Cancer rehabilitation in Germany: principles and procedures

Thanks to high technologies, a developed infrastructure and high professionalism of doctors, cancer rehabilitation in Germany has become the best in Europe.

Cancer is always a significant event for those affected.

When cancer treatment is complete, most patients will not be able to seamlessly return to their everyday lives.

Their physical performance is often impaired, and some also have mental health problems.

Already during the treatment and especially afterwards it is necessary to become physically fit and emotionally stable again.

Those people who want to return to work need to restore their performance as quickly as possible. In order to support this return to life, patients are entitled to cancer rehabilitation following treatment.

Cancer rehabilitation in Germany is a part of treatment

Rehabilitation should be scheduled as soon as possible after surgery. If after surgery the patient undergoes chemotherapy, rehabilitation is prescribed at the end of the course of treatment, or part of the chemotherapy will be carried out in a rehabilitation clinic. Other medical procedures may be carried out in parallel with rehabilitation measures.

Cancer patients benefit from oncological rehabilitation if they:

• Suffer from side effects of the disease and / or therapy
• Limited in their daily lives due to pain or side effects of treatment
• Need to improve the physical and mental health before the next course of therapy.

Examples of rehabilitation measures

Depending on the type of cancer, different steps may be necessary to reintegrate the patients into their environment. Psychotherapeutic treatments are usually necessary to help those concerned with their self-esteem (for example, patients after mastectomy) and to help them continue treatment.

Depending on the type of cancer, the following measures are offered:

• Art therapies such as music or dance therapies
• Bladder training techniques
• Counseling for erectile dysfunction
• Counseling on the use of medical devices
• Improvement of nutritional status through special diet
• Improvement of the physical condition (moderate activity)
• Language training after surgery on the larynx
• Lymph drainage massage
• Physiotherapy for the improvement of limited mobility
• Psychological counseling
• Relaxation techniques
• Respiratory training to improve the lung volume
• Social counseling

The Deutsche Rentenversicherung has compiled a brochure on the subject of cancer rehabilitation in Germany.

As a rule, the physician recommends a rehabilitation facility that is suitable for the specific diagnosis and condition. The patient has the option to choose the clinic independently. Medical tourists can find a list of the best rehabilitation clinics in Germany in our previous article.

Objectives of cancer rehabilitation

The aim of rehabilitation is to contribute to both the physical and mental recovery of the patient so that he can stabilize after the exhausting cancer treatment. Another goal of rehabilitation is to enable the patient to return to everyday life as soon as possible. This includes not only the restoration of earning capacity, but also coping with everyday matters.

A key principle of cancer rehabilitation in Germany is "rehab before retirement". This means that medical or occupational rehabilitation is the best way to restore earning capacity. The goal is to allow the person to return to working life, either in the old or in a new profession.

Reducing of the long-term consequences

Cancer is an extreme stress. Even if the tumor could be cured, many sufferers have to struggle with long-term consequences. Any side effects, both from the cancer itself and from the treatment should be reduced by the rehabilitation. Cancer rehabilitation also helps to prevent long-term consequences, such as depression, incontinence, and muscle weakness.

Improvement of fatigue as the goal of rehab

Chronic fatigue syndrome is a persistent fatigue and weakness that is disproportionate to any previous physical or mental effort. It cannot be compensated by sleep and recovery phases. Patients may also suffer from poor concentration and memory problems. A normal participation in the social and professional life is hardly possible for those affected by this condition. To boost energy German doctors recommend psychological interventions and moderate physical activity, which can be gradually increased.

Treatment of depression and anxiety

Depression in cancer is very common. The treatment of this condition is the goal of psycho-oncological care in a rehabilitation clinic.

Most often, cancer patients are afraid of permanent damage after therapy, they are afraid of death, before isolation or recurrence of the disease. Symptoms of depression include depressed mood, sadness, loss of appetite, increased need for sleep, suicidal thoughts, and fatigue.

Psycho-oncological care can be provided both in individual and in group classes.

Incontinence treatment and stoma care

Surgery for prostate cancer or pelvic irradiation can cause urinary incontinence. This often occurs with exercise, such as coughing, sneezing, or lifting weights (stress incontinence). In most cases this is a temporary disorder, but in some cases urinary incontinence persists for a long time.

In colorectal cancer, it may happen that an artificial intestinal exit (stoma) must be created. Here, the bowel is diverted to an artificial opening in the abdominal wall, where feces are collected in an ostomy pouch. One aim of the rehabilitation is therefore to teach the handling of devices such as the ostomy pouch and to improve the incontinence through targeted measures such as pelvic floor exercises.

