Title : Investigating cancer rehabilitation's acceptability, facilitators, and barriers in Pakistan: Stepping toward the development of a comprehensive rehabilitation program
Abstract:
Introduction: Cancer is a major worldwide health issue that has a substantial impact on patients' physical, mental, and social well-being. For cancer survivors, rehabilitation is essential to enhancing their functional independence and quality of life (QoL). Fatigue, discomfort, lymphedema, and physical deconditioning are among the disabilities brought on by the illness and its therapies. Evidence shows that cancer rehabilitation can improve outcomes and lower healthcare costs, making it a crucial part of survivorship care globally. Cancer rehabilitation is still a little-studied field in low- and middle-income (LMIC) nations like Pakistan, even though it offers both special potential and problems for better treatment.
The significance of cancer rehabilitation is emphasized in an expanding corpus of literature. Silver et al. (2017) emphasized the importance of impairment-driven rehabilitation in improving survivability outcomes worldwide and the necessity of it as a component of high-quality cancer care(1). In a similar vein, Zopf et al. (2015) showed how structured rehabilitation programs, such as supervised exercise, improved the physical and mental outcomes of individuals with prostate cancer(2). Geographical disparities and a lack of resources are the main obstacles to cancer rehabilitation in Pakistan, according to a study conducted by Shaukat Khanum Memorial Cancer Hospital. An additional investigation by MA Kennedy (2021) titled "Implementation barriers to integrating exercise as medicine in oncology: an ecological scoping review" found that two major obstacles were workforce capacity limitations and rural disparities(3). All of these studies highlight the problems facing the world, but they mostly concentrate on high-income environments, which leaves developing countries like Pakistan without adequate research.
Even though there are more than 8,000 new cancer cases reported at Shaukat Khanum hospitals alone each year, Pakistan's cancer burden is rising, yet there is little integration of rehabilitation into oncology care. Access to these crucial services is significantly hampered by the lack of public awareness campaigns, skilled rehabilitation specialists, and standardized standards. Furthermore, rural residents face injustices due to the geographic concentration of cancer treatment facilities in urban areas(4). To create a thorough, situation-specific rehabilitation program that caters to the particular requirements of Pakistani patients, these gaps highlight the urgent need to look at the acceptability, enablers, and obstacles of cancer rehabilitation in Pakistan.(5)
Background and Literature Review: Cancer is a serious worldwide health issue that influences patients' social, psychological, and physical health. The necessity for comprehensive rehabilitation services has been brought to light by the shift in focus from acute treatment to long-term survivorship care due to cancer improvements and rising survival rates. By addressing the various issues that survivors encounter, such as pain, exhaustion, limited mobility, and emotional anguish, cancer rehabilitation seeks to enhance their quality of life(6).
A growing cancer burden and a shortage of organized rehabilitation programs are driving up demand for cancer rehabilitation in Pakistan(7). Low awareness, resource constraints, and sociocultural hurdles make the issue worse. Though their application in Pakistan is still restricted and poorly studied, multidisciplinary techniques combining physiatrists, physical therapists, psychologists, and other specialists have demonstrated promise in improving patient outcomes worldwide. Developing successful rehabilitation programs in the area requires filling in these gaps with context-specific research. Breast cancer and cancers of the mouth and lips were the most prevalent cancers in women and men, respectively. Brain and nervous system malignancies were most prevalent in the pediatric population. Sadly, compared to other Pakistani cities, Karachi males have the highest ASR of lip and oral cavity cancers(6).
To guarantee sustainability and acceptance, research from low- and middle-income nations indicates that successful rehabilitation programs need to address contextual barriers and leverage enablers. By examining the viewpoints of important participants—patients and medical professionals—this research will help close a significant gap in Pakistan's oncology care system and eventually enhance long-term survivability results.
FA Rathore's "The Role of Multidisciplinary Rehabilitation in Enhancing Comprehensive Cancer
Care: A) Descriptive Review" is This analysis emphasizes how crucial it is to incorporate multidisciplinary teams—which include psychologists, oncologists, and physical therapists—into cancer care. It emphasizes how these teams increase quality of life by attending to social, psychological, and functional requirements. According to the study, customized rehabilitation can improve survivorship results, but its incorporation into cancer care necessitates systemic support.
B) Patel's article "A Brief Review of Inpatient Palliative Rehabilitation" explores how palliative rehabilitation can help with end-of-life care issues. According to the study, even in cases with advanced disease, rehabilitation can help patients control their pain, increase their mobility, and accomplish their objectives. It highlights the necessity of inpatient services that, particularly in settings with limited resources, integrate symptom management with functional progress(8).
SA Rattani's study "Cancer Care in Pakistan: A Descriptive Case" The present status of cancer care in Pakistan is described in this report, which also identifies significant deficiencies in human resources, infrastructure, and access to rehabilitation services. It draws attention to the differences between rural and urban locations as well as the absence of coordination between rehabilitation and cancer care. The report emphasizes the necessity of governmental actions and public awareness campaigns to provide rehabilitation services top priority within Pakistan's healthcare system(9).
S. Ullah Ullah's article "Cancer Rehabilitation: Emerging Role of Physiatrists in a Multi- Disciplinary Cancer Care Team" examines how physiatrists' participation in multidisciplinary teams might maximize patient recovery. According to the study, physiatrists have a major role in functional rehabilitation, pain management, and care plan coordination. It does, however, highlight how few qualified specialists are available in many nations, including Pakistan(10).
Aim: This study's main goal is to create a culturally appropriate cancer rehabilitation program for Pakistan by:
1.To evaluate the cancer rehabilitation techniques and knowledge of medical experts.
2.To investigate the perceptions and acceptance of rehabilitation services among cancer patients.
3.To determine what supports and hinders Pakistan's implementation of cancer rehabilitation.
4.To collaborate with medical experts in creating an evidence-based cancer rehabilitation program.
