Download Cancer Rehabilitation: Systematic Review

4/16/2015
Cancer Rehabilitation:
Systematic Review
American Occupational Therapy
Association Annual Conference 2015
Elizabeth G. Hunter, PhD, OTR/L
Robert W. Gibson, PhD, MSOTR/L
Mariana D’Amico, EdD, OTR/L, BCP, CIMI
Review Team

AOTA Review Advisors: Marian Arbesman, Phd,
OTR/L and Deborah Lieberman, MHSA, OTR/L,
FAOTA
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Librarian: Devera W. Kastner, MSLS, Medical
Librarian, Alumni Library, Case Western Reserve
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Clinical Consultants: Claudine Campbell, MOT,
OTR/L, CLT- Memorial Sloan Kettering Cancer
Center and Lauro Munoz, OTR, MOT, CHC- MD
Anderson Cancer Center
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Learning Objectives
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Objective 1: Describe the scope of the systematic
review on Occupational Therapy and Cancer
Rehabilitation
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Objective 2: Present the steps of the systematic
review
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Objective 3: Describe the results of the systematic
review, Occupational Therapy and cancer
rehabilitation
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Objective 4: Discuss implications of these findings
for OT practice, education, research and advocacy
Overview of the Systematic Review Process
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Framing the question
Identifying relevant research publications
Assessing study quality
Summarizing the evidence
Interpreting the findings: a research perspective
Interpreting the findings: a clinical perspective
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Framing the Question- Background
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There were1.4 million individuals diagnosed with
cancer in 2006 (American Cancer Society: Cancer
Facts and Figures, 2006).
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An estimated 65% of these individuals will survive at
least 5 years following their diagnosis (Reis, et al,
2007).
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Barring significant progress in cancer prevention, the
absolute number of people aged 65 and older
diagnosed with cancer is expected to double from
2000 to 2050(Edwards, et al., 2002).
Background Continued
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As survival improves and cancer becomes a chronic
condition in many patients, measures to maximize the
level of function and, thereby, the quality of life, of cancer
patients become increasingly relevant.
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Cancer can cause impairments, activity limitations and
participation restrictions (Fialka-Moser, et al., 2003;
Hewitt, et al., 2003).
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Many cancer survivors report declines in their physical
functioning, including basic body mobility and
engagement in work and leisure activities (Kroenke et al.,
2004; Nomori, Watanabe, Ohtsuka, Maruke & Suemasu,
2004).
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Background Continued
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Across cancer diagnoses and types of treatment,
many adult survivors report that they have not fully
regained their pre-cancer levels of physical
functioning or engagement in social, work or leisure
activities (Ganz, et al., 2003).
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Functional status is lowest immediately after
treatment and tends to improve over time; however
the presence of pain and co-occurring diseases may
negatively affect this projected improvement (Ko,
Maggard & Livingston, 2003).
Background Continued

Cancer rehabilitation is an underutilized service.
With a population of 10.1 million cancer survivors,
1.3 million cancer survivors are estimated to be
using these rehabilitation services for their cancer or
other co-morbid conditions.

To better understand where we stand with cancer
rehabilitation, this review was designed to explore
the research focused on cancer rehabilitation from
an OT’s perspective.
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The Question
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Advisory group:
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Lauro Munoz- MD Anderson
Marjorie McClure- Breast Cancer Related Lymphedema
Organization
Michael Stubblefield, MD- Sloan Kettering
Kathleen Lyons- Dartmouth
Contacted via email with an introductory letter, a
draft of the question and a brief questionnaire related
to search terms and asking for feedback
Initial Boundaries
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We defined cancer survivorship as beginning at the point
of diagnosis.
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There are numerous systematic reviews that
demonstrate the importance of exercise for cancer
survivors. We did not feel these reviews needed to be
repeated. In this review we only included studies that
employed exercise as an occupational outcome (i.e. a
meaningful activity the cancer survivor would like to
return to).
