The World Health Organization (WHO) World Cancer Report predicts a 50% increase in global cancer incidence by 2020, with approximately 15 million new cancer patients each year, 20% of whom will be in China. Patients who have been cured, are under treatment or have no hope of being cured need rehabilitation in different ways and to different degrees. The World Health Organization (WHO) strongly advocates the “people-centered” approach: the commitment to improving quality of life and prolonging survival has become the goal of the current oncology community.
With the development of medicine and comprehensive treatment, cancer is no longer a disease that is equated with death. Most cancer patients have their pain relieved and are able to regain their lives after treatment and rehabilitation. Psychological barriers, physical disabilities, lack of functional recovery, occupational maladjustment and lack of economic support caused by cancer itself or treatment methods such as surgery and radiotherapy should be addressed in the context of cancer rehabilitation. Cancer rehabilitation runs through the whole process of cancer patients during the diagnosis period, treatment period and after treatment. Rehabilitation medical treatment can give patients the hope to enjoy a healthy life again. In terms of the form of rehabilitation, it includes three aspects: comprehensive treatment, education and personal practice. In other words, rehabilitation is an educational activity facing cancer patients and family members, a training combining group-driven and individual growth, and a special treatment model designed for cancer patients: in this treatment system, clinicians, psychologists, nutritionists, physical trainers, social workers and patients and family members participate and actively interact together, featuring traditional Chinese medicine treatment, allowing cancer patients to practice in learning and benefit from practice, helping patients to move step by step towards recovery through a constantly adjusted rehabilitation program.
Cancer rehabilitation includes two important components, namely physical rehabilitation and psychological rehabilitation, through which occupational functions, family roles and social values are ultimately restored. Physical rehabilitation restores the physical damage and functional deficiencies brought by cancer itself and treatment to the greatest extent possible through comprehensive treatment mainly with Chinese medicine, limb rehabilitation exercise and functional exercise, and nutritional therapy, etc. This process requires close cooperation between patients and medical personnel, active participation in exercise, and adjustment of living habits to achieve the expected rehabilitation purpose; psychological rehabilitation mainly relies on the common care and understanding of society and family, and building a harmonious relationship with In the aspect of psychological rehabilitation, it mainly depends on the joint care and understanding of society and family, and establishing a harmonious personal, family and social relationship with tumor patients. Clinicians, psychologists, patients and family members as well as social workers can all play an active role in this process. The following will briefly introduce these two aspects, hoping that cancer patients and their family members will have more understanding of cancer rehabilitation.
I. Physical rehabilitation
1.Integrated Chinese medicine therapy: The therapeutic and maintenance effects of Chinese medicine are crucial to tumor patients, and it is essential to use Chinese medicine to regulate the whole process of tumor treatment and recovery.
(1) Pharmacotherapy: In different treatment stages, Chinese medicine plays different roles, either to support the righteousness or to dispel the evil, so as to achieve the balance of yin and yang by harmonizing the functions of internal organs. Firstly, it can demobilize the damage caused by surgery, reduce the side effects of radiotherapy and chemotherapy, and enhance various therapeutic effects; secondly, Chinese medicine itself has anti-cancer and corrective effects, which can regulate the internal environment of human body, improve the body’s ability to resist disease, control the growth of tumor, and prevent recurrence and metastasis; thirdly, Chinese medicine can solve many symptoms caused by the disease, some of which are not satisfactory by using western medicine, such as Some symptoms are not satisfactory with western medicine, such as fatigue, dry mouth, bitter mouth, dullness, excessive sweating, insomnia and dreaminess, etc., which can play an unexpected therapeutic effect through the diagnosis and treatment of TCM.
(2) Medicinal tonic: Chinese medicine in the recovery period is mainly to support the righteousness, and the poultice made of compound tonic Chinese medicine is the best tonic for tumor patients, which has the advantages of evidence-based tonic, easy to take, and harmless. It can be used not only for post-operative and deficiency of qi and blood caused by radiotherapy and chemotherapy, but also for nourishing yin, warming yang, nourishing spleen and stomach, tonifying kidney, nourishing liver and protecting liver, tonifying lung, etc. It is suitable for cancer patients in all treatment stages. The ancients have long proposed the treatment of cancer by “nourishing the righteousness and eliminating the accumulation”, which is the ancient term for cancer tumors. In clinical treatment, we call the adjustment of qi, blood, yin and yang and the internal organs as “supporting the righteousness”, and the method of supporting the righteousness is usually used throughout the cancer treatment. Cancer patients all know that their family members or friends will buy many health care products for them to take after they get sick, hoping to help them recover as soon as possible and improve their immune function, and some of them even hope to cure their cancer by consuming certain kinds of health care products, which are not scientific and reliable. All kinds of “food” or “health” supplements are food products, which are not comparable to herbal poultices in terms of therapeutic effect. We suggest that cancer patients should consult their clinicians when choosing supplements to reduce unnecessary financial losses.
