In oncology and limb salvage care, doctors walk a very delicate line. Every decision carries emotional weight, medical risk, and long-term consequences for the patient’s quality of life. When limb salvage fails or becomes unsafe, the shift toward amputation and prosthetic planning must be handled with clarity, compassion, and precise timing. Yet in real clinical practice, this pivot often feels complex. Tumor response varies, complications appear suddenly, and patients struggle with fear during an already overwhelming journey.
This article offers a clear and practical clinical protocol to help you decide when and how to move from limb salvage to prosthetic referral. It uses simple language, a human tone, and a structured pathway that shows the exact clinical moments when prosthetic involvement becomes essential. The goal is to help you guide your patients safely through uncertainty, reduce delays, and prepare them for a future where function and dignity remain central.
Step One: Understanding the Goals of Limb Salvage
Balancing Tumor Control With Functional Outcomes
Limb salvage aims to remove or control the tumor while keeping the limb functional. Oncologists and orthopedic surgeons work together to reduce the cancer load and maintain as much healthy tissue as possible. But even when salvage succeeds on paper, the final function of the limb may still remain limited. Some patients experience stiffness, weakness, or chronic pain that keeps them from using the limb comfortably.
Understanding this balance early is important because it shapes later decisions. When tumor control compromises limb strength too much, or when reconstruction limits movement, an amputation with prosthetic rehabilitation may offer better quality of life. Doctors watch these early signs closely to anticipate whether a pivot might be needed.
Explaining Salvage Expectations to the Patient
Patients often begin limb salvage with high hopes, believing they will return to full function. Doctors guide them gently by explaining what surgery and treatment can realistically achieve. Early transparency helps prevent disappointment later, especially if complications arise.
This honest communication also builds trust. Patients who understand the goals and limits of salvage care feel more prepared when new decisions must be made.
Recognizing the Emotional Weight Behind Limb Preservation
For many patients, keeping the limb feels tied to identity and hope. Doctors acknowledge this emotional complexity as part of the clinical process. When patients feel supported emotionally, they cope better with changes in recovery and are more receptive to future discussions about prosthetic referral.
Emotional readiness becomes a quiet but essential part of clinical decision-making.
Step Two: Monitoring Salvage Progress Over Time
Tracking Tumor Response During Treatment
As treatment progresses, doctors monitor how the tumor responds to chemotherapy, radiation, or targeted therapy. If the tumor shrinks or stabilizes, limb salvage continues as planned. If the tumor grows or invades critical structures, the chances of functional recovery may decrease sharply.
These patterns help clinicians determine whether salvage remains safe. When the tumor behaves unpredictably, doctors begin weighing alternative options, including the possibility of transitioning toward prosthetic planning.
Evaluating Tissue Viability After Surgical Reconstruction
Reconstruction after tumor removal relies on healthy tissue surviving the procedure. Surgeons watch for signs of flap failure, infection, poor perfusion, and delayed healing. In oncology cases, tissues are often more fragile than trauma cases due to radiation or disease involvement.
When reconstructed tissue fails to support stable movement or healing, limb salvage may no longer offer the patient a functional future. Doctors note these signs carefully as part of the pivot decision.
Communicating Salvage Status With the Rehabilitation Team
Rehabilitation specialists help track functional progress. They observe the patient’s strength, motion, and ability to bear weight. When therapy stalls despite good effort, this may signal deeper problems with salvage outcomes.
Open communication between teams helps identify early warning signs that the limb may not support long-term function. This teamwork keeps the patient’s pathway safe and realistic.
Step Three: Recognizing Red Flags That Signal Salvage Failure
Watching for Recurring Infections or Non-Healing Wounds
In oncology patients, wounds sometimes refuse to heal due to radiation damage or compromised immunity. Persistent infection or slow-healing incisions reduce the chances of limb survival and limit mobility. If these problems continue despite proper care, the limb may not be viable long-term.
These red flags guide the medical team toward reconsidering the salvage approach. Doctors begin preparing for discussions about prosthetic care to protect the patient from future complications.
Identifying Structural Instability in the Limb
Some tumors weaken bone or muscle so severely that reconstruction cannot restore stability. If the patient cannot stand safely, or if the limb bends under weight, daily living becomes difficult and risky. Surgeons assess whether additional reconstruction can fix the issue or whether the limb simply cannot support reliable function.