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Interventions included in the review would fall within the
purview of OT practice however, the research or
intervention does not need to be carried out by an OT.
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The Question
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Compiled Advisory Board responses
Revised the systematic review question
Final question:
“What is the effectiveness of cancer rehabilitation
interventions (within the scope of occupational
therapy practice) addressing the activity and
participation needs of adult cancer survivors in:
ADL, IADL, work, leisure, social participation, and
rest/sleep?”
Identifying Relevant Research
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Search terms
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Developed by review authors, medical librarian and AOTA
staff
Reviewed by advisory group
Search completed by medical librarian with experience in
searches for systematic reviews
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General Inclusion Criteria
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Intervention research of an approach within the
scope of practice of occupational therapy
Studies related to adults with cancer
Scientific literature published in English
Consolidated information sources, such as Cochrane
Database of Systematic Reviews
Published from January1995 through June 2014
Level I, II, III evidence
General Exclusion Criteria
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Not research
Not an intervention study (Descriptive, testing an
assessment or model, etc.)
Qualitative studies
Non-peer reviewed research literature
Dissertation or theses
Outside scope of practice of occupational therapy
(require different licensure or degree)
Published prior to 1995
Non-English language study
Studies focusing on caregiver/family/friends not cancer
survivor
Childhood cancer
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Search Terms Used to Search Literature
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Diagnosis/conditions: cancer(or)oncology(or)neoplasm
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Interventions (or): Cancer rehabilitation, rehabilitation,
occupational therapy, physical therapy, survivorship care,
physical rehabilitation, ADL, IADL, leisure activity, problem
solving, palliative care, psychosocial intervention, coping
strategies, emotional support, spiritual support, social support,
therapy, vocational rehabilitation, recreational therapy, mindbody, exercise, work hardening, return to work, energy
conservation, symptom management
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Outcomes (or): function, functional capacity, activity level,
physical function, disability, functional outcomes, quality of life,
goal, physical impairment, recovery of function, well-being,
community participation, fatigue, pain, participation, selfefficacy, return to work, patient satisfaction, treatment
outcomes
Search Terms- Continued
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Sequelae/adverse effects/etc.: radiation fibrosis
syndrome, surgical complications, chemo-induced
neuropathy, cancer related fatigue, fatigue, cancer
related pain, pain, deconditioning, chemobrain,
chemofog, lymphedema, participation restrictions,
role restriction, role performance, sexual disorder,
sleep disorder, self-image, self-concept, mobility,
mild cognitive disorder, executive function,
communication skills, chemotherapy, anxiety, stress,
depression, occupational performance, endurance,
safety, rest, sleep
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Search Terms- Continued
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Study and Trial Design: Appraisal, best practices, case
control, case report, case series, clinical guidelines,
clinical trial, cohort, comparative study, consensus
development conferences, controlled clinical trial,
critique, cross over, cross-sectional, double blind,
epidemiology, evaluation study, evidence-based,
evidence synthesis, feasibility study, follow-up, health
technology assessment, intervention, longitudinal, main
outcome measure, meta-analysis, multicenter study,
observational study, outcome and process assessment,
pilot, practice guidelines, prospective, random allocation,
randomized controlled trials, retrospective, sampling,
scientific integrity review, single subject design, standard
of care, systematic literature review, systematic review,
treatment outcome, validation study.
Databases
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Medline
PsychInfo
CINAHL
OTseeker
Evidence-based medicine reviews: Cochrane
Database of Systematic Reviews
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Review of Citations/Abstract
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Citations/abstracts reviewed by authors
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Articles removed by review authors due to:
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Duplicates
Not research
Not adult cancer patients/survivors
Completely off topic (i.e. not cancer related)
Review of Full Articles
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Assessed for:
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Within OT scope of practice
Feasibility versus true research study
Functional outcomes
Level of evidence
Quality (scientific rigor)
Note: The psychosocial category of research has not
been analyzed to date, so the number of articles following
the Screening Phase on the following slides has the
psychosocial numbers removed.
