lexi harlow, pt, dpt, clt seattle cancer care alliance · references egan my, mcewen s, sikoral,...

Lexi Harlow, PT, DPT, CLT Seattle Cancer Care Alliance

Importance of Rehabilitation In Oncology Care

Patient and family centered care Individualized treatment and management of side

effects from cancer modalities Reduce symptom burden Maintain or restore function Enhance quality of life

education.healthcaresource.com

© Lexi Harlow, 2017

Importance of Rehabilitation in Oncology Care

Education for providers and patients Screening for impairments Rehabilitation referrals Cost containment (Shih, 2009)

Evidence based

oncologypt.org © Lexi Harlow, 2017

What services do we uniquely provide to the cancer setting? Enhanced care of unique needs of cancer patients Rehabilitation perspective through “oncology” lenses Support oncologists in managing side effects Provide prestige, leadership, and marketing

opportunities

eyesightcorner.com © Lexi Harlow, 2017

What services do we uniquely provide to the cancer setting?

Education outreach to providers, patients, community Research opportunities Program development


Melanoma Treatment: What have you experienced? Fatigue Joint pain Joint restrictions Deconditioning/weakness Balance challenges Peripheral neuropathy Cognitive impairments Depression Anxiety

Gait difficulties Lymphedema Osteopenia/osteoporosis Scar adhesions Difficulty with daily

activities (dressing, bathing)

Difficulty with chores, shopping, driving

Need for assistive device


Rehabilitation Professionals: Who can help me? Rehabilitation Medicine Physician (Physiatrist) Physical Therapists Occupational Therapists Speech/Language Pathologists Rehabilitation Psychologist


Rehabilitation Physicians (Physiatrists) Nerve, muscle, and bone experts who treat

injuries or illnesses that affect how you move Treat any disability resulting from disease or injury Pinpoint the source of an ailment and design

appropriate rehabilitation treatment plan

What might a physiatrist do? New and Follow-up

Patient Visits Injections

Botulinum Fluoroscopic Ultrasound guided Joint Trigger point

EMG Testing Medical guidance on

physical activity/exercise programs

Physical Therapists Examine, diagnosis, and develop an individualized

plan of care Work with patients to achieve the following:

Reduce pain Improve or restore mobility Prevent or manage condition Minimize disability


Typical Physical Therapy Needs

Deconditioning/muscle mass loss Scar tissue restrictions and/or fibrosis Cording (Axillary Web Syndrome) Joint contracture Fatigue Pain

vanderbilthealth.com


Typical Physical Therapy Needs Osteopenia/osteoporosis Peripheral neuropathy Mobility challenges Decreased balance/fall risk Peripheral edema/lymphedema management

livingwith peripheralneuropathy.com © Lexi Harlow, 2017

Physical Therapy Treatment

Patient education Cardiovascular conditioning Strength training Flexibility and balance training Edema/lymphedema management Maximize and facilitate independence Pain and fatigue management

www.actx.edu


Occupational Therapists Individualized evaluation with customized

intervention Health promotion Prevent or enhance quality of life with injury, illness,

or disability


ecmc.edu

Typical Occupational Therapy Needs Fatigue Peripheral neuropathy (upper extremity) Cognitive impairments Lymphedema Difficulty with ADLs (dressing, bathing) Difficulty with chores, shopping, etc. Need for assistive device or adaptive equipment Home safety evaluation Return to work assessment/workplace evaluation Driving evaluation


Occupational Therapy Treatment Patient education Self-care task instruction and/or modifications Task simplification Energy conservation Edema/lymphedema management Hand therapy Maximize and facilitate independence Compensatory strategies for cognitive deficits


Evidence Based Practice Musculoskeletal concerns Deconditioning/endurance deficits Fatigue management Balance/falls UE function after breast cancer treatment Pain Sexual functioning Lymphedema

Silver 2011; Egan 2013

usf.edu


Other Rehabilitation Professionals Rehabilitation Psychologist

Assess and treat cognitive and emotional disability due to injury or illness

Speech Language Pathologist

Prevent, assess, diagnose, and treat speech, language, social communication, cognitive communication, and swallowing disorders in children and adults


Current State of Our Program Physical therapy services

only Staffing:

Physical Therapists (7) Department Coordinator Physical Therapy Manager

Staff skill set includes the following expertise: lymphedema, orthopedics, neurologic, myofascial techniques, pelvic floor/incontinence


Future Treatments and Programs Activities of Daily Living Training Hand Therapy Vestibular Rehabilitation Speech and Swallowing Rehabilitation Return to Work Program Cognitive Rehabilitation Group Exercise/Therapy Survivorship (long-term needs) Integrative Care (massage, acupuncture, etc.)

Dr. Julie Silver “After Cancer Treatment: Heal Faster, Better, Stronger”


References Egan MY, McEwen S, Sikora L, Chasen M, Fitch M, Eldred S. Rehabilitation

following cancer treatment. Disabil Rehabil. 2013 Mar 15. Fitzpatrick, TW (2009). Principles of physical and occupational therapy in cancer.

In MD Stubblefield, MW O’Dell (Ed.), Cancer Rehabiliation: Principles and Practice (pp. 785-796). New York: Springer Publishing.

Shih YT, Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, Perkins GH, and Elting LS. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. Journal of Clin Onc. 2009 27:12, 2007-2014

Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 2013;63:295-317

Silver JK, Gilchrist LS. Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions. Am J Phys Med Rehabil 2011;90(suppl):S5-S15.

Stout NL, Silver JK, Raj VS, Rowland J, Gerber LH, Cheville AL, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Campbell G, Hendricks J, Perkin K, Chan L. Toward a national initiative in cancer rehabilitation: recommendations from a subject matter expert group. Arch Phys Med and Rehab. 2016;97:2006-15

Thank you! Email: [email protected] Phone: 206-288-6233

mailto:[email protected]

lexi harlow, pt, dpt, clt seattle cancer care alliance · references egan my, mcewen s, sikoral,...

Documents