Dr. Julie Silver, 38 and the mother of three young children, was diagnosed with breast cancer in 2003. She survived surgery and chemotherapy and was sent home cancer free. But life-saving treatments took a devastating toll her psychological and physical health.
"I felt really good in the beginning, but just terrible at the end of treatment," said Silver, a physiatrist and assistant professor of physical medicine and rehabilitation at Harvard Medical School.
"I had too many symptoms to list. I was weak and in pain almost constantly," she said. "My day was pretty relentless with 24/7 mom's duties."
Silver, now 47, knew how to help others heal, but with a rotator cuff impingement, chemotherapy-induced peripheral neuropathy and cancer-related fatigue, she could hardly do it for herself.
"I couldn't step out of the world with cancer," she said. "I had to deal with life now and it was impossible to do that. I knew how to rehabilitate myself, but it was just so hard."
Unlike others who have suffered major illnesses and injuries, the 13 million cancer survivors in the U.S. are typically told by their doctors to get back to living after finishing their toxic treatments.
But surgery, chemotherapy, radiation and immunotherapy can be debilitating. They can keep people from jumping into life again.
"If a patient had a stroke, you would never tell him them, 'This is your new normal -- if you want to get better, figure it out on your own," said Silver.
So she co-founded the Star Program Certification, an evidence-based model of cancer rehab offered in hospitals in 40 states. Two states, Rhode Island in 2011 and Massachusetts in 2012, have launched the first statewide initiatives so any cancer survivor can find treatment close to home.
Silver and businesswoman Diane Stokes began Oncology Rehab Partners in 2009, which certifies health care professionals to address the physical and emotional problems of recovering cancer patients, building individualized rehabilitation plans.
The Star program has been endorsed by the American Cancer Society and receives financial support from several charitable groups, including the Gloria Gemma Breast Cancer Resource Foundation in Rhode Island and the Friends of Mel Foundation in Massachusetts.
Cancer rehabilitation with licensed professionals is covered by Medicare and most insurance plans, according to Silver.
Cancer survivors can face myriad ailments: pain, fatigue, weakness, immobility, cognitive impairment, sleep difficulties, sexual dysfunction, anxiety and depression. Treatments tend to occur consecutively or simultaneously, which contributes to the development of impairments.
Carolyn Spring of Westboro, Mass., lost the use of her left arm after surgeons took out 18 lymph nodes, followed by chemotherapy and radiation when she was diagnosed with breast cancer in 2008.
At her sixth-month check-up, her oncologist sent her on her way, warning her to go easy on that arm or she might develop lympodemia, which can lead to dangerous infections.
"He told me not to lift more than 10 or 15 pounds for the rest of my life on that arm," said Spring, 54, an estate-planning lawyer. "I just thought it was a fact of life, that I would no longer be able to use that arm. But I was just happy to be alive."
"I was in a lot of pain," said Spring, who found she was unable even to lift her briefcase, carry a light grocery bag or hold her dog's leash.