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Identificatio
n
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Records identified through database
searching
(n = 7866 )
Screening
Duplicates removed
(n=1374)
CancerOT Psych Info 1 – 1000
CancerOT Psych info 2 – 436
CINAHL - 425
Cochrane –3086
Medline 1 - 1000
Medline 2 - 1000
Medline 3 – 399
Medline 4 – 520
Additional records identified through other
sources:
OT Seeker- Systematic Reviews and RCT
(n = 570)
Records after duplicates removed
(n =6492+280=6772)
Records screened – Title and
abstract (n = 6772)
Duplicates removed
(n=290)
Records excluded- (paired
reviewers)
(n =5514+168=5772)
Full-text articles assessed for eligibility
(n =1090)
*still includes psychosocial articles
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Eligibility
Full-text articles assessed for eligibility
(n =1090)
*still includes psychosocial articles
Full-Text Review
(Total n =406)
Exercise (n=83)
Complementary (n=161 )
Rehabilitation (n=62)
Lymphedema (n=38)
Physical Symptoms (fatigue, pain,
breathing) (n=41)
PAM (n=6)
Work (n=10)
Wellness (n=0)
Sexuality (n=5)
Included
Psychosocial (n= Unfinished, not
included)
Studies included in final qualitative synthesis
(Total n =121)
Exercise (n=26)
Complementary (n=26 )
Rehabilitation (n=25)
Lymphedema (n=13)
Physical Symptoms (fatigue , pain , breathing ) (n=23)
PAM (n=3)
Work (n=3)
Sexuality (n=2)
Full-text articles excluded (Individual
Reviewers)
(Total n =508)
Exercise (n=214)
Complementary (n=93 )
Rehabilitation (n=65)
Lymphedema (n=36)
Physical Symptoms (fatigue 23, pain 38,
breathing 5) (n=46)
PAM (n=7)
Work (n=6)
Wellness (n=12)
Sexuality (n=2)
Psychosocial (n= Unfinished, not included)
Full Text Review- Excluded from
Qualitative Synthesis (paired reviewers)
(Total n=285)
Exercise (n=55)
Complementary (n=135 )
Rehabilitation (n=39)
Lymphedema (n=25)
Physical Symptoms (fatigue, pain, breathing)
(n=18)
PAM (n=3)
Work (n=7)
Sexuality (n=3)
Psychosocial (n=unfinished, not included)
Psychosocial (n= unfinished, not included)
Levels of Evidence
• Level I – Systematic reviews, meta-analyses, randomized
controlled trials
• Level II – Two group, non randomized studies (e.g.
cohort, case-control)
• Level III – One group, non-randomized (e.g., before-after,
pretest and posttest)
• Level IV – Single subject design, case series
• Level V – Case reports, expert opinion, including narrative
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literature reviews and consensus statement
Note: Qualitative studies were not reviewed
Adapted from Sackett, D.L., Rosenberg, W.M., Muir Gray, J.A., Haynes, R.B. &
Richardson, W.S. (1996). Evidence-based medicine: What it is and what it isn’t.
British Medical Journal, 312, 71-72.
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Slide 24
1
is this AOTA's critieria. That is what we should be using and the AJOT citation.
Robert Gibson, 3/28/2015
4/16/2015
Point of Hierarchy of Evidence
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Studies at the higher level of evidence are:
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Least vulnerable to bias
More generalizable
Outcomes are more likely to be attributed to the
intervention being studied
Studies Included in Full Qualitative
Synthesis
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Total articles included in final review (not including
any psychosocial articles): 121
Level I studies:
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Systematic Reviews-55
RCT- 57
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Level II studies: 3
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Level III studies: 4
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Other: 1 Level IV (assessment of a specific tool for
pain management that an OT could use)
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Full text Qualitative Synthesis
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Main Themes:
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Exercise- 26 articles
Complementary Medicine- 26 articles
Rehabilitation- 25 articles
Lymphedema- 13 articles
Physical symptoms (fatigue, pain, breathlessness)- 23
articles
Physical Agent Modalities (PAM)- 3 articles
Work- 3 articles
Sexuality- 2 articles
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Psychosocial-Not included at this point
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Findings- Exercise
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Total # articles: 26
Level I
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Systematic Review- 12
RCT- 14
Level II- 0
Level III- 0
Strength of Evidence- Strong
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Exercise is beneficial no matter the stage of cancer or
stage of survivorship
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Exercise Strength of Evidence
Strength of Evidence:
 Supervised better than non-supervised
 Exercise is safe and feasible for the majority of cancers,
stages of cancer and age of survivor.