This structural weakness often leads to conversations about amputation as a safer and more functional alternative.
Understanding When Pain Becomes a Limiting Factor
Sometimes pain becomes the barrier rather than tissue failure. Chronic pain from nerve damage, radiation effects, or bone involvement can limit function even if the limb is technically intact. When pain keeps the patient from moving, walking, or participating in therapy, salvage loses its functional meaning.
Recognizing when pain becomes disabling helps avoid prolonged suffering and directs the patient toward options that may bring better comfort and mobility.
Step Four: Preparing for the Pivot Conversation
Giving the Patient Time and Space to Process New Information
When limb salvage stops serving the patient’s long-term goals, doctors approach the pivot conversation with sensitivity. They create a calm, private space and use clear, simple language to explain why amputation may now offer a better future. Patients often need time to understand the change and process the emotional impact.
Doctors allow space for questions and take the conversation step by step. This slow, respectful approach helps the patient feel supported, not pressured.
Explaining How Amputation Can Improve Function and Comfort
Many patients fear that amputation means losing movement forever. Doctors explain that a well-planned transtibial, transfemoral, or upper-limb prosthesis can restore walking, reduce pain, and offer predictable function. They compare realistic outcomes of continued salvage versus prosthetic rehabilitation to help the patient see the benefits clearly.
This perspective shift helps the patient recognize that amputation is not a failure but a pathway toward mobility and quality of life.
Involving Family Members and the Care Team Early
Family members play a significant role in emotional support and decision-making. Doctors include them in the discussion, helping them understand the clinical reasoning behind the pivot. Their presence helps the patient feel reinforced rather than alone.
When the entire care team communicates consistently, the patient receives a unified message that builds trust and comfort.
Step Five: Determining the Ideal Timing for Amputation
Choosing a Moment That Balances Medical Safety and Patient Readiness
Timing is a delicate matter. Surgery should happen when the patient is medically stable, emotionally prepared, and no longer likely to benefit from salvage efforts. Severe infection, tumor progression, repeated reconstruction failures, or structural collapse may accelerate the timeline.
Doctors also consider the patient’s mental readiness. Even a few days of preparation can reduce fear and improve postoperative engagement. Balancing clinical urgency with emotional stability leads to better long-term outcomes.
Evaluating Overall Health Before Moving Forward
Cancer treatment often affects the patient’s immune system, organ function, and energy levels. Doctors evaluate whether the patient can handle anesthesia, blood loss, and postoperative healing. They review chemotherapy schedules, white cell counts, and nutritional status to minimize surgical risk.
These evaluations ensure that amputation is carried out safely and without jeopardizing ongoing cancer management.
Preparing the Rehabilitation Team for the Change
Once timing is clear, doctors notify physiatrists, therapists, and prosthetists so they can prepare for early rehabilitation. Planning ahead prevents delays and keeps the patient from feeling lost after surgery. This preparation also gives the team time to coordinate care across departments.
A smooth transition reduces confusion and creates a sense of security for the patient.
Step Six: Surgical Goals When Salvage Transitions to Amputation
Creating a Limb Shape That Supports Future Prosthetic Use
During amputation, surgeons focus not only on removing diseased tissue but also on shaping the limb for a comfortable prosthetic fit. They create balanced muscle flaps, manage nerves carefully, and shape bone edges smoothly. These details reduce postoperative pain and prevent long-term irritation inside the socket.
For oncology patients, tissue quality may be limited, so surgeons adapt techniques to protect the remaining structures. Their choices during surgery directly influence comfort and mobility with a prosthesis.
Protecting Soft Tissue Compromised by Radiation or Chemotherapy
Radiation therapy can weaken skin and soft tissue. Surgeons choose incision lines and closure methods that minimize tension and reduce the risk of breakdown. They may adjust the amputation level to avoid fragile areas.
These decisions improve healing speed and make the limb more tolerant of prosthetic pressure later.
Reducing Post-Amputation Pain and Sensitivity
Careful handling of nerves helps reduce neuroma formation. Surgeons use techniques that encourage nerves to heal smoothly rather than form painful clusters. This attention reduces chronic pain and improves the patient’s ability to tolerate a prosthesis during daily activities.
Managing pain well at this stage lays the foundation for successful rehabilitation.
