Chapter 15 Attending to the Quality of Life at the End of Life. Palliative Rehabilitation Is Person-Centered Care for Patients With Advanced Cancer

Palliative rehabilitation is focused on the optimization of the functionality and quality of life of individuals in the advanced stages of cancer. Care is delivered in the context of a transdisciplinary team model and is driven by the values and preferences of the patient with the assent of their closest communication partners. The care model is person-centered with a focus on preservation of capabilities and potentially time-limited goals that address concerns identified by the person served as meaningful and of personal significance in sustaining dignity and self-esteem. In this sense, palliative care and cancer rehabilitation share a common approach and philosophy, facilitating their integration in supportive oncologic care. In this chapter, the elements of a palliative rehabilitation program provided in the context of palliative care for advanced cancer will be examined. Physical rehabilitation must be closely integrated with psychosocial interventions addressing the psychologic distress, existential anxiety, and spiritual pain that often arise in the process of person-centered and family-oriented care in both patients and caregivers struggling to come to terms with the exigent experience of advanced cancer. Clear communication about therapeutic goals and end-of-life preferences including the specification of advanced directives is critical and should occur while the patient retains capacity to relate their requests unambiguously. Some of the issues impacting palliative rehabilitation associated particularly with neoplastic disease involving the central nervous system will also be considered.