The Role of Physiotherapy in Palliative Care: Enhancing Quality of Life for Cancer Patients

Cancer – a word that often evokes fear and uncertainty. Globally, cancer remains the second leading cause of death, with 9.7 million cases recorded in 2022. In Malaysia, it was the third most common cause of death that same year, with 15,200 reported cases — up from fourth place in 2021 (Malay Mail, July 2024).

Understanding cancer

Cancer is the result of abnormal cells in the body growing and spreading uncontrollably. Unlike healthy cells, which follow a natural cycle of growth, division, and death (a process known as apoptosis), cancer cells bypass these controls, leading to tumors and damage to organs and systems, including the immune system. (Brown et al., 2023).

Cancer can present with a wide range of symptoms, depending on the type and stage (Koo et al., 2019). These may include:

• muscle weakness

• persistent fatigue or lethargy

• weight changes

• changes in bowel and bladder habits

• chronic cough

• unexplained joint or muscle pain

• body imbalances

• balance or coordination issues

• frequent headaches

While early detection and treatment are crucial, many patients are diagnosed at advanced stages. For these individuals, palliative care offers an essential layer of support — and physiotherapy plays a key role in this care model.

How Physiotherapy Supports Palliative Care

Palliative care focuses on improving the quality of life for patients with serious illnesses, including advanced-stage cancer. Physiotherapists contribute by addressing both physical and emotional challenges, aiming to relieve discomfort, maintain function, and support emotional well-being. The goals of physiotherapy in palliative care include:

• Pain management

• Preserving or improving muscle strength and mass

• Enhancing posture and breathing patterns

• Reducing phlegm accumulation and chest congestion

• Improving coordination, balance and mobility

• Facilitating use of assistive devices and home modifications

• Educating patients and caregivers

• Providing emotional support

Physiotherapy interventions are tailored to each individual’s needs and comfort level. Common techniques include:

• Soft tissue and lymphoedema massage

• Active or passive strengthening exercises, including core, neck, chest, limbs

• Stretching routines for flexibility and mobility

• Gentle balance and coordination activities

• Breathing and posture correction exercises

• Relaxation and guided positioning techniques

In cases of life-limiting illness, physiotherapists often work in tandem with other healthcare providers to ensure a holistic approach that includes emotional, psychological, and spiritual support.

Benefits of physiotherapy in palliative care

Integrating physiotherapy into palliative care offers multiple benefits, such as:

1. Increases Physical Comfort: By managing pain, reducing stiffness, and relieving muscle spasms, physiotherapy provides physical comfort and promotes relaxation.

2. Reduces Psychological Stress: The active involvement in therapy can be empowering for patients, allowing them a sense of control over their care, reducing anxiety, and enhancing mood.

3. Enhances Social Interaction and Communication: Physiotherapy sessions provide a regular source of social engagement, offering patients emotional support and reducing feelings of isolation.

4. Improves Quality of Life: By alleviating symptoms and promoting physical function, physiotherapy contributes to an improved quality of life and sense of well-being for patients and their families.

Challenges in implementing physiotherapy in palliative care

Despite its ma y benefits, physiotherapy to palliative settings comes with its own set of challenges:

1. Managing Pain Sensitivity: Patients in palliative care may have heightened pain sensitivity, requiring careful, patient-centered approaches to avoid causing discomfort during therapy.

2. Limited Energy and Fatigue: Fatigue is a common symptom in terminal illness, making it essential to adapt therapy sessions to a patient’s energy levels.

3. Emotional and Psychological Barriers: The acceptance of palliative care can be emotionally taxing for patients and families, potentially impacting their motivation to engage in physiotherapy. Compassionate communication and supportive care can help ease these barriers.

Takeaway

Physiotherapy plays a vital and compassionate role in palliative care. It is not just about movement — it’s about dignity, comfort, and enhancing quality of life. Whether by easing pain, promoting mobility, or offering emotional support, physiotherapists stand alongside patients and families during some of life’s most challenging times.

By integrating physiotherapy into palliative care plans, we help ensure that patients live as fully and comfortably as possible — one movement, one breath, and one day at a time.

References

Brown, J. S., Amend, S. R., Austin, R. H., Gatenby, R. A., Hammarlund, E. U., & Pienta, K. J. (2023). Updating the Definition of Cancer. Molecular cancer research : MCR, 21(11), 1142–1147. https://doi.org/10.1158/1541-7786.MCR-23-0411

Koo, M. M., Swann, R., McPhail, S., Abel, G. A., Elliss-Brookes, L., Rubin, G. P., & Lyratzopoulos, G. (2019). Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study. The Lancet Oncology, 21(1). https://doi.org/10.1016/s1470-2045(19)30595-9 Mail, M. (2024, July 19). Health ministry: Sharp rise in cancer cases, late detection raise concern. https://www.malaymail.com/news/malaysia/2024/07/19/health-ministry-sharp-rise-in-cancer-cases-late-detection-raise-concern/144239

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