Estimates suggest that nearly 18 million Americans will be living with cancer by 2022. Thanks to continued therapeutic improvements, more of them will be living longer with the disease.

Although many patients will face significant functional morbidity due to their cancer, their treatment, or both, multiple studies suggest that doctors are still struggling to identify and address the adverse physical and psychological effects. Despite the high need, most patients are not referred to rehabilitation services for their impairments.

In 2018, Rusk Rehabilitation at NYU Langone Health launched a specialized and highly collaborative program to address the complex rehabilitative needs of people who have cancer.

“Our mission is to improve function and quality of life for all cancer survivors throughout the entire care continuum, from the time of diagnosis through treatment to post-treatment care, remission, and even long-term follow-up,” says Jonas M. Sokolof, DO, director of the new Division of Oncological Rehabilitation. Dr. Sokolof arrived at NYU Langone in 2018 from Memorial Sloan Kettering Cancer Center.

In partnership with medical oncologists, radiation oncologists, surgeons, and nurses at NYU Langone’s Perlmutter Cancer Center as well as a wide array of other providers, the rehabilitation program creates individualized care plans for each patient, Dr. Sokolof says.

“Given the broad range of preventive, restorative, supportive, and palliative rehabilitative services, every single cancer patient can benefit from some form of rehabilitation encounter.”—Jonas M. Sokolof, DO

Care may include physical therapy, occupational therapy, osteopathic manipulation, speech–language pathology and swallowing therapy, vocational therapy, psychological services, music and recreational therapy, pain management, social work services, and lifestyle interventions such as nutritional counseling, exercise, and stress management.

Emphasizing the Role of Exercise

Dr. Sokolof aims to further expand rehabilitation services by starting a program that emphasizes the role of exercise in cancer survivor health and treatment of the disease.

“We want patients to be physically active from the time of diagnosis all the way through their completion of treatment, he says. “There is strong data that exercise can improve quality of life for cancer survivors, improve overall function, decrease fatigue, protect against the disease itself, improve mortality and survival, and reduce the risk of recurrence.”

One question is how to determine the appropriate exercise recommendations for each person. Dr. Sokolof is participating in an American College of Sports Medicine international multidisciplinary roundtable on exercise and cancer to create new guidelines on prescribing therapeutic exercise.

In conjunction with a separate group of specialists gathered by the American Congress of Rehabilitation Medicine, he is also working on a new model for exercise-focused rehabilitation.

Exploring New Options for Head and Neck Cancer

To help bolster the rehabilitative tool kit, Dr. Sokolof and Kenneth S. Hu, MD, associate professor of radiation oncology, are investigating the potential of low-level laser therapy, also called cold laser therapy, in treating radiation fibrosis and lymphedema in people with head and neck cancer.

Dr. Sokolof is also exploring the potential of a technique called functional electrical stimulation (e-stim) in helping people with dysphagia, another complication for those with head and neck cancer.

E-stim could help facilitate laryngeal closure during swallowing through adaptive learning. “Getting these patients swallowing again and off their PEG [percutaneous endoscopic gastrostomy] feeding tubes would be a big breakthrough,” he says.