COLUMBUS, Ind. (AP) — Cathy Tower's arms and legs moved smoothly and quickly on an elliptical trainer at Mill Race Center while she looked out the fitness center's large windows, enjoying the sight of autumn colors.
The retired math teacher always enjoyed exercise, especially walking near her westside Columbus home, where she and her husband, Ed, own a Christmas tree farm.
But when undergoing treatment last year for colon cancer, she had to put her exercise routine on hold.
She lacked the strength and energy to enjoy the outdoors, work occasional days as a substitute teacher and hold her young grandchildren, activities that she had enjoyed.
"I was on the couch a lot," Tower, 67, told The Republic (http://bit.ly/191ThXg ). "The effects of chemo zapped me. It was hard to just lift my legs."
Tower is making strides in her recovery, participating in the Columbus Regional Health Cancer Rehabilitation Program. She makes twice-a-week visits to the Mill Race fitness center to build her strength and endurance.
First offered in February and now available at five area sites, more than 200 patients have been evaluated for physical or occupational rehabilitation, as well as speech therapy. Others have spent time with a neuropsychologist to discuss cognitive or behavioral changes following cancer treatments.
"Each patient is evaluated and measured individually," said Julie Deckard, outreach development representative with CRH Rehabilitation.
Deckard said efforts have helped patients improve their strength, return to daily-living activities and increase their endurance and overall independence.
Outcomes are measured by a national company, Focus on Therapeutic Outcome, through patient surveys. Other CRH rehabilitation programs already have received multiple Outcomes Excellence Awards from the company.
For Tower, a mother of two and grandmother of five, the cancer-rehabilitation program earned high marks. She appreciated the pace that allowed her to progress as she needed.
Tower's physical therapist started her with simple leg-stretching exercises and moved to more demanding workouts as she became stronger. Her rehabilitation also included working with an occupational therapist and a dietitian.
The former McDowell Adult Education Center teacher now uses a variety of the exercise machines to strengthen her upper and lower body and regain mobility and flexibility. Tower's doctors said her cancer appears to be in remission, although she is waiting for final test results.
The CRH medical and support team were trained in August 2012 in a national cancer rehabilitation model called STAR, or Survivorship Training and Rehabilitation. The team learned about the evidence-based program from cancer survivor and program founder Dr. Julie Silver, an associate professor at the Harvard Medical School.
The team earned certification in February, when the local effort kicked off. Only two other Indiana hospitals offer the STAR program.
The team approach to working with cancer patients has been around CRH and other hospitals for many years, but STAR provides a more structured, dedicated program, said Dr. Rahul Dewan, a radiation oncologist at CRH.
Instead of just treating medical issues, he said, the team will look at other support that is needed.
"It's more coordinated care, looking at the individual as a whole," Dewan said. "The patient has enough stress dealing with the cancer."
Dewan explained that the idea originated in part from how young cancer patients are treated.
"The children get help adjusting back to their lives," he said. "We thought, we should be doing that with adults, too."
Adult support can include such professionals as social workers, psychologists and speech-language pathologists. They can address such issues as fatigue, difficulty with memory, lack of concentration, swelling of limbs, depression or speech issues.
Dewan said part of the change was driven by the fact that more people with cancer are surviving, and more survivors need help getting readjusted to their lives once treatment concludes.
"Cancer survivors don't want to just accept a new normal. They want to get back to their old lives," Deckard said. "We offered these things before, but now they're all connected."
Karen Hauersperger, an occupational therapist who specializes in lymphedema therapy for swelling, said many cancer patients need this type of treatment.
"Left untreated, lymphedema can cause wounds and nerve damage and a myriad of problems," Hauersperger said, adding that such swelling is common in breast cancer patients.
Hauersperger, who has worked as a therapist for 30 years, said cancer patients need a different approach because of their fatigue and other challenges, such as lack of appetite, speech and swallowing issues, and confusion.
"You can get your life back, but it takes a very organized, systematic approach. You just don't pick back up where you left off," she said.
Patients also must have patience and willingness to work with therapists.
"You have to respect the fatigue but still work through it and deal with the other side effects. It's all manageable, but it takes guidance to get you there so you don't get discouraged," she said.
Overall, the STAR program is part of CRH's effort to deliver better care with improved results for patients, Deckard said.
Joni Woodhouse, Tower's physical therapist, said team members must learn how to work with cancer patients and pay special attention to their individual needs. This includes realizing they have good days and bad days.
"We always have to monitor the intensity of the program and adjust to how they are feeling," Woodhouse said.
Tower said mornings were always best for her therapy sessions.
Her therapist would caution her to conserve her energy, knowing how easily she became overtired. That attention drew high praise from Tower.
She also liked that she was able to work with a dietitian who helped her plan healthy menus and food choices at a time when chemotherapy and radiation took away her appetite.
"Nothing to eat appealed to me," said Tower, who lost more than 20 pounds during five months of chemotherapy.
Tower said having the added support of the rehabilitation team helped make a difficult time easier to manage.
"I think (the rehabilitation program) is wonderful," Tower said. "They energize you, but they helped me step away from my grandiose ideas and realize I had to a lot to rebuild."
Tower said her husband, who retired as a math teacher at Columbus East High School, helped keep her going. The two have been married 43 years.
Instead of walking on their tree farm while she was going through her cancer treatments and recovery, she and Ed went to FairOaks Mall. There were times when she could only walk past two or three stores before tiring.
"I'll still keep coming here (to Mill Race Center) a couple of days a week to build my endurance," Tower said.
But this holiday season, she plans to do more walking outdoors on the family farm.
Information from: The Republic, http://www.therepublic.com/
This is an AP Member Exchange shared by The Republic.