Rehabilitation before care

The principle of “rehabilitation before care” is included in the Social Code and states that, before a patient becomes dependent on care, it is necessary to try all possible rehabilitation measures in order to maintain a normal life and independence. The purpose of cancer rehabilitation in this case is to prepare the patient for an independent daily life.

If the patient already needs care, it is necessary to do everything possible to improve the situation.

Follow-up cancer rehabilitation

The best time to start rehabilitation is usually right after completing the treatment. For example, if the surgery is followed by chemotherapy, it may also be possible to continue treatment in the rehabilitation clinic. An oncological rehab immediately following the hospital stay is called a follow-up rehabilitation (AHB, Anschlussheilbehandlung).

The so-called follow-up rehabilitation (AHB) begins shortly after inpatient cancer treatment. According to the current guidelines, AHB begins no later than two weeks after surgical treatment and no later than six weeks after the completion of radiotherapy. In exceptional cases, the period may be extended with appropriate medication.

As a rule, the patient is transferred directly from the hospital to the rehabilitation clinic. However, in some cases, the patient is discharged, and rehabilitation will begin as soon as he chooses a clinic. AHB usually takes about three weeks, but can be extended.

The goal of AHB is to restore the patient’s physical and mental health as quickly as possible and to prepare for possible follow-up measures. AHB also focuses on further employment based on the effects of the disease. Every cancer patient in Germany has the right to comprehensive follow-up rehabilitation. Special attention is paid to the side effects of aggressive cancer treatment.

Inpatient and outpatient rehabilitation

There are several forms of rehabilitation, which differ mainly in whether the patient lives in the clinic or at home during the treatment.

Inpatient cancer rehabilitation

Inpatient rehabilitation includes round-the-clock patient care in a specialized rehabilitation clinic. All necessary procedures are performed under the same roof. The advantage of inpatient treatment is that patients can fully concentrate on rehabilitation and rehabilitation, without facing the problems of everyday life. The cost of such treatment is usually more expensive due to hospital stay and additional care.

Outpatient cancer rehabilitation

More and more patients in Germany are choosing outpatient rehabilitation. This is especially true of people who have family responsibilities or a business that requires their presence in the workplace. As part of outpatient rehabilitation, the entire program is also offered, including physiotherapy and occupational therapy, as well as nutritional counseling and psychotherapy.

During outpatient rehabilitation, a person lives at home and continues to attend various procedures throughout the day. If there is a specialized clinic nearby, the necessary activities can be held under one roof. Outpatient rehabilitation usually lasts three weeks. If the condition allows, most patients choose outpatient rehabilitation. Only if this approach does not lead to the desired result, the doctor will consider traditional inpatient treatment.

Partial inpatient rehabilitation

A mixture of inpatient and outpatient services is called partial inpatient rehabilitation.

In these cases patients stay in the rehabilitation clinic from morning to afternoon and return home in the evening.

The rehabilitation clinic should therefore be as close as possible to the home or hotel. It is recommended to choose a facility no more than 45 km away. In the partially inpatient rehab you also receive all necessary treatments, but it is more comfortable compared to the hospital stay.

How to choose a clinic for cancer rehabilitation in Germany?

Patients are free to choose which center they want to go to. However, it is recommended to consult with your doctor and carefully examine the services offered by a specific institution. Such large centers as Rehaklinik Am Kurpark (Bad Kissingen) have experience treating foreign patients. But not all centers of the country can offer such high level of services to medical tourists.

Important criteria for choosing a clinic:

• First and foremost, patients should be aware of whether the rehabilitation clinic is certified and thus has high quality standards that are regularly reviewed.
• The clinic should have experience in the treatment of the particular cancer and be suitable for the specific patient.
• The location of the clinic can also play a role. While some patients prefer to stay in the immediate vicinity of their home, others want to get away from their everyday lives and search a clinic by the sea or in the mountains.
• First of all one should ask oneself whether an inpatient or an outpatient rehabilitation is preferred. If a clinic provides an outpatient rehab and is located near the place of residence, this is the best option. Again, the patient's wishes play a crucial role.
• It is preferable that the clinic deals not only with medical aspects, but also with psychological or social issues.
• The patient should know if there is adequate equipment in the rehabilitation clinic to facilitate recovery.
• Pay attention to physical therapy and nutritional consultation.

Medical rehabilitation for cancer patients

Medical rehabilitation includes measures that must be completed within one year after cancer treatment. The physician and the patient must jointly set individual rehabilitation goals and develop a set of procedures and consultations based on these goals. Comprehensive rehabilitation consists of diagnostic and therapeutic measures designed to assist the patient in his recovery and return to daily life.

