Rebuilding Function After Cancer Hospitalization

People come home from a cancer admission and say the same thing: "I am not myself." Underneath that sentence there are usually three different problems, and each one has a different fix.

• Strength. Muscle is lost fast in a hospital bed and slowly out of it. Standing from a low chair or climbing stairs is where it shows.
• Balance. Even with decent leg strength, the body can stop correcting itself. Turning, reaching up, and walking on carpet or grass are the risky moments.
• Thinking. Memory, attention, and word-finding can all be slower.

Ask the team to address them one at a time. A single referral for "weakness" often gets you only a leg exercise sheet.

The CDC runs a fall-prevention program for clinicians called STEADI, which stands for Stopping Elderly Accidents, Deaths, and Injuries. It uses three short tests that any clinic can do in a few minutes. Ask for them by name.

Timed Up and Go. You sit in a chair with arms. On "go" you stand, walk 10 feet at your normal pace, turn, walk back, and sit down. The clinician times it. CDC's cutoff is plain: "An older adult who takes 12 seconds or more to complete the TUG is at risk for falling."

30-Second Chair Stand. You sit with arms crossed over your chest and stand up and sit down as many times as you can in 30 seconds. Below-average counts by age:

Age	Men	Women
60-64	under 14	under 12
65-69	under 12	under 11
70-74	under 12	under 10
75-79	under 11	under 10
80-84	under 10	under 9
85-89	under 8	under 8
90-94	under 7	under 4

4-Stage Balance Test. You hold four standing positions, each harder than the last, to see where balance breaks down.

These numbers are useful twice. They tell you where you are starting, and they justify a therapy referral to an insurer.

This is the piece families most often get wrong.

The National Cancer Institute defines delirium as "a confused mental state that includes changes in awareness, thinking, judgment, sleeping patterns, as well as behavior." The key clue is timing. Symptoms "usually occur suddenly (within hours or days) over a short period of time and may come and go."

Delirium comes in three forms. In the hyperactive form the person is restless, anxious, or suddenly agitated. In the hypoactive form the person "seems sleepy, tired, or depressed" and is easily missed. The mixed form swings between the two.

Common causes include dehydration, infection, high-dose opioids, stopping a medicine, brain tumors, older age, and advanced cancer. Many episodes caused by a medicine or by dehydration are reversible. That is why it is worth calling instead of waiting.

What helps at home: keep the room quiet and well lit, put a clock and a calendar in view, keep familiar possessions around, and keep the same few caregivers rather than a rotating cast. Family presence helps. Delirium also raises the risk of falls, of losing bladder and bowel control, and of not drinking enough, so all three need watching.

Delirium is not the same as dementia or depression, and the treatments differ.

A different problem sits alongside delirium. Chemotherapy, some radiation to the brain, and immunotherapy can cause memory and concentration trouble, sometimes called chemo brain. It can start during treatment or after it. Age and other health conditions add to it.

The National Cancer Institute's advice: tell your team if you have difficulty remembering things, thinking, or concentrating. Exercise helps, partly by cutting stress and raising alertness. Get real sleep at night, and keep daytime naps under an hour. Keep a written list of important information.

Three professions do this work: a neuropsychologist, who tests thinking in detail; an occupational therapist, who rebuilds daily tasks around the deficits; and a vocational therapist, who works on return to a job.

There are four settings, and they differ in intensity and in what Medicare requires.

Inpatient rehabilitation facility. The most intensive option. Medicare Part A covers physical therapy, occupational therapy, and speech-language pathology, along with the room, meals, nursing, and drugs. Your provider has to certify three things: that you need intensive rehabilitation, that you need continued medical supervision, and that you need coordinated care from your providers. In 2026, days 1 to 60 carry a $1,736 deductible and then $0 a day. Days 61 to 90 cost $434 a day. If Medicare already charged a deductible for a hospital stay in the same benefit period, you do not pay it twice.

Skilled nursing facility. Covers nursing, therapy, meals, medications, and supplies. There is a hard entry rule: you generally need a prior inpatient hospital stay of at least 3 days in a row. Time in observation status and time in the emergency room do not count toward those 3 days, which catches many families out. You also need to enter the facility generally within 30 days of leaving the hospital. In 2026, days 1 to 20 cost $0 after the Part A deductible, days 21 to 100 cost $217 a day, and after day 100 you pay everything.

Home health. Skilled nursing, physical and occupational therapy, speech-language pathology, and part-time aide help, delivered at home. You must be homebound. You pay nothing for the covered services.

Outpatient therapy. You travel to a clinic. This is usually where the longest and most specific work gets done.

Ask which setting is being proposed, why, and what happens when that benefit runs out.

CDC's home checklist is short and mostly cheap:

• Handrails on both sides of the stairs, running the full length.
• Light switches at both the top and the bottom of the stairs.
• Throw rugs removed, or taped down with non-slip backing.
• Cords coiled and taped along the wall.
• Everyday items moved to shelves about waist high.
• Grab bars beside and inside the tub, and beside the toilet.
• A non-slip mat or stick-on strips in the tub or shower.
• A lamp within reach of the bed and a nightlight on the route to the bathroom.

An occupational therapist can do this walk-through and write the findings down, which also supports equipment orders.

The National Cancer Institute's general target for survivors is moderate exercise such as walking, biking, or swimming, for about 30 minutes every day or almost every day. Check with your doctor or a physical therapist before starting, and build up gradually rather than jumping to that on day one. Exercise lowers anxiety, lifts mood, and reduces fatigue.

Track something you can measure. A chair-stand count, a walking distance, or a TUG time all work better than "a bit better this week."

Call 911 straight away for any of these. They are emergencies, and calling the clinic first wastes the time that decides the outcome.

• New weakness or drooping on one side of the face or body, sudden trouble speaking or understanding speech, or sudden loss of vision. These are stroke signs, and treatment is time-limited.
• A first-ever seizure, or a seizure lasting more than five minutes.
• A fall with a head injury, a blood thinner on board, or a limb that cannot bear weight.
• Someone who cannot be roused, or who is confused with a fever, shaking chills, or fast breathing.
• A temperature of 100.4 °F (38 °C) or higher during chemotherapy. The CDC calls that a medical emergency.

Call the team the same day for:

• New confusion, agitation, or unusual sleepiness that came on over hours or days, without the emergency features above.
• A fall with no head injury and no obvious injury afterwards.
• Fever off treatment, or signs of an infection such as burning with urination or a new cough.
• Not drinking enough, or making much less urine than usual.

Sudden confusion in someone with cancer is a symptom, not a personality change. It often traces back to a medicine, dehydration, or an infection, and those are fixable.

• Delirium and Cancer Treatment (PDQ) Patient Version — National Cancer Institute
• Memory or Concentration Problems and Cancer Treatment — National Cancer Institute
• Follow-Up Medical Care After Cancer Treatment — National Cancer Institute
• STEADI: Older Adult Fall Prevention — Centers for Disease Control and Prevention
• STEADI Clinical Resources — Centers for Disease Control and Prevention
• Timed Up and Go (TUG) Assessment — Centers for Disease Control and Prevention
• 30-Second Chair Stand Assessment — Centers for Disease Control and Prevention
• Check for Safety: A Home Fall Prevention Checklist for Older Adults — Centers for Disease Control and Prevention
• Inpatient rehabilitation care coverage — Medicare.gov
• Skilled nursing facility (SNF) care coverage — Medicare.gov
• Home health services coverage — Medicare.gov
• Fever during cancer treatment — Centers for Disease Control and Prevention