(3) Acupuncture and massage: Ancient people respected acupuncture therapy, which is widely used in the treatment and health care of various diseases. Applying acupuncture in cancer rehabilitation has good effect on local pain, digestive symptoms such as diarrhea, constipation, abdominal distension and loss of appetite. Pain is one of the important symptoms affecting the quality of life of cancer patients, and acupuncture has a long history and rich practical experience in pain relief and anesthesia. The U.S. media recently reported that acupuncture, a traditional Chinese medical technique, is gaining the attention of the U.S. military. The U.S. Army Medical Command is hiring highly paid Chinese acupuncturists to relieve the ailments of officers and soldiers, while acupuncture is included in the Army’s interdisciplinary pain research. The unique efficacy and status of acupuncture for pain relief can be seen in this. The Yellow Emperor’s Classic of Internal Medicine records the circulation of human meridians and their relationship with internal organs and limbs, and the adjustment of human meridians and acupoints through massage and moxibustion during the recovery period can play a role in strengthening the body and improving the immune function of the body. All these are undoubtedly beneficial to the recovery of cancer patients.
2.Exercise therapy: A study found that people who exercise less are prone to cancer, and the mortality rate of cancer patients who insist on exercise is lower than those who do not exercise. Physical exercise is beneficial to both body and mind. It not only enhances immunity, promotes blood circulation, improves oxygen deficiency, helps regulate digestive function, reduces bloating and constipation, promotes faster excretion of carcinogens in the body, regulates sleep, etc., but also effectively relieves tension, regulates mood and increases self-confidence.
(1) Rehabilitation exercise and functional exercise: Different parts of the cancer and different treatments have different damage to the human body and require different exercise methods. For example, lung cancer mainly affects the whistling system, causing coughing, breath-holding and shortness of breath, etc. After surgery to remove the lung lobes, it will cause a decrease in ventilation, and patients are prone to shortness of breath and shortness of breath after activities, etc. Therefore, lung cancer patients should focus on exercises for whistling muscles, including upper limb and thoracic exercises, puffing and breath-holding exercises, and exercises for the retraction whistling method, etc.; modified radical surgery for breast cancer often causes lymphatic circulation disorders, and postoperative patients are prone to Therefore, the rehabilitation exercises of the affected upper limbs should be started as early as possible after breast cancer surgery, with attention to the right amount and the right time to promote the recovery of lymphatic circulation; for patients with brain tumor, postoperative rehabilitation guidance and exercises should be provided according to the situation for limb movement and language function; after colorectal tumor surgery and radiotherapy, postoperative exercises such as anal lift and abdominal massage can be performed together with acupuncture, acupuncture, and other exercises. After surgery and radiotherapy for colorectal tumor, we can use methods such as anal lift and abdominal massage together with acupuncture and Chinese herbal medicine to regulate intestinal function and frequency of bowel movement, etc.
(2) Types of exercise: Physical exercise includes passive and active exercise. Passive exercise depends on the operation of others, such as limb joint mobility training, so that cancer patients can passively receive exercise and improve local blood circulation. Active exercise is various forms of exercise that cancer patients can do by themselves to increase muscle tone and improve endurance and endurance. The forms of active exercise include qigong, Yi Jin Jing, Five Animal Play, Six Characters, Eight Duan Jin, Taijiquan, walking, jogging, gymnastics, sword practice, hiking, swimming, etc. In addition to these, they also include flower raising, fishing, singing, painting and calligraphy, chess playing, moderate housework, etc.
(3) exercise precautions: from simple to complex: start with a light exercise intensity, strict control of time, strength, speed; moderate: generally do not feel fatigue as the degree, according to their ability to bear, gradually increase the amount of exercise; dynamic and static combination: exercise to move to nourish the form, static to nourish the spirit, the form of movement to strengthen the body, the spirit of quiet to nourish the heart, rigid and flexible, complement each other.
3, nutritional therapy: “Nei Jing” recorded the method of food therapy: “five grains for nourishment, five fruits for help, five animals for benefit, five dishes for the full, the smell and served to nourish the essence and benefit the qi”, clearly put forward the theory that grains, vegetables, fruits and meat can nourish the essence, the ancients based on this, according to the taste of food and the body’s yin and yang qi and blood The ancient people used this as a basis for food therapy to maintain health according to the relationship between the nature and taste of food and the strength and weakness of the body’s yin and yang energy and blood. Therefore, the principle of food therapy is to first understand the physical condition of the self, such as the strength and weakness of yin and Yang, deficiency, cold and heat, and also to understand the nature and function of food and medicine, in order to nourish the body with food.