 The strongest evidence related to exercise is that it
reduces cancer related fatigue (CRF). Particularly
aerobic exercise.
 Strong evidence that exercise can increase muscle
tone/strength and lung capacity.
 Moderate evidence it helps HRQOL for some survivors
and that it can increase sexual activity.
 Moderate evidence that counseling and telephone
support can be helpful to keep people exercising.
 Very low evidence related to dose and if CBT combined
with exercise is beneficial.
Findings- CAM
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Total # articles: 26
Level I
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Systematic Review- 22
RCT- 4
Level II-0
Level III-0
Strength of evidence- limited support for most CAM
interventions (i.e. Art, Music, Dance/Movement, Creative
Arts, Expressive writing, Tai Chi, Guided Imagery).
Moderate support for Yoga especially YOCA (Yoga &
Callanetics), Qigong, Meditation and Mindfulness being
used for symptom management of Pain, Anxiety,
Depression, and for increasing Quality of Life; YOCA
improved sleep quality and quantity
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Findings- Rehabilitation
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Total # articles: 25
Level I
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Systematic Review- 4
RCT- 16
Level II- 2
Level III- 2
Other- 1 Level IV (OT specific intervention)
Strength of evidence- Strong/Moderate
Rehabilitation Strength of Evidence
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Strong evidence Rehab is beneficial (increased SF-36).
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Single domain or outcome focus appeared more successful
than programs with multiple aims.
Don’t need to focus on specific types of cancer.
Face to face is best way to conduct rehab with one follow up
phone call.
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No evidence showing services were more effective if they
were delivered by a particular type of health professional.
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Rehab can be beneficial pre and post treatment in many
cases.
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OT was the specific focus in two of these studies.
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Findings- Symptom Management
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Total # articles: 23
Level I
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Systematic Review- 7
RCT- 14
Level II- 1
Level IIIOther- Level IV-1 (included because it evaluated a
tool OTs could use when providing service for pain
management)
Strength of evidence- Range from strong to
insufficient
Symptom Management- Strength of
Evidence
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The studies included in this section were predominantly
focused on CRF. The second most common was pain
management and finally breathlessness for those with
lung cancer.
There is strong support for exercise to reduce CRF and
increase QOL
Strong support for non-pharmacological interventions for
breathlessness.
Moderate support for
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sleep therapy/modification
behavioral modification or psychoeducational programing for
CRF
education and problem solving for pain management
CBT for CRF management.
There is insufficient data to support the use of a daily
pain management diary but preliminary data is positive.
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Findings- Lymphedema
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Total # articles: 13
Level I
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Systematic review- 7
RCT- 5
Level II- 0
Level III- 1
Strength of evidence- Very strong for the use of
compression garments
Lymphedema Strength of Evidence
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There are a lot of studies looking at treatment of
lymphedema. Most did not qualify for this review due
to only looking at arm volume.
The studies that were reviewed showed strong
support for the use of compression garments
Strong support for the use of exercise.
There is limited support for manual lymph drainage
low support for relying on only self-care.
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Findings- Work
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Total # articles: 3
Level I
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Systematic Review-2
RCT
Level II
Level III-1
Strength of evidence- Limited
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There were no RCT studies looking at rehabilitation and
return to work. There was one study describing positive
outcomes of an OT return to work program.
