symptoms,
mental health, social support, and physical activity in
cancer survivors.[19]
A physician’s recommendation to exercise or the
perceived approval of the physician was associated
with higher level of physical activity, suggesting
that health‑care providers have an influential role in
promoting exercise among their patients.[20,21] Referrals by
physicians, who understand the principles and methods
that physiotherapists use in cancer rehabilitation, will
lead to timely care and the functional return of the
patient. It should also be noted that patients themselves
can exert pressure on physicians to refer them to
physiotherapy.[22]
The importance of rehabilitation in cancer patients is
being recognized in recent times. However, there is an
enormous discrepancy between the incidence of disabling
physical impairments among cancer patients and the
provision of medical rehabilitation services for them in
developing countries. The inadequacy of the service is
even more apparent when one considers the number of
cancer survivors who did not receive any physiotherapy
despite referral.[23] For instance, there are differences
between the provision of cancer rehabilitation services
during acute care and those provided for outpatients.
However, the extent to which presence of advanced
cancer has accentuated the magnitude of the differences
Physiotherapy ‑ The Journal of Indian Association of Physiotherapists ‑ Volume 12, Issue 1, January-June 2018 23
between inpatient and outpatient rehabilitation service
delivery is unclear.[24] It was also found that more cancer
patients were dissatisfied with the quality of treatment;
they received for their cancer symptoms.[8]
Collecting data on the current physiotherapy practices
and services in cancer rehabilitation may be beneficial
in influencing the provision of the future services and
ultimately help improve patient care. The data may also
lead to the development of educational and research
opportunities in this geographical area. In this regard,
the present study aims to assess the availability of
physiotherapy services for cancer patients and cancer
survivors in South India. The study also aims to describe
the patient satisfaction with the available treatments and
services and their reliability and efficiency.
Methodology
Since India is a large country with diverse languages,
cultures, and medical services, it would be an expensive
and difficult undertaking to study the availability of
physiotherapy treatments for the cancer patients and
cancer survivors. Therefore, this exploratory research
focused on three geographically contiguous South Indian
states to gain an insight into the current physiotherapy
practices in cancer treatment.
Participants
The population for the study was the cancer patients
and survivors in cancer rehabilitation centers three
states of South India which are Tamil Nadu, Karnataka,
and Kerala. Total population size for the cancer patients
was obtained from the hospital‑based cancer registries
of Bangalore, Chennai, and Trivandrum. A total of 1410
cancer patients from over 15 cancer centers around the
three states were contacted. The sample size for margin of
error 0.05 was obtained based on the previous literature
by population‑based sample size calculation method.[25]
The participants were male and female cancer patients
and cancer survivors over 18 years of age who were
either getting in‑patient treatment from the hospitals or
approached the hospitals for follow up care. Severely ill,
uncooperative and mentally affected patients and those
with speech and/or comprehension impairments were
excluded from the study and also excluded were those
who did not want to take part in the study by refusing
to sign the consent forms.
Survey instrument
An earlier study to assess the physiotherapy practice
pattern in cancer rehabilitation was employed a
self‑administered, validated, questionnaire. [10] The
questionnaire had three sections and included 31
questions. All three sections consisted of a mixture of
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Guru, et al.: Physiotherapy practice in cancer rehabilitation

open‑ended and closed‑ended questions. The first section Another 33 questionnaires were unusable because those
(10 questions) was related to the patients’ demographic patients were just admitted to the hospitals and did not
characteristics and personal details such as the complete any part of the cancer treatments.
disease symptoms and treatment history. The second
section (13 questions) asked the patients about their Respondent demographics
physiotherapy assessment and treatment. The final Table 1 shows the demographic characteristics of the
section (8 questions) referred to the patients’ satisfaction respondents. Out of 745 patients, 435 respondents
with services provided and their ability to use the were male, and 310 were female. The mean age of the
information they had learned. The survey questionnaire respondents was 30.51 ± 4.3 years. Nearly 565 (75.8%)
was translated into three South Indian languages, Tamil, respondents were receiving inpatient treatment, and
Malayalam, and Kannada and had been validated as 180 (24.2%) were receiving outpatient treatments. The
described in a previous study by the same authors.[26] number of patients from Tamil Nadu were 281 (37.7%),
The questionnaire was approved by a panel of experts 253  (34.0%) were from Kerala, and the remaining
and institutional ethical committee. 211 (28.3%) were from Karnataka. The cancers for which
the respondents were getting treatment for were Head
Procedure and Neck cancer (22.2%), breast cancer (20.1%), pelvic
Cancer population size was determined from the cancer organ cancer  (15.0%), abdomen cancer  (13.6%), bone
registries of three states: Tamil Nadu, Karnataka, and cancer (13.0%), and lung cancer (8.7%). Nearly 71% of
Kerala. The cancer centers, including Bangalore hospital the patients were suffering from cancer for more than
in Bangalore, Father Muller hospital in Mangalore, 1 year while the rest (29.1%) were aware of their cancer
Karnataka cancer institute in Hubli, Amala cancer symptoms for < 1 year. The number of patients who were
institute in Trichur, Amrita Cancer centre, Malabar
cancer centre, Regional cancer centres in Calicut and
Kottayam, Government hospitals in Chennai, Ambilikai Table 1: Demographic characteristics of the
respondents
cancer centre, Govt hospitals in Kancheepuram, Trichy,
Characteristics n %
Coimbatore, and Madurai and from International cancer
Gender
centre in Neyyoor were contacted for the samples. Some
Male 435 58.4
of the centers required the presentation of the synopsis
Female 310 41.6
of the study to their Institute Scientific Review Boards
State
and Ethical Committees. These organized approved
Tamil Nadu 281 37.7
the patient consent forms designed by the researchers. Kerala 253 34
After permissions to contact the patients were obtained Karnataka 211 28.3
from the institutional boards and committees, the data Hospital visit
collection was undertaken. All the participants of the In‑patient 565 75.8
study were presented with the consent forms for their Out‑patient 180 24.2
signatures and agreements to participate in the study. Body part affected/type of cancer
Then, the questionnaires were administered to the Head and Neck 165 22.2
participants, and the language questionnaire was chosen Abdomen 101 13.6
that was in the native language of the participants. The Nervous system 18 2.4
completed questionnaires were collected back after a Lung 65 8.7
couple of hours. Those patients who could not read the Blood/Lymph 25 3.4
questionnaires were interviewed to get their responses. Bone 97 13.0
Pelvis 112 15.0
Data obtained from the surveys were entered into Breast 150 20.1
and analyzed with SPSS (version 20.0). Frequency Others 12 1.6
distributions (number and percentage) were calculated Duration of the illness
for each question. For the Likert‑type scale questions, <1 year 217 29.1
frequency distributions were calculated for each item in More than 1 year 528 70.9
the question and for each level of response. Type of admission/approach
First time admitted 127 17.1
Results For Regular Rx 327 43.9
Recurrent symptom Rx 124 16.6
A total of 745 surveys were partially or fully completed Follow up 167 22.4
and were used in the study. Some surveys were returned Pain
but were excluded from the study. The excluded Yes 572 76.8
questionnaires consisted of 21 incomplete questionnaires. No 173 23.2

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Guru, et al.: Physiotherapy practice in cancer rehabilitation

admitted to the hospital for the first time was 127 (17.1%),
327 (43.9%) patients were visiting the hospital for regular
treatments, 124 (16.6%) patients came for the treatment
for recurrent symptoms, and 167  (22.4%) came for
follow‑up care. The number of patients who experienced
severe pains was 572, and the remaining 173 did not
experience any pain before seeking the cancer treatment.
chemotherapy, and 311 underwent surgeries. At
the time of the survey, a number of patients were
continuing to receive treatments. They included
307 patients who were receiving chemotherapy, 423 were
receiving radiotherapy, 77 patients were scheduled for
chemotherapy, 210 were on waiting list for radiotherapy,
and 72 were scheduled for the surgery.

Cancer symptoms and treatments Physiotherapy treatment for cancer patients

The most common cancer‑related symptoms reported by Over half of the respondents (54.1%) did not know that
the respondents were fatigue (37.2%) where the patients physiotherapy treatment is beneficial in cancer‑related
were tired and weak, lymphedema  (15.8%), general symptom management while 25.4% knew that it was
weakness (15%), cough (12.8%), muscle pain (12.1), and required and the remaining respondents (20.5%) thought
shortness of breath (10.5%). The least common symptoms that physiotherapy was not required in the cancer‑related
symptom management [Table 2].
experienced by the patients were joint pain  (5.4%),
fracture (3%), back/neck pain (2.4%), paralysis (1.6%),
How did physiotherapy help the patients? The responses
and decreased sensation (0.3). Around 6.4% of patients from 189 patients who said physiotherapy was required
reported difficulty in sleeping, walking and doing daily in cancer‑related symptom management helped in
activities, and other symptoms. However, 54.4% of the the following areas: reduced pain  (40.7%), reduced
respondents were unable to identify their cancer‑related swelling (27%), improved quality of life (QOL) (20.1%),
symptoms. improved physical function  (1.6%), and helped in all
areas (two patients). The remaining 10.1% respondents
Among those participants who received anticancer did not know how exactly physiotherapy helped.
treatments, 701 received radiotherapy, 618 received
More than two‑thirds of the patients (514, 69%) were not
Table 2: Physiotherapy treatment knowledge among referred to physiotherapy to treat their cancer‑related
cancer patients problems while the remaining 231 patients (31%) were
Knowledge aspects Responses n % indeed advised/referred to physiotherapy. Among
Do you think physiotherapy n=745 those patients referred for the physiotherapy, swelling
treatment is required in Yes 189 25.4
cancer management?
was the most common symptom  (30.7%) followed
No 153 20.5 by muscle tightness/breathing difficulty  (22.5%),
Don’t know 403 54.1 joint stiffness  (20.8%), and difficulty in activities of
How physiotherapy n=189
daily living  (ADL)  (16.9%), pain  (11.7%), general
treatment may help Decrease pain 77 40.7
relieving your cancer related weakness  (7%), and other problems  (4.8%). Further,
Decrease swelling 51 27
problem? a q u a r t e r o f r e s p o n d e n t s  ( 2 5 . 5 % ) h a d t a k e n
Improve physical function 3 1.6
physiotherapy for chest‑related symptoms followed
Improve mental function 0 0
by the shoulder  (21.2%), head and neck  (20.4%), and
Improve QOL 38 20.1
abdomen (17.3%). Lower back, knee, hip, and ankle and
All the above 2 1.1
foot regions were treated the least [Graph 1].
None 0 0
Other 4 2.1
A majority of the patients (50.7%) received physiotherapy
Don’t know 19 10.1
Body part for which PT had n=231
been taken Head and Neck 47 20.4
Abdomen 40 17.3
Lower back 15 6.5
Chest 59 25.5
Shoulder 49 21.2
Hip 7 3.0
Knee 12 5.2
Ankle and foot 2 0.9
Who referred for n=231
physiotherapy? Physician 117 50.7
Surgeon 98 42.4
PT 9 3.9
Graph 1: Problems for which patients have been advised/referred to take
Self 7 3.0 physiotherapy

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Guru, et al.: Physiotherapy practice in cancer rehabilitation

Graph 2: Treatment received from physiotherapy department Graph 3: Monitoring procedures used to evaluate the problem before and after the
physiotherapy treatment

by physician’s referral, 42.4% were referred to by

Table 3: Physiotherapy monitoring methods used in
surgeons, 3.9% were referred by physiotherapists, and 3%
the treatment for cancer patients
of the patients went directly to the physiotherapists. The
Characters Responses n %
types of physiotherapy treatments received by patients
Did the Physiotherapist n=231
are [Graph  2]: stretching  (42.9%), breathing exercises evaluate your problem? Yes 71 30.7
(28.6%), strengthening  (16.9%), massage  (13.9%), and Yes, some what 94 40.7
aerobic exercises (10.8%). The least commonly provided No 66 28.6
treatments were advice on ADL (6.9%), electrotherapy Parameters used to n=231
modalities  (6.1%) and manual therapy  (0.9%). A  few evaluate the problem? Heart rate 49 21.2
of the patients were referred to departments/services BP 27 11.7
other than physiotherapy. These services included diet ROM 71 30.7
therapy  (34.2%), yoga/meditation  (7.4%), and speech Strength 31 13.4
therapy (2.2%). The remaining 58.4% of the patients were Pain 96 41.6
not referred to any other therapies. Fatigue 12 5.2
Respiratory rate 26 11.3
Monitoring Edema 88 38.1
Out of 231 patients who received physiotherapy ADL 21 9.1
treatments, 71 patients said that physiotherapists evaluated QOL 12 5.2
their problems completely, 94 said they were evaluated None 118 51.1
only partially, and 66 patients were not evaluated by the Don’t know 15 6.5
physiotherapists before their cancer treatment.
After the physiotherapy treatments, the parameters
The parameters evaluated before and after the which were used to monitor the progress of the patients
physiotherapy treatment for the patients are presented included VAS for pain  (34.2%), goniometer  (29%),
in Graph 3. Out of 231 patients received physiotherapy, sphygmomanometer (10.8%), questionnaire (7.4%), and
96 stated that edema was measured (41.6%) followed by stethoscope (2.2%). As in the case of prephysiotherapy
ROM (30.7%), heart rate (21.2%), strength (13.4%), blood
treatment, a majority of patients  (64.9%) were not
pressure (11.7%), and respiratory rate (11.3%). The least
evaluated using any of these measures after their
common evaluation parameters were ADL (9.1%), fatigue,
physiotherapy treatments [Table 3].
and QOL (5.2%). More than half of the patients (51.1%)
were not evaluated using any of these parameters before
Professional approach and satisfaction
receiving the physiotherapy treatment.
To assess the professional approach of the therapists
The parameters used to evaluate the patients before toward their patients and the patient satisfaction toward
their physiotherapy treatments included visual analog the care they received, eight items based on Likert scale
scale  (VAS) for pain  (29.9%), goniometer  (16%), scoring system were used [Table 4]. These items are
sphygmomanometer  (11.7%), reflex hammer  (6.5%), satisfaction by physiotherapists’ explanations  (55.4%),
questionnaire (5.2%), and stethoscope (2.2%). However, treatments (63.6%), advices on lifestyles (44.2%), patient
more than two‑thirds (73.2%) of the patients were not health after physiotherapy  (48.5%), physiotherapists’
evaluated by any of these parameters before subjecting consideration  (72.3%), and attitude  (68.8%). These
them to physiotherapy treatments. factors helped patients’ rehabilitation. Even the
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Guru, et al.: Physiotherapy practice in cancer rehabilitation
Table  4: Patients’ Response towards the physiotherapy treatment and approach
Practice pattern
Satisfied with the explanation of treatment
Satisfied with the type of physiotherapy treatment received
Satisfied with the advise on lifestyle by the therapist
Satisfied of my health now after physiotherapy treatment
Physiotherapist was courteous and considerate
Satisfied with the attitude of the Therapist
Exercise has major benefits
I shall tell the benefits of physiotherapy and encourage others
Read the values as: Frequency (percentage)
acceptance of positive benefits of the exercises (68.8%)
and idea of referring to the known cancer patients to get
physiotherapy (58.4%) also were agreed by most of the
patients. At the same time, few respondents reported
that they disagree such things in their part of their
rehabilitation.
Discussion
Cancer rehabilitation has received relatively little
attention in Indian physiotherapy research and education.
Evidence indicates that physical exercise has the
potential to improve QOL for those undergoing cancer
treatment, [20,27] but little is known about exercise
promotion within cancer rehabilitation services.[28] The
number and type of cancer survivors who might benefit
from physiotherapy interventions are unclear as the
research on this subject is sparse. This study presents
novel data about current perceptions of the cancer
patients and cancer survivors on the role of physiotherapy
in cancer rehabilitation patients in south India.
The response rate in this study was 100% as we have
adopted in‑person survey/interview for the survey. More
than 75% of the total individuals were approached in the
inpatient departments of various cancer centers in South
India. However, the results indicate that 69% of participants
were never referred to the physiotherapy treatment for
their cancer‑related symptoms and treatments. As the
percentage is more, to avoid any bias, the cancer patients
who had been referred till now only were allowed to fill
the questions regarding the physiotherapy treatment
modalities for the impairments.
The survey found that only a few physiotherapists
were exclusively working in the cancer centers. This
could be a reason for the smaller number of cancer
patients receiving physiotherapy treatment as a part of
their cancer rehabilitation. In South India, a majority
of the major cancer centers are operating without
physiotherapy departments or qualified physiotherapists
on staff. The reasons for the underrepresentation of
physiotherapists on staff in cancer centers, despite huge
cancer patient load, are not unclear.
Physiotherapy ‑ The Journal of Indian Association of Physiotherapists ‑ Volume 12, Issue 1, January-June 2018 27
Strongly agree Agree Disagree Strongly disagree