Step Seven: Early Post-Operative Management After Amputation
Monitoring Healing in a Limb With Prior Cancer Treatment
After surgery, the limb requires close observation. Prior radiation or chemotherapy may slow healing, making small signs of breakdown important to catch early. Doctors check skin color, drainage, swelling, and incision integrity in frequent intervals.
Good postoperative care prevents complications that could delay the start of prosthetic planning. Patients appreciate the reassurance that their recovery is being watched attentively.
Managing Pain and Emotional Distress
Pain management plays a central role in early recovery. Oncology patients may already be fatigued or emotionally overwhelmed, so clinicians use gentle communication while adjusting medications. When pain is controlled, the patient feels more hopeful about rehabilitation.
Addressing emotional distress early prevents withdrawal, fear, or hopelessness that might slow progress.
Beginning Safe, Gentle Movement
Therapists introduce light exercises to protect joint mobility and maintain strength. Even small movements help the patient regain confidence in their ability to function. This early activity prevents stiffness and prepares the patient for later prosthetic use.
Re-establishing movement early sets a positive tone for the entire rehabilitation process.
Step Eight: Pre-Prosthetic Therapy for Oncology Patients
Supporting Strength and Mobility After Complex Treatment
Oncology patients often feel weak after surgery, chemotherapy, or radiation. Therapists help them rebuild strength slowly with safe, simple exercises that protect healing tissues. These early movements restore confidence and prevent stiffness in nearby joints. As strength returns, the patient feels more capable and prepared for the next stages of rehabilitation.
Doctors watch closely for fatigue, dizziness, or swelling that could signal complications. Treatment-related weakness sometimes limits how quickly therapy can progress. By monitoring these signs carefully, the team adjusts the plan to keep the patient safe and moving at a gentle, steady pace.
Shaping and Protecting the Residual Limb
Limb shaping is essential for future socket fit. Compression therapy reduces swelling and helps create a smooth limb contour. Oncology patients, however, may have delicate skin or surgical flaps that need special handling. Therapists apply compression gradually and check the skin frequently for irritation.
As swelling decreases, the patient begins to notice more stability in the limb. This consistency reassures them that progress is happening, even if slowly. Clear communication from the team helps the patient understand the purpose of this phase and stay engaged.
Maintaining Hope and Motivation During Recovery
The emotional toll of cancer treatment often affects rehabilitation. Some patients feel tired not only physically but mentally. Therapists use calm, encouraging language and celebrate small improvements. These positive moments help the patient stay motivated, especially during times when progress feels slow.
A sense of hope is essential. When patients believe they can regain function, they participate more fully in therapy and feel more ready for prosthetic planning.
Step Nine: Identifying Readiness for Prosthetic Referral
Confirming Wound Stability and Skin Integrity
Before sending the patient to a prosthetist, clinicians ensure that the incision has healed, swelling is predictable, and skin can handle gentle pressure. Oncology tissues may take longer to heal because of prior radiation or ongoing treatments. Doctors inspect the limb carefully, knowing that fragile skin needs extra time to stabilize.
When the tissue shows consistent strength and no signs of breakdown, the patient is ready for the next step. This careful timing protects them from complications during socket fitting.
Assessing Strength, Balance, and Joint Mobility
Prosthetic rehabilitation requires a stable, mobile patient. Doctors check hip and knee movement, evaluate balance, and observe how the patient handles sitting, standing, and transfers. These indicators show whether the patient has the physical foundation needed to begin using a prosthesis.
If mobility remains limited, extra therapy may be prescribed before the referral. This preparation helps ensure a smoother and safer prosthetic experience.
Understanding Emotional Readiness and Cognitive Clarity
Some oncology patients face emotional fatigue, anxiety, or fear during recovery. Doctors check for emotional readiness by asking simple questions and observing reactions. If the patient shows interest, curiosity, or determination, they are likely ready for prosthetic planning.
Cognitive clarity is also important. Patients must understand instructions and participate actively in rehabilitation. When both emotional and cognitive readiness align, the referral timing is ideal.
Step Ten: Making a Strong Prosthetic Referral
Writing Detailed Notes for the Prosthetist
The referral note becomes the prosthetist’s first window into the patient’s history. Doctors include details about tumor location, type of reconstruction, radiation exposure, nerve handling, and wound behavior. These notes guide the prosthetist in selecting safe socket designs and alignment choices.
