Oncologic rehabilitation is an evidence-based, multidisciplinary intervention to optimize function, mobility, and quality of life in cancer patients across the disease continuum from diagnosis through survivorship and end-of-life care. ECOG (Eastern Cooperative Oncology Group) performance status, originally designed for clinical trial eligibility, is widely used to stratify functional capacity: ECOG 0 (fully active, no restrictions), ECOG 1 (ambulatory, restricted in strenuous activity, can do light work), ECOG 2 (ambulatory, capable of self-care, unable to work, up and about >50% of waking hours), ECOG 3 (limited self-care, confined to bed/chair >50% of waking hours), ECOG 4 (completely disabled, cannot self-care, totally bed/chair-bound), ECOG 5 (death).
Common rehabilitation needs in metastatic cancer include: 1) Cancer-related fatigue (CRF) — most common symptom (80-100% in metastatic disease), addressed with graded aerobic exercise (NCCN Category 1 evidence), energy conservation, and sleep hygiene; 2) Cachexia and sarcopenia — progressive weight loss with muscle wasting, requiring resistance training, nutritional support, and pharmacologic interventions (orexigenic agents); 3) Chemotherapy-induced peripheral neuropathy (CIPN) — sensory and motor deficits requiring balance training, sensory reeducation, fall prevention; 4) Lymphedema — complete decongestive therapy (manual lymphatic drainage, compression bandaging, exercise, skin care); 5) Bone metastases — pain management, weight-bearing precautions, fracture prevention; 6) Post-radiation fibrosis — stretching, scar management; 7) Cognitive deficits ('chemobrain') — cognitive rehabilitation strategies.
Rehabilitation prescription stratified by ECOG: ECOG 0-1 — active rehabilitation with progressive resistance training (2-3 sessions/week, 60-80% 1RM, 8-12 reps), aerobic exercise (3-5 days/week, 30-60 minutes, moderate intensity RPE 12-14), prehabilitation before chemotherapy/surgery, return-to-activity programs; ECOG 2 — modified rehabilitation with energy conservation principles ('5 Ps': Plan, Pace, Prioritize, Position, Praise), balance training to prevent falls, low-resistance exercise, occupational therapy for ADL adaptations; ECOG 3-4 — palliative rehabilitation with positioning, range-of-motion exercises (passive/active-assist), contracture prevention, transfer training, family caregiver education, equipment provision (commodes, shower chairs, hospital beds), psychological support.