After surviving four cancers in 18 years, Angela Kulp is no stranger to the side effects of cancer treatment, including nerve damage that requires her to use a leg brace and a cane.
Her many health care team members were at a loss as to how to contend with the ways her body had been impacted by cancer treatment after her oncologists had done their job: she had survived two melanomas and two lymphomas and weathered a CAR T-cell treatment that had re-engineered her body’s own cells then reinfused them into her body to fight her disease.
Kulp, 57, was seeing so many specialists for cancer-related claims that one day, an insurance company representative—a nurse by trade—said: “You need to see a physiatrist.”
Kulp responded, “What’s that?”
She’s not alone in having never heard of the profession, which is not widely known. Physiatry, which is also called physical medicine and rehabilitation (PM&R), is a medical specialty that encompasses brain and spinal cord injuries and sports medicine as well as cancer rehab. Last year, Dr. Hanna Oh joined Seattle Cancer Care Alliance (SCCA) as its first ever cancer physiatrist.
The need for physiatrists is considerable, as up to 50% of patients undergoing cancer treatment and up to 70% of those who have metastatic cancer experience pain, according to published research in cancer journals. Other cancer-related studies have documented that cancer survivors report a poorer quality of life in terms of physical and emotional health than adults without a history of cancer.
Dr. Oh works closely with specialties including speech therapy, occupational therapy, physical therapy and lymphedema therapy, collaborating with other providers to help manage patients’ side effects. "As the physician who leads this team, I want to address things that impact quality of life so people can continue to participate in hobbies, work and engage with their families,” says Dr. Oh.
She recommends appropriate home exercises that may emphasize balance and strength. “Physiatrists treat exercise like medications,” says Dr. Oh. She also performs joint injections for pain, Botox injections to manage spasticity caused by spine or brain tumors, and is a certified lymphedema therapist, trained in managing the swelling that can occur in limbs when the lymphatic system is blocked as a possible result of cancer treatment.
Physiatrists can diagnose and determine the cause of symptoms as well as assess whether patients may benefit from injections, bracing and adaptive equipment to restore their mobility.
“We see anyone who is experiencing a change in mobility to the point they are no longer able to do activities they enjoy,” says Dr. Oh. That can include a wide spectrum of patients, such as breast cancer patients with shoulder pain or anyone with cancer-related fatigue.
“Sometimes we see patients once to give guidance or we see them regularly to follow their functional progress,” says Dr. Oh. "Often when an athlete has an injury, it requires a multidisciplinary team of experts in exercise, nutrition, and psychology to rehab them. We should be taking the same approach for our patients.”
Not long after Dr. Oh graduated from medical school, her mother was diagnosed with pancreatic cancer. "She had such a great team of oncologists, but the most challenging thing was seeing her lose her independence and her change in function,” says Dr. Oh. “It would have been great to have someone address that, but we didn’t know about cancer rehabilitation.”
When she learned about the specialty a year or so after her mother’s death, she knew that it was her calling. "Now that I am a physiatrist, hopefully I can be that advocate for patients,” she says.
Dr. Oh started seeing patients at SCCA last September, and Kulp became one of her first after an SCCA physical therapist told Kulp about the new physician on staff. Seeing Dr. Oh has changed Kulp’s life for the better, she says. “She's amazing,” says Kulp. “We talk about what’s working and what’s not. She listens to everything I have to say and helps me figure out what to focus on. She understands that cancer recovery is more than just about treatment; it’s about recovering from what you’ve gone through.”
Nancy Kelly is another of Dr. Oh’s patients. After a breast cancer diagnosis in 2019, Kelly developed lymphedema. She also experiences swelling of her hands due to a drug she takes, which is painful and makes it hard for her to grab things like a cell phone. Dr. Oh has helped Kelly adapt, helping to treat the swelling and pain and identifying a shoulder tear that was limiting Kelly’s posture. After following Dr. Oh’s exercises, the shoulder pain is gone and the swelling in Kelly’s hands has decreased. “She is such a resource,” says Kelly, who is 69. “She knows what can happen to cancer patients. She knows how to help people like me.”
Helping cancer patients live a good life is what motivates Dr. Oh. “There is so much more to cancer treatment than just treating cancer itself,” she says. “We have to be able to treat patients and what they want to live for.”