Clear communication prevents misunderstandings and ensures that the prosthetist is fully prepared for the patient’s evaluation. This foundation reduces risk and improves long-term comfort.
Helping the Patient and Family Understand the Next Step
Many oncology patients feel uncertain when entering prosthetic care. Doctors explain what the first prosthetic evaluation will involve, using simple and comforting words. They describe measurements, limb assessment, and the purpose of early socket trials.
When the patient and family understand the timeline and expectations, anxiety decreases. Knowledge gives them a sense of control and prepares them emotionally for the transition.
Coordinating Appointments and Transportation Needs
Oncology patients may have limited stamina or require assistance for appointments. Doctors help plan logistics so the patient can attend prosthetic sessions comfortably. This preparation prevents delays and keeps the rehabilitation flow smooth.
A well-organized referral reduces confusion and supports steady progress.
Step Eleven: The First Prosthetic Evaluation
Understanding What the Prosthetist Looks For
During the first evaluation, the prosthetist examines the shape, strength, and sensitivity of the residual limb. They assess how prior treatments may affect socket design. Areas exposed to radiation or surgical flaps may need softer interfaces or special accommodations to avoid skin damage.
Doctors prepare the patient for this process by explaining that the prosthetist needs detailed information to create a safe and comfortable plan. This understanding helps the patient relax and participate openly.
Checking the Limb’s Response to Touch and Gentle Pressure
The prosthetist may press lightly on certain areas to understand tissue behavior. Oncology tissue can react differently, especially if it has been irradiated. Doctors and therapists observe these reactions and note any signs of sensitivity or discomfort.
These observations influence early design decisions. Identifying sensitive areas prevents future pressure points inside the socket.
Building Trust Between the Patient and Prosthetist
The first evaluation sets the tone for the entire prosthetic journey. A patient who feels respected and understood becomes more confident moving forward. The prosthetist uses calm communication and invites questions, while doctors reinforce the message that this step is safe and beneficial.
This trust becomes essential as the rehabilitation path becomes more hands-on and physically demanding.
Step Twelve: Early Test Socket Fitting
Introducing the Patient to Their First Physical Prosthetic Experience
The test socket is a lightweight, temporary version of the final prosthesis. For oncology patients, this may be their first time standing with support since surgery. Doctors prepare them mentally by explaining that this socket is meant for learning and adjustment, not perfection.
Patients often feel emotional during this stage. Standing again can bring relief, hope, or even sadness. Clinicians support them gently through this moment, helping them focus on progress rather than fear.
Checking Pressure Zones for Fragile Oncology Tissue
During the trial fit, doctors and therapists check skin reactions frequently. Radiation-affected tissue may turn red quickly or become irritated from even mild pressure. The prosthetist adjusts socket trim lines, padding, and alignment to distribute pressure safely.
These early adjustments protect the limb and help the patient build positive associations with the prosthesis.
Helping the Patient Understand That Adjustments Are Normal
Patients sometimes worry when the socket needs multiple changes. Doctors reassure them that refining the socket is part of the process. Oncology cases often require extra fine-tuning to accommodate tissue sensitivity.
When patients understand this, they become more patient and communicative, which leads to a better final fit.
Step Thirteen: Beginning Gait Training
Teaching Safe Movement After Complex Cancer Treatment
Oncology patients may begin gait training with limited stamina. Therapists start with short, controlled steps, focusing on balance and posture. The goal is to introduce walking in a safe and predictable way.
Doctors assess how the limb and prosthesis respond to early loading. If swelling increases or discomfort appears, therapy intensity is adjusted. This careful approach builds trust and prevents injury.
Helping the Patient Build Rhythm and Coordination
Cancer treatments can disrupt the patient’s strength and coordination. Therapists work on restoring smooth, rhythmic steps. They teach the patient how to shift weight, engage core muscles, and maintain stable hip movement.
As the patient develops rhythm, walking becomes easier and more sustainable. Each small improvement brings a sense of hope and accomplishment.
Monitoring Emotional and Physical Fatigue
Fatigue is common in oncology rehabilitation. Doctors watch for signs of exhaustion, frustration, or discouragement. When needed, therapy sessions are modified to match the patient’s capacity.
Supporting the patient emotionally during this phase keeps them engaged and motivated.