Findings- PAM
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Total # articles: 3
Level I
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Systematic Review- 0
RCT- 3
Level II- 0
Level III- 0
Strength of evidence- Moderate
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PAM- Strength of Evidence and Gaps
Revealed
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There are studies looking at the effect of PAM.
The three RCT that were included in this review
showed moderate levels of evidence.
There was some proof of pain reduction.
There was some difference in lymphedema swelling
related to PAM usage.
There was significant difference using PAM in
swallowing training
Findings- Sexuality
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Total # articles: 2
Level I
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Systematic Review- 1
RCT- 1
Level II-0
Level III-0
Strength of evidence- Moderate
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The findings from these two papers highlight the benefits
of exercise and the importance or couple-based, psychoeducational interventions that include an element of
sexual therapy.
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Discussion- Exercise Gaps Revealed
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Huge amounts of exercise research, but explicit
functional outcomes were rare
Studies were kept in the review if they at least
looked at HRQOL using assessments that touch on
physical function
Never connected the use of exercise with returning
to meaningful roles or activities (except sleep).
How an OT would use exercise was poorly
illustrated. Much more focus on exercise
physiologists or PTs
Discussion- CAM Gaps revealed
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Rigor of studies: many of poor quality and potential bias
Limited number of studies per CAM intervention,
Many SRs focused on multiple CAM methods and inconsistent
dosages (even yoga had many types and different amounts)
Many of the meta-analyses conducted with the SRs did not support
findings of improvement or change
Focus most relevant to OT: QoL, anxiety, mood, relaxation
Many measured: physiologic level changes (i.e. cortisol), nausea
relief
Many were interventions requiring other licensure and training (i.e.
acupuncture, massage)
Minimal to no mention about improved performance of daily
functions
Need to look at CAM in terms of measuring engagement in daily
activities
Consider OT implementation of CAM related to coping, patterns of
behavior and routines
Most studies done with female population vs. male
OTs not conducting studies or implementing CAM interventions
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Discussion: Rehabilitation Gaps Revealed
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There was a limited number of studies that overtly looked
at activity/participation. We included studies that looked
at QOL, which often have a functional component. This is
a gap in current research.
The studies in this category included a wide variety of
topics/interventions.
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Energy conservation
Pulmonary rehab
Rehab in hospice/palliative care
Cognitive rehab
Problem solving
Exercise
Multidisciplinary rehab
Pelvic floor rehab
Room for more, well designed, RCT studies in this area.
Discussion- Symptom Management- Gaps
Revealed
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Limited connection to functional outcomes
Great area for OT to take the lead in developing
programming
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Discussion-Lymphedema Gaps Revealed
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Lymphedema was well researched but very few
studies looked at functional outcomes.
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The vast majority (and most were excluded from the
review) focused purely on ROM, arm volume and
arm circumference.
Discussion- Work- Strength of Evidence and
Gaps Revealed
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Very limited strength of evidence as the majority of
return to work studies were feasibility studies,
descriptive studies or qualitative studies.
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There is a definite gap in research looking at
interventions to increase return to work and work
satisfaction among cancer survivors. This is an
important opportunity.
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Discussion
Work- Gaps revealed
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PAM- Gaps revealed
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Very few studies and none are Level I strength
This is an important area for OT to begin developing
services
None of the studies connected the outcomes with
function/participation
Sexuality- Gaps revealed
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Sexual function and sexuality is another area with limited
research.
Conclusion-Strengths
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There is research that supports the importance of
rehabilitation as a whole and multiple specific
rehabilitation type intervention for cancer survivors
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This included
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All types of cancer
All stages of cancer
All stages of the survivorship trajectory
There a many proven interventions/treatments for a
variety of cancer survivor issues that OTs are
involved in and can be more involved in.
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Conclusion- gaps/weaknesses
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Function was a limited factor in the vast majority of
the research
There was even less focus on return to roles and
participation
There is incredible opportunities for OT researcher
and clinicians to design and execute research
projects that examine what interventions increase
cancer survivors return to function and support
increased participation.