(1) Avoidance of food: Patients often consult the issue of “avoidance of food” in the clinic, we believe that “avoidance of food” is not a certain type or a certain food absolutely can not eat, the main basis of “avoidance of food” is to see The main basis of “taboo” is to see whether the food is suitable for the body’s qi and blood cold and heat deficiency, and those who are not suitable should be “taboo”. For example, those with heat should be careful with hot foods such as cinnamon, venison and mutton; those with cold deficiency should be careful with cold foods such as watermelon, pear and acacia; those with yin deficiency should eat less spicy and warm foods such as chili, onion and ginger; those with phlegm and dampness should eat less sweet and greasy products such as sea cucumber and turtle. Secondly, patients should choose suitable food according to the characteristics of treatment, such as radiotherapy, heat poisoning yin, it is appropriate to eat asparagus, duck, radish and other heat-clearing food, avoid dry food; chemotherapy, damage to the spleen and stomach, qi and blood deficiency, it is appropriate to eat red dates, yams, pig liver, tomatoes and other digestive, blood nourishing food, constipated patients should also eat more fiber-rich and laxative food, such as walnuts, pine nuts, corn, carrots, celery, spinach, etc. spinach, etc.
(2) Nutritional advice: Patients who have lost weight, lost appetite, or have difficulty eating, as well as those who are not sure what they should eat, can seek nutritional guidance. Doctors or dietitians will look for possible causes through relevant nutritional evaluation tools, provide nutritional advice and evaluate the effect of dietary adjustment according to the needs of the disease and the nutritional status of the patient. Dietitians who are familiar with oncology nutrition and the characteristics of cancer patients’ treatment can also formulate suitable dietary recipes, including the daily caloric intake, composition ratio, dietary contraindications, dietary therapy prescriptions, etc.
(3) Precautions for dietary adjustment: First of all, cancer patients do not have strict “taboos”, they need about 20% more calories than healthy people, so they should not suffer from malnutrition due to taboos; complete vegetarian diet will cause incomplete nutrition intake, so vegetarian diet should be treated with caution, and if you choose vegetarian diet, you should seek the help of dietitian to meet your body needs with scientific dietary combination. If you choose vegetarian diet, you should seek the help of nutritionist to meet the needs of your body with scientific diet. Secondly, cancer patients should not blindly “take supplements” and should not believe in the advertisements of health care products, but should selectively take supplements suitable for their health conditions under the guidance of experts. Finally, based on the principles of cancer diet, combined with the principles of TCM diet, the effect of tonic will be better.
Psychological rehabilitation
Chinese medicine always emphasizes the idea of “unification of form and spirit” and “treatment of spirit first”, and believes that the seven emotions of joy, anger, worry, thought, grief, fear and fright are closely related to heart, liver, spleen, lung and kidney, and emotional disorders can directly affect the function of internal organs, resulting in qi stagnation, blood stasis, phlegm condensation and even qi-blood disorder, leading to various kinds of disorders. Even Qi and blood rebellion can lead to various diseases. As a matter of fact, psychology and cancer are mutually influential, and mental factors are closely related to the development of cancer. Bad mental states such as depression, anxiety, doubt and anger can cause endocrine and immune system disorders, resulting in deterioration of the disease; on the other hand, cancer itself or treatment can bring certain mental trauma to patients. On the other hand, cancer itself or treatment can bring some mental trauma to patients. Medical survey shows that about 66% of tumor patients suffer from depression, 10% from psychosis and 8% from obsessive-compulsive disorder. Oncology patients often suffer from depression, anxiety, psychosis, anorexia, pain, nausea, vomiting, persistent insomnia and other mental and psychological problems, among which the incidence of depression and anxiety is higher. Mental breakdown leads to recurrence or metastasis in a quarter of cancer patients after treatment. Therefore, early identification of psychological problems of cancer patients and giving appropriate and effective interventions, and actively creating a harmonious family and social atmosphere for cancer patients are very beneficial to their recovery. Psychological problems are one of the key points of cancer recovery and also a difficult point. Once they are well solved, they often have immediate effects and have a great impact on the quality of life of cancer patients. A good mood can relieve physical fatigue and pain more than ten pairs of good medicine.
1.Psychological assessment: Psychological assessment can be conducted objectively by using various psychological assessment scales, such as anxiety self-assessment scale, depression status scale, SCL90 symptom inventory, hospital anxiety and depression scale, Eysenck personality scale, family function scale, marital quality scale, social support questionnaire, social adaptation scale, etc. Cancer patients can choose according to the questions and options in the scales, and different options correspond to different scores. Based on the total score, the psychological condition and its degree can be initially judged. In addition to the scales, psychologists usually conduct subjective assessment by talking with the patients, during which potential or hidden psychological problems can be more easily detected. Psychologists usually use a combination of both scales and conversations to evaluate the psychological status of cancer patients.