Step Fourteen: Preparing for Full-Time Prosthetic Use
Increasing Wear Time Slowly and Safely
As the patient becomes more comfortable, clinicians guide them in increasing prosthetic wear time. Oncology patients may progress more slowly because of tissue sensitivity or treatment fatigue. Doctors emphasize patience and consistent communication.
Slow increases in wear time give the limb space to adapt, reducing the chance of pressure injuries or pain.
Teaching Daily Care and Skin Monitoring
Oncology tissue requires careful monitoring. Patients learn to check for redness, warmth, swelling, or texture changes. Clean skin and a clean socket reduce infection risk and promote long-term comfort.
Teaching these habits early helps prevent complications that could interrupt rehabilitation.
Helping the Patient Return to Everyday Life
Daily activities such as cooking, bathing, or walking outdoors slowly become part of the patient’s routine again. Doctors guide them through challenges and help them manage energy levels.
These small steps restore independence and give the patient a sense of normalcy after a long medical journey.
Step Fifteen: Long-Term Oncology Follow-Up With a Prosthesis
Monitoring for Recurrence and Protecting the Residual Limb
After prosthetic fitting, oncology patients require ongoing cancer surveillance. Doctors examine the residual limb carefully at each visit, knowing that previous tumor sites or radiation zones may remain sensitive. Any sudden change in swelling, texture, or pain needs prompt evaluation.
The prosthesis itself can place new pressures on the tissue, so clinicians check for signs of irritation. By combining cancer follow-up with prosthetic monitoring, the care team protects the patient from complications that may arise months or years after treatment.
Adjusting the Prosthesis as the Limb Changes Over Time
Residual limbs can change size due to weight fluctuations, muscle adaptation, or treatment effects. These changes may require socket adjustments or new suspension methods. Doctors help patients recognize these patterns so they can seek help early rather than waiting until discomfort becomes severe.
Long-term success depends on smooth communication between physicians, therapists, and prosthetists. When each professional contributes observations, the patient benefits from steady and predictable care.
Supporting the Patient’s Emotional Journey After Treatment
Cancer survivors often carry emotional memories from their journey. Some feel relieved, while others struggle with fear of recurrence or frustration over functional limits. Doctors and therapists take time to acknowledge these feelings and guide patients toward supportive resources.
Emotional stability remains as important as physical progress. When patients feel understood, they participate more confidently in long-term rehabilitation.
Step Sixteen: Understanding When a New Prosthesis Is Needed
Watching for Signs of Poor Fit or Increased Sensitivity
Over time, the patient may notice rubbing, pressure, or discomfort during daily activities. Oncology patients, in particular, may develop sensitivity due to radiation fibrosis or scar changes. Doctors listen closely to these concerns because even small issues can grow quickly if unaddressed.
When the limb no longer matches the socket shape, a new prosthesis becomes necessary. Catching these signs early prevents pain and keeps the patient active.
Evaluating Wear Patterns in the Socket and Components
A worn socket interior or loose suspension can cause instability. Prosthetic components may also degrade due to frequent use or environmental factors. Doctors examine the prosthesis with the patient present, helping them understand how wear affects function.
Replacing components at the right time prevents accidents and protects the limb from injury. This proactive approach helps the patient maintain confidence in their device.
Revisiting Functional Goals as the Patient’s Life Changes
Patients often return to work, hobbies, or daily routines after recovery. Their goals may evolve as they regain strength or adapt to new responsibilities. Doctors discuss these changes to determine whether a more specialized prosthesis might support their lifestyle better.
When the prosthesis aligns with the patient’s long-term goals, quality of life improves significantly.
Step Seventeen: When Oncology Complications Affect Prosthetic Use
Managing Lymphedema Around the Residual Limb
Some oncology patients develop lymphedema due to lymph node removal or radiation. Swelling can make socket fit unpredictable and uncomfortable. Doctors help manage this with safe compression techniques and gentle exercises to improve drainage.
When swelling is controlled, patients can continue to use their prosthesis with greater stability and reduced pain. Gradual improvements help them stay active without fear of sudden changes.
Handling Radiation Fibrosis That Limits Limb Movement
Radiation fibrosis can stiffen tissues and restrict movement around joints. This stiffness affects gait and may increase pressure in specific socket areas. Doctors coordinate closely with therapists to design stretching plans that protect the limb without causing irritation.