An example of easy low hanging fruit would include
studies related to return to work
Recommendations- Occupational Therapy
Practice
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Recognize cancer as an important diagnosis for OT
services. There is more to cancer care than
lymphedema.
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Understand that cancer survivorship is an up and
coming area that is now beginning to look at long
term return to function and participation (not just
survival)
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Current State of
Occupational Therapy Practice in
Oncology: Clinical Perspective
Lauro Munoz, OTR, MOT
Claudine Campbell, MOT, OTR/L, CLT
Oncology population – Who do we treat?
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Cancer affects clients of all ages
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~1 million new cases of cancer are diagnosed each year
(www.cancer.org)
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60% of cancers occur in individuals ≥65 years old
(www.cancer.net)
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Approximately 60,000 pediatric cancers are diagnosed in clients
under the age of 14 each year
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By 2024, it is predicted that there will be 18,914,670 cancer
survivors in the U.S. (www.cancer.org)
Cancer survivors experience a diverse and
complex set of impairments
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Typical OT referral reasons
12 Most common symptoms
• Weakness
• Swollen legs
• Dry mouth
• Nausea
• Anorexia
• Constipation
• Depression
• Vomiting
• Pain
• Confusion
• Insomnia
• Dyspnea
Reasons for OT referral
 Decreased BADL/ IADL
performance
 Impaired cognition
 Limited endurance
 Pain/neuropathy in the hands
 Impaired coordination
 Deconditioning/general
weakness
 Impaired balance
 Difficulty returning to work/life
roles
Memorial Sloan Kettering
Cancer rehab programs
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Acute care hospital: 471
inpatient beds
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Outpatient pediatric gym
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Gym based PT/OT (birth – 18)
Pediatrics: (birth - 18)
Adults: (19 - 90+)
Acute care OT programs
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Pediatric and adult clients on Bone
Marrow Transplant service
Referrals for all clients post
orthopedic/neuro-surgery
Ostomy referral program
Early mobility PT/OT/RT program
Lymphedema/edema program
Cognition/delirium screening
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Outpatient adult PT/OT
clinic
Regional outpatient
cancer treatment clinics
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MD Anderson
Cancer rehab programs
Acute Care Hospital: 700
beds
Acute Care/Outpatient OT
programming
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Cognition and Mild Cognitive impairment
programming
Fatigue and cancer related pain
programming
Lymphedema related programming
Vision program and Vision Clinic with Neuro
ophthalmology
Sexuality and self esteem programming
Orthotic fabrication
Wheelchair and Power mobility device fitting
and prescription
Outpatient clinic (5,000 square feet) also
used by inpatient team
4 Regional Care Centers providing OT
services
Training/education needed to practice in
oncology
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An understanding of cancer treatment options and side
effects (chemotherapy, radiation, surgery, hormone
therapy)
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Knowledge of general contraindications and
precautions for therapeutic activity
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Cancer related fatigue
Cancer related cognitive dysfunction
Peripheral neuropathy
Psychosocial issues (anxiety, depression)
Impact of lab values on participation in self-care, exercise, mobility
Presence of bony disease/metastases – weight bearing restrictions
Beneficial specialty training/certifications
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
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Lymphedema certification – Complete decongestive therapy
Acute care – treatment of the medically complex client
Cognition – Árnadóttir OT-ADL Neurobehavioral Evaluation (A-ONE)
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Cancer treatment continuum
**Functional status may fluctuate throughout
•
Pretreatment
•
Active treatment

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•
Long-term therapy to maintain remission
Post treatment

•
Presently receiving treatment with a curative goal
Maintenance

•
Newly diagnosed, no treatment initiated
Medical treatment is complete with no evidence of disease
Palliative care
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Palliative treatment for incurable cancer
Optimize comfort
Decrease caregiver burden
Patient-centered goals
(Stubblefield & O’Dell, 