Médecine physique et de réadaptation et cancérologie : réflexion éthique à partir de cas cliniques

Abstract

Introduction

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.

Method

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.

Discussion and Conclusion

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.