This process consists of several blocks. Psychologists will work actively with the patient to alleviate the effects of stressful treatment. Presentations will inform about the disease so that the patient can make the right decisions regarding further treatment, lifestyle and prevention. During group sessions, patients can share experiences, feelings and ideas.

Each clinic in Germany provides rehabilitation a little differently, so patients have a lot of opportunities.

Let's take a quick look at the essential components of medical rehabilitation.

Diagnostics:

• Blood gas analysis
• Blood pressure measurement
• Cardiac stress test to determine exercise tolerance
• Electrocardiography (ECG), including daily monitoring of ECG and ECG during exercise.

• Endoscopic examinations of internal organs
• Gynecological and urological examinations
• Medical history: attending physicians review an individual case
• Pulmonary function test
• Ultrasound examinations
• X-ray

Sports and exercise therapy:

• Medical Training Therapy (MTT)
• Moderate endurance training (bicycle, walking, aqua jogging)
• Body perception training (for example, Qigong)
• Coordination and balance training
• Special needs gymnastics classes

Physical therapy:

• Massages
• Medical baths
• Manual and mechanical lymph drainage
• Pelvic floor exercises

Occupational therapy:

• Body awareness training (BAT)
• Treatment of neuropathies (sensory disorders caused by therapy)
• Dance meditation techniques
• Creative therapy
• Handling aids

Pain and relaxation therapy:

• Acupuncture
• Pain medication
• Pain management and documentation
• Relaxation techniques (progressive muscle relaxation, meditation)
• Cognitive behavioral therapy (CBT)
• Individual psychological talks
• Specific physiotherapy
• Electrotherapy

Psycho-oncological therapy

Since cancer can have a devastating effect on mental health, psycho-oncological therapy is a top priority in rehabilitation. German clinics offer patients individual and group classes, but not all rehabilitation centers conduct such classes with foreign patients in English. For some people, a frank conversation about their fears and concerns will be very helpful.

Nutrition counseling

After surgery, the body usually weakens. During this period, a healthy and balanced diet is especially important. Nutrition counseling includes professional advice on organizing the diet for cancer patients. A light diet can be recommended to alleviate the potential effects of therapy.

Enteral nutrition (tube feeding), that is, the intake of liquid food through a tube may be required for some patients, especially after surgery. In addition, smoking cessation training may be included.

Vocational rehabilitation

Cancer usually means a big career break for patients. Vocational rehabilitation measures are specifically designed for patient reintegration and are based on the individual needs of each person. Vocational rehabilitation is carried out independently or in addition to cancer rehabilitation.

Vocational rehabilitation may be required if the complications of the disease or therapy prevent a person from returning to his previous occupation or finding a new job. The goal is to help the patient re-enter the work, giving him new opportunities in the labor market. The vocational rehabilitation system in Germany makes every effort to prevent early retirement after cancer.

There are different models. At best, immediate reintegration into professional life takes place a few weeks or months after rehabilitation. Another option is a gradual reintegration (Stufenweise Wiedereingliederung). It may include, for example, part-time work.



Gradual reintegration shows the effectiveness of the employee for the company and the tolerance of the person to the daily workload. According to German law, until the full number of hours is reached, the employee will continue to be on sick leave and receive payments.

Course of cancer rehabilitation in Germany

Before rehabilitation, the patient must collect all relevant documentation.

These include laboratory results and X-rays. They must be transferred to the doctor along with the previously received and completed form. Among other things, this form contains information about any previous diseases or allergies. After arrival at the rehabilitation clinic, the patient is provided with detailed information about the rules of stay. The staff then shows the patient the most important clinic premises and his room.

As a rule, rehabilitation begins on the second day. This process includes physiotherapy, lymphatic drainage, relaxation courses, sports, and nutritional counseling. Treatment activities aimed at improving physical and mental health will continue for the next three weeks.

What do you have to bring to rehab?

If you choose outpatient rehabilitation, you can bring a minimum set of things for current procedures every day.

For inpatient rehabilitation, when you stay in the clinic for the entire course, take the following:

• Medical records
• Necessary medicines
• Clothing for active recreation
• Swimsuit and bath towel
• Sportswear

Who is employed in the rehabilitation team?

In a rehabilitation clinic, not only doctors but also other specialists will take care of your health.

For successful cancer rehabilitation in Germany a comprehensive team approach is always applied.

The rehabilitation team includes:

• Doctors of several specialties
• Experienced nurses
• Psychotherapist
• Sports instructors
• Certified nutritionist
• Social worker
• Cook and others

The cost of the program varies greatly depending on the clinic and the specific clinical case. Cancer rehabilitation is long and expensive, but it is an important process for returning to a full life after a serious illness. German specialists are among the best in this field.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator