Interventions and Treatment
Intervention planning in oncology balances dose, precautions, and goals. Core approaches: therapeutic exercise (aerobic, resistance, flexibility), manual therapy with tissue precautions, lymphedema management (compression, manual lymphatic drainage, decongestive exercise), gait and balance training for neuropathy, energy conservation and fatigue management, and pain modulation. Know the principles of progressive overload adapted to treatment cycles, and that exercise is safe and beneficial during and after many treatments when appropriately dosed.
Key concepts: complete decongestive therapy phases (intensive then maintenance), compression garment fit and timing, neuropathy balance training with sensory substitution, and activity pacing for fatigue. For bone metastases, avoid high-impact and end-range loaded positions; favor supported, low-impact activity. After surgery, respect wound healing and flap precautions.
Traps
- Applying aggressive stretching to irradiated, fibrotic tissue without accounting for reduced tissue tolerance.
- Prescribing high-impact exercise with known lytic bone lesions.
- Stopping all exercise for fatigue instead of adjusting dose and timing.
Rule of thumb
Dose exercise to the patient's current treatment phase and tolerance; when in doubt, lower intensity and increase frequency rather than eliminating activity.
Worked example
A patient with chemotherapy-induced peripheral neuropathy and falls reports numbness in both feet. Prioritize balance training with visual and proprioceptive cues, home safety, and strengthening, rather than high-intensity aerobic progression alone.