Current status of Cancer rehabilitation in South Korea

1. Cancer Rehabilitation
in South Korea: status quo
Jongkyu Kim

2. Contents
• Introduction of Cancer rehabilitation
• Management of lymphedema
• Safety issues of exercise for cancer patients/survivors
• Prehabilitation
• In private fields
• Current hurdles on cancer rehabilitation
• Expanding the realm of rehabilitation medicine
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3. Pillar boxes/letter boxes and cyphers
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4. 4 July 2023
4 from https://www.postalmuseum.org/blog/royal-cyphers-on-letterboxes/

6. Why rehabilitation
for cancer patients?
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7. Cancer care continuum
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8. Cancer care continuum – survivorship care
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8 The 2005 Institute of Medicine (IOM) report

9. Cancer Care Continuum
2023-07-03
From https://www.cancer.org/content/dam/cancer-org/cancer-control/en/reports/cancer-
survivorship-moving-beyond-patient-satisfaction-tips-to-measure-impact.pdf
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10. Before cancer rehabilitation was
not established
• Neurorehabilitation for CNS tumour/metastatic brain tumours
• SCI rehabilitation for spinal tumour/metastatic cord tumour/2ndary
SCI to vertebral column collapsed patients
• MSK rehabilitation for each problem
→ but, no specific clinic for cancer survivors
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12. Physical function of advanced cancer
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13. Cancer rehabilitation concept
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14. Post-mastectomy lymphoedema
• Breast cancer
• Most common cancer of women in
South Korea
• 5-year survival: 91.2%
• 10-year survival: 84.8%
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• Report many physical/mental
issues
Modifed from Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2019,
Cancer Res Treat. 2022;54 (2): 330-344.

15. Good 5-year survival
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16. Post-mastectomy lymphoedema
• About 20~30 percent of all breast cancer patients
• Recent statistics in South Korea: 24.9%
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16 Cancer Rehabilitation Fact Sheet in Korea. Ann. Rehabilitation Med. 46, 155–162 (2022)

17. 4 July 2023
17 https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/lymphoedema-after-
treatment

18. Management of lymphoedema
• Non-surgical management
• Complex Decongestive Therapy
• Manual lymphatic drainage
• Short stretch bandage
compression
• Compression garment
• Skin care
• Exercise education
• Surgical management
• Lympho-venous anastomosis
• Post-surgical care
• Complication management
• Cellulitis management
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19. Development of lymphoedema management
in Rehabilitation medicine
• 1995, the first lymphoedema MDT
clinic by RM/vascular surgeon in
one hospital (Samsung Seoul
Hospital)
• 2004, the first academic
symposium of lymphoedema
management
• 2004, established small academic
society, “Korean lymphedema
research society”
• 2010, the society was expanded
and renamed “Korean Society of
Lymphedema”
• 2016, NHIS started to compensate
the lymphoedema therapy
materials – short stretch band,
compressive garments
• Now, every rehabilitation medicine
residents must learn about
lymphoedema management
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20. Lymphoedema in rehabilitation medicine
• Lymphoedema is
• The most common post-cancer
sequelae which can be managed
• The first gateway to the cancer
rehabilitation of RM specialists
• Sometimes curable, but in general,
not curable, but manageable
condition
• Expanding the realm
• Primary lymphoedema
• Lower extremities lymphoedema
associated gynaecologic
cancer/prostatic cancer
• MDT with vascular/plastic surgeon
for lympho-venous anastomosis
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21. 4 July 2023
21 Cancer Rehabilitation Fact Sheet in Korea. Ann. Rehabilitation Med. 46, 155–162 (2022)

22. Clinical hurdles
• Myth of exercise-induced
lymphedema
-> now, many evidences of safety
• Physiotherapist’s skill dependent
• Learning curve for MLD
• Every year new materials, but
coverage in insurance is limited
and registration is very slow
• In fee-for-service payment
system, the treatment fee is too
low (several pounds each
session), relatively expensive
bandages
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23. 23
2023-07-03
Schmitz, K. H. et al. Weight Lifting in Women with Breast-Cancer–Related Lymphedema. New
Engl J Medicine 361, 664–673 (2009)

