title: [Physical medicine and rehabilitation and oncology: ethical reflexion].
abstract: BACKGROUND
  Physical medicine and rehabilitation (PMR) can involve the care of cancer patients requiring rehabilitation for associated deficiencies. In this case, rehabilitation methods may differ due to the evolutive nature of the disease.
  
  
  OBJECTIVE
  To reflect on this aspect of PMR based on real cases.
  
  
  METHODS
  Cases study of patients hospitalised in the PMR unit for neurological rehabilitation and diagnosed with cancer.
  
  
  RESULTS
  Twenty-four recorded cases (1998-2006); four cases are described because of difficult problems; in only seven cases the coexisting cancer had no impact on the rehabilitation process.
  
  
  CONCLUSIONS
  Supportive care for patients with a bad vital prognosis differs from standard rehabilitation and raises therapeutic and relational issues not commonly faced in PMR. Responses when confronted with a terminal disease are not the same as when confronted with a handicap. The role of the rehabilitation team is brought into question when functionality is of secondary importance. The response to physical pain is different in rehabilitation and often implies a behavioural approach, which requires the commitment of the patient to therapeutic programmes. We do not find this approach in oncology and the treatment of pain uses first some drugs. Supportive care of these patients requires a close working relationship with the oncology unit. Thus, a different approach must be taken to rehabilitation. It should always take into account the evolutive nature of cancer, which can undermine the patient's functions or setback the patient's recovery. It also requires the support of a care team, which is fully prepared for these setbacks.
authors: Service de médecine physique et réadaptation, hôpital de Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne cedex 2, France. isabelle.fayolle_minon@chu-st-etienne.fr
authors: I
authors: I
authors: Fayolle-Minon
authors: A
authors: A
authors: Condemine
authors: V
authors: V
authors: Phaner
authors: P
authors: P
authors: Calmels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009422:Nervous System Diseases / Q000209:etiology* / Q000534:rehabilitation*; D012046:Rehabilitation / Q000941:ethics*