Radiation oncologists work tirelessly to formulate treatment regimens that will help their patients. Unfortunately, treating cancer does have side effects. In radiation oncology, consistent body positioning is paramount to ensure the most accurate treatment is administered to the patient. While radiation teams utilize customized immobilization equipment to help prevent pain or injury, patients may experience some discomfort. For instance, some patients that undergo weeks of radiation for breast cancer have been known to develop neck and shoulder pain related to the daily positioning of their body for radiation treatment. This musculoskeletal pain, sometimes called cervical radiculopathy, or a pinched nerve, may disrupt treatment because of its severity. It is undesirable for both the patient and physician to delay treatment due to discomfort.
When this type of side effect occurs, having the option of conservative, non-pharmacologic pain management from a doctor of chiropractic on staff can help manage the pain and get the patient back to treatment faster. In addition to the painful condition mentioned, other less painful but pertinent issues can arise. The stress of a cancer diagnosis coupled with the stress of receiving treatment frequently creates muscular tension. When this muscle hypertonicity is combined with lying in certain positions for extended periods of time during treatment, muscle discomfort can increase exponentially. Offering patients a more immediate sense of relief allows for continued care so the patient may return to their activities of daily living following treatment. Again, this is where the utilization of chiropractic for relieving muscular stress can benefit the patient immensely.
This information might lead us to ask the question, “Is it typical to find chiropractors working collaboratively as a member of a medical oncology team?” In short, the answer is no. It is uncommon to see chiropractors on staff in hospitals, let alone in a cancer hospital. However, as the field of integrative oncology has grown and evolved, there has also been increased focus on quality of life issues that affect the cancer patient population. This has created opportunities for more patient-centered and non-pharmacological approaches to addressing pain and discomfort in an already heavily medicated group of patients.
Some centers have been trailblazers when it comes to the focus on improving quality of life for cancer patients. The idea is that if oncology care is focused on treating cancer through chemotherapy, radiation and surgery, great attention must also be paid to improving function and reducing pain and discomfort with a paralleled and significant effort.
In a truly patient-centered model of care, the status of each patient is discussed daily at team huddles, allowing for better collaboration between providers. In those meetings, patient complaints are reported and appropriate actions are taken. In the case of a chiropractic referral, a radiation therapist may report that a patient complains of neck and shoulder pain from daily treatment positioning. This triggers a chiropractic order that is entered into the patient’s electronic health record. The doctor of chiropractic will then be contacted by a care manager that a patient has been added to the schedule, noting the reason for referral.
Currently, few health care institutions have successfully integrated chiropractic services into their models of care, and there is very little publicized collaboration or integration with chiropractors and cancer centers. However, with more than 70,000 doctors of chiropractic practicing throughout the United States, there is certainly opportunity for more patient-centered relationships to grow between these clinical professions.
It should be noted that not every chiropractor may be willing to treat cancer patients or is even equipped with the clinical experience, tools or “know-how.” There are contraindications that must be addressed prior to any referral of a cancer patient to a doctor of chiropractic. In order to find a competent and willing chiropractic provider that understands the complexity of treating cancer patients with regard to contraindications to chiropractic care, it is best to consult with leadership from the American Chiropractic Association, state associations or state licensing boards for an appropriate referral.
It is important to continue providing new and helpful information toward improving quality of life for cancer patients, and to create useful interdisciplinary communication and collaboration to benefit those patients in need. Partnering radiation therapy services with chiropractic services is a step in paving the way for innovation and well-rounded treatment for patients.
Dr. Sklar is a Palmer Chiropractic University graduate. He holds the position of Director of Chiropractic Services at Cancer Treatment Centers of America in Philadelphia. Dr. Sklar also serves as District Director in Philadelphia for the Pennsylvania Chiropractic Association.