24. Weight-lifting in breast-cancer-related
lymphedema
24
2023-07-03
Schmitz, K. H. et al. Weight Lifting in Women with Breast-Cancer–Related Lymphedema. New
• RCT for lymphedema patients
• Unilateral arm lymphedema
• 1-year membership at community fitness
center
• Twice a week, 90 minutes, small group
• Supervised exercise for first 13 weeks
• Unsupervised exercise for 39 weeks
• Results
• No change in interlimb volume difference
• Decreased numbers of exacerbation
• Decreased numbers of change of symptom
severity

25. 25
2023-07-03
Schmitz, K. H. et al. Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema:

26. Weight-lifting for risky patients of
lymphedema
• Same authors, same exercise
program
• RCT for breast cancer survivors for
1~5 years without lymphedema
• Decreased numbers of newly
onset lymphedema patients
• No change in symptom severity
• Discrepancy for lymphedema
onset
26
2023-07-03
Schmitz, K. H. et al. Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema:

27. 27
2023-07-03
Schmitz, K. H. et al. Effect of Home-Based Exercise and Weight Loss Programs on Breast

28. 2 scientific societies in Korea
The Korean Society of Lymphedema
• Established on 2004
• Focus on lymphoedema itself
• Consist of general surgeon, plastic
surgeon, gynaecologist,
rehabilitation medicine,
radiologist, nuclear medicine,
nurses, physiotherapist, etc
• https://www.kslymph.or.kr/
Korean Society of Cancer Rehabilitation
• Established on 2012
• Focus on various approaches of
cancer rehabilitation
• Consist of rehabilitation medicine
specialists/residents only
• https://www.kscr.co.kr/
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29. Prehabilitation before cancer surgery
• Re-habilitation
= Re + habilitation
• Pre-habilitation
• Preventive exercise before the
insult (surgery)
• Cancer prehabilitations with
strong evidences
• Shoulder exercise before breast
cancer surgery
• Exercise before colo-rectal surgery
• Pulmonary exercise before lung
cancer surgery
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30. Basic hypotheses
in lung cancer prehabilitation
• When determine resection area in lung cancer patients, FVC is very
important
• Higher FVC means more resection area and less recurrence
• Also, higher FVC, less post-operative complications
• Aerobic exercise can enhance FVC
→ Aerobic exercise before lung resection may be helpful on less post-
operative complications, less recurrence
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31. Prehabilitation for lung cancer
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Exercise prehabilitation in lung cancer: Getting stronger to recover faster. Eur. J. Surg. Oncol. 47,
1847–1855 (2021)

32. 4 July 2023
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Exercise prehabilitation in lung cancer: Getting stronger to recover faster. Eur. J. Surg. Oncol. 47,
1847–1855 (2021)

33. More cancer rehabilitations
• Chemotherapy induced
polyneuropathy
• Metastatic bone lesion
• Supportive care for advanced
cancer patients
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34. In private fields
• Private hospitals find insurance-uncovered items for the money
• Supportive care for patients post-operative or on chemotherapy
• NHIS uncovered exercise program
• Nutritional program
• Very luxurious hospital to take rest
• Intra-venous nutritional therapy
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35. Expanding realm of rehabilitation medicine
• When I was a resident, major
parts of rehabilitation included
• SCI rehabilitation
• Neuro-rehabilitation
• Paediatric rehabilitation
• EMG and neuromuscular diseases
• Musculoskeletal and sports
medicine
• Nowadays, RM residents must
learn about also
• Cardiac rehabilitation
• Pulmonary rehabilitation
• Musculoskeletal medicine
• Geriatric medicine
• Cancer rehabilitation
• Intensive care rehabilitation
(rehabilitation in ITU)
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36. Summary
• Lymphoedema has a major role in cancer rehabilitation
• More needs on prehabilitations
• Supportive care is emerging in cancer rehabilitation
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37. Thank you

38. And thank you for this wonderful year
I will leave UK and come back to Korea
On 14 July
If you come to Korea, or any questions about Korea,
please don’t hesitate to contact me
levite02@gmail.com
jongkyukim@seoulmc.or.kr
+82-10-8649-3488
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4 July 2023