35 (15.2) 128 (55.4) 57 (24.7) 11 (4.8)
29 (12.6) 147 (63.6) 48 (20.8) 7 (3.0)
17 (7.4) 102 (44.2) 96 (41.6) 16 (6.9)
7 (3.0) 112 (48.5) 103 (44.6) 9 (3.9)
21 (9.1) 167 (72.3) 27 (11.7) 9 (3.9)
32 (13.9) 159 (68.8) 32 (13.9) 16 (6.9)
54 (23.4) 150 (64.9) 27 (11.7) 0
85 (36.8) 135 (58.4) 11 (4.8) 0
Individuals undergoing cancer treatment often develop
functional deficits from pain, movement restrictions,
fatigue, lymphedema, skin and soft tissue breakdown,
and difficulty breathing.[29] The problems that occur
in relation to the cancer disease and its treatment
vary with the type of cancer, disease stage, and type
of medical treatment. Difficulties may develop in the
period between diagnosis and primary treatment, during
primary treatment, and during follow‑up.[30] Most of the
respondents in this study reported fatigue, lymphedema
and general weakness, and breathing difficulties.
Regarding the knowledge about physiotherapy in cancer
rehabilitation, only 25.4% of the respondents were aware
of physiotherapy treatment in cancer rehabilitation
and most of them reported that physiotherapy helped
to reduce pain, swelling, and to improve their QOL.
Likewise, most of the respondents among those referred
for physiotherapy had suffered from swelling, breathing
difficulty, soft‑tissue tightness, pain, joint stiffness, and
difficulty in ADL which were indicated for physiotherapy
management. It is known that physiotherapy in oncologic
rehabilitation helps in restoring function, reducing pain,
reducing disability, increasing conditioning and mobility,
and ultimately improving QOL.[31]
The most common interventions used in cancer
rehabilitation were strengthening, ROM, energy
conservation, and breathing treatments.[32] A Canadian
survey suggested that most of the patients preferred
to receive exercise counseling face‑to‑face from a
specialist affiliated with a cancer unit.[33] The availability
of specialized physiotherapy services resulted in
significantly higher functional levels on follow‑up
assessment.[34] Regarding interventions, larger numbers
of patients received stretching, strengthening exercises,
breathing exercises, ROM exercises, and chest clearance
techniques. At the same time, patient education on ADL,
electrotherapy modalities, and aerobic exercises were
least commonly used for the rehabilitation. A change
in the functional component of QOL and significant
improvements in fatigue, pain, and appetite were
noted in patients who received optimized levels of
physiotherapy time and resources.[34]
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Guru, et al.: Physiotherapy practice in cancer rehabilitation
Individuals who undergo chemotherapy or radiation
treatments are at risk for developing cardiovascular and
pulmonary toxicities and therefore require monitoring
of vital signs to assure safety during physiotherapy
interventions. [35] Among the respondents, 28.6%
were not evaluated by the physiotherapists for their
symptoms for which they have been referred. Pain,
edema, ROM, and heart rate were most commonly
measured as a monitoring procedure while 51.1% were
not monitored using any of the monitoring procedures.
More importantly, 73% patients were never evaluated
before the beginning of the physiotherapy treatment
and about 64.9% patients were never evaluated after the
completion of physiotherapy treatment.
Physiotherapy may influence patient satisfaction in
cancer rehabilitation setting. It involves physical contact
and the therapy requires the patient’s active participation.
The patient‑therapist interaction often takes longer than
a routine medical visit; however, the therapy may cause
pain and may be perceived as physically threatening.
It is known that the efforts are required to improve
exercise compliance in cancer patients.[36] The provision
of early intervention and community follow‑up may
contribute significantly to the functional independence,
patient satisfaction, and QOL among patients requiring
palliative care. A physiotherapist to inpatient ratio of 1:12
is recommended to produce such results.[34]
Patient satisfaction is a crucial aspect of the quality of
cancer care,[37] and patient satisfaction is increasingly
used to monitor the quality of healthcare services.[38]
In this study, eight items were used to investigate the
patient satisfaction toward the physiotherapy treatment
in cancer rehabilitation. The increased time available to
the physiotherapist to patient would have influenced the
ability to ensure understanding of advice and instructions
by the patients.[39] This study reports that most of the
patients who received physiotherapy were satisfied
with the therapists’ professional approach. Only a few
of them were dissatisfied with the approach, treatment,
and behavior of the physiotherapists. Likewise, only a
few patients did not think that exercise and physical
activity were beneficial to them. This study had some
limitations regarding generalizations from this study
to other geographic locations are restricted as it is done
only in South India that too only three limited states.
Conclusion
Although individuals with oncology‑related functional
deficits appear to benefit from physical therapy
interventions, this study found some shortcomings
regarding referral and delivery of the physiotherapy
treatment. The commonly used treatment modalities in
cancer rehabilitation and the professional approach by
28 Physiotherapy ‑ The Journal of Indian Association of Physiotherapists ‑ Volume 12, Issue 1, January-June 2018
the physiotherapists practicing in South India appear
to be effective. However, monitoring physical and
physiological parameters of the cancer patients during
and after the physiotherapy treatment in South India
were inconsistent.
It is found that the availability of the physiotherapy
departments and numbers of qualified physiotherapists
working in the cancer centers is inadequate considering
the increasing demand for their services for cancer
patients. It is surprising that some regional cancer centers
in South India do not have physiotherapy facilities and
staff to serve their patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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