Adjusting the prosthesis or socket design can help reduce discomfort. Early recognition of fibrosis makes the rehabilitation process smoother.
Addressing Fatigue From Ongoing Cancer Therapy
Some patients continue long-term cancer treatment even after prosthetic fitting. Fatigue, reduced stamina, or anemia can affect their ability to walk or participate in therapy. Doctors adapt the schedule to match the patient’s energy levels.
Helping the patient balance treatment and prosthetic use prevents frustration and burnout. This balance encourages long-term mobility.
Step Eighteen: When to Pause Prosthetic Use During Oncology Treatment
Understanding When the Limb Needs a Break
There are moments when the residual limb becomes too vulnerable for prosthetic wear. Severe skin breakdown, infection, or rapid swelling may require rest. Oncology treatments can also weaken the skin temporarily, making it unsafe to apply socket pressure.
Doctors guide patients through these pauses with reassurance, explaining why rest is needed and how long it might last. Clear expectations help reduce anxiety and maintain trust.
Protecting the Limb During Treatment-Induced Changes
Cancer therapies sometimes cause inflammation that affects socket tolerance. When this happens, clinicians adjust wear time or recommend alternative mobility tools. These adjustments protect the limb until the patient can resume prosthetic use safely.
Patients benefit from knowing that pauses are normal and do not mean regression. Understanding this keeps morale steady.
Planning a Smooth Return to Prosthetic Use
After a pause, the limb may need time to readapt to the socket. Doctors help the patient increase wear time slowly and observe for sensitive areas. The prosthetist may need to adjust or reshape parts of the socket to restore comfort.
These careful steps create a safer return and reduce the risk of recurring issues.
Step Nineteen: Coordinating Oncology and Prosthetic Care
Creating a Shared Plan Across All Specialties
Effective care for oncology amputees requires strong coordination between oncologists, surgeons, physiatrists, therapists, and prosthetists. Doctors share treatment timelines and upcoming procedures so the prosthetic plan can adjust accordingly.
This shared approach reduces confusion and avoids scheduling conflicts. Patients feel more supported when everyone on the team communicates clearly and consistently.
Using Simple Language to Guide Patients Through Changes
When multiple specialists are involved, information can easily overwhelm the patient. Doctors simplify explanations and repeat key points when needed. This helps the patient stay calm and understand each step of the process.
Clear language also prevents misunderstandings that might delay rehabilitation.
Building Trust Through Predictable and Unified Messaging
When all team members deliver consistent information, the patient gains confidence. This trust encourages them to follow instructions closely and engage fully in rehabilitation.
A unified team message reassures the patient that they are on a safe and guided path.
Step Twenty: Supporting the Patient’s Life After Recovery
Helping the Patient Return to Daily Routines
As the patient regains independence, they begin reintegrating into daily life. Doctors help them manage common challenges such as endurance, balance, or uneven surfaces. These practical conversations make the transition smoother.
Small successes, like walking in the kitchen or stepping outside independently, boost confidence. Each new achievement helps the patient rebuild their identity beyond cancer and amputation.
Encouraging Continued Therapy for Long-Term Mobility
Even when the patient walks well, ongoing therapy can improve strength and coordination. Doctors encourage maintenance exercises to prevent future issues. These routines support long-term success and keep the patient active.
Patients who continue therapy often maintain better posture, smoother gait, and greater endurance over the years.
Guiding the Patient Toward Community and Emotional Support
After the intense phases of treatment, some patients feel isolated or unsure about their future. Doctors connect them with support groups, peer mentors, or counseling services. These resources help them build resilience and feel understood.
Emotional well-being strengthens physical recovery, making support networks an essential part of long-term care.
Conclusion
Oncology and limb salvage care involve one of the most delicate decision-making pathways in medicine. Knowing when to pivot from salvage attempts to prosthetic planning requires careful observation, steady communication, and deep compassion. By recognizing key medical signs early, guiding patients gently, and coordinating closely with the prosthetic and rehabilitation teams, doctors can help patients achieve safety, independence, and dignity.
A clear clinical protocol not only protects the patient but also empowers the entire team. When each step is handled with intention and clarity, the transition from limb salvage to prosthetic use becomes less frightening and far more hopeful. This pathway supports healing not only of the body but also of the patient’s confidence and identity.