2.Psychological treatment: Psychological problems of cancer patients are often intricate and complex, both influenced by life events and their historical origin; both personality problems and family of origin influence; some problems are both psychological and related to economic support and social support; due to different growth sites of cancer and different treatment methods, there are also a lot of physiological and pathological problems brought by the disease itself or treatment methods in different stages. Therefore, the psychological treatment for cancer patients is not only related to economic support but also related to social support. Therefore, psychological treatment for cancer patients requires psychologists with certain clinical knowledge of oncology and familiarity with the common psychological problems in cancer patient groups, in addition to the application of general psychological counseling techniques and methods. We suggest that cancer patients in need of psychological counseling should preferably seek help from professionals with experience in this type of counseling. In addition, cancer patients should eliminate the avoidance of psychological counseling, and should not think that those who do psychological counseling must have psychological diseases, nor should they think that they will not have any psychological problems because they are “open-minded”. In fact, there are various ways and means of psychological intervention, which can not only solve the existing psychological problems, but also help patients to build up confidence, perceive the beauty, enhance the ability to love and improve the quality of life. For example: relaxation therapy: reduce anxiety and tension, relieve pain, improve sleep, and reduce sensitivity to adverse reactions through meditation and music; cognitive therapy: improve patients’ scientific understanding of cancer, correct misconceptions, and eliminate the impact of adverse emotions on health; supportive psychotherapy: invite successful cancer treatment patients to present themselves and set up role models for patients to enhance their self-confidence; group psychotherapy In addition, for patients with moderate or severe psychological or psychiatric problems, medication can be used (must be used under the guidance of a specialist), such as sedatives, antidepressants, anti-anxiety drugs, etc., which can help patients to understand their feelings. In addition, for patients with moderate or severe psychological or mental problems, medication (must be used under the guidance of a specialist), such as sedatives, antidepressants, anxiolytics, etc., can effectively relieve clinical symptoms.
3.Self-care: Cancer patients should carry out positive self-psychological care and adopt some methods to help themselves regulate their emotions, such as the method of changing perspectives: not any reality can be escaped, learn to change perspectives to look at the problem, come out from negative emotions and find the positive side; the method of self-consolation: explain the reality with some “rationalization”, change the malignant stimulus to the positive side. Self-soothing method: to explain the reality with some “rationalization” and turn malignant stimulus into benign stimulus for psychological comfort; catharsis method: if anger is forcibly suppressed, it is like a time bomb, which is always in danger of destruction; to catharticize psychological pressure through appropriate catharsis methods can win a clear sky psychologically. In short, cancer patients should establish the attitude of facing reality and accepting challenges. Not only should they cherish themselves, but also give love to others and love life. Cancer patients must believe in science, respect science, communicate more with doctors, nursing staff and all kinds of professionals, and learn to express their needs correctly and express their inner thoughts and emotions.
Physical and psychological rehabilitation of cancer patients is a prerequisite for the restoration of occupational functions, family roles and social values. In this process, rehabilitation medical professionals and family members play an important role. Family members, in particular, shoulder the multiple burdens of care, nursing and companionship, and are a strong support for patients’ recovery. Therefore, in all aspects of physical and psychological rehabilitation, family members and patients are required to learn and practice together, and implement various scientific rehabilitation methods into their lives, especially in the areas of diet, living, exercise and psychological care, and the role of family members is irreplaceable. In view of the limited space, we would like to talk about several issues for the family members of cancer patients: First, it is not appropriate to “over-care” cancer patients, such as showing pity and sympathy in front of the patients, or taking care of them too much, or for the purpose of “protection” or “compliance”. “These practices will strengthen the cancer patient’s awareness of the disease and are not conducive to recovery; second, do not use inappropriate abstinence from food, which will cause another sense of “malnutrition”; third, the patient can be informed of the disease at the right time. As long as patients are informed that they can benefit from the treatment, it is possible for them to cooperate with the treatment.
Rehabilitation is an important part of comprehensive cancer treatment, and it is carried out throughout the treatment. As long as cancer patients focus on
As long as cancer patients focus on the combination of internal regulation and external treatment, such as freeing emotions, diet, regulating living, adapting the environment and exercising, and actively adopting comprehensive rehabilitation methods such as traditional Chinese medicine, qigong, acupuncture, medicinal food and psychological intervention, rehabilitation is no longer an unattainable dream. Are you ready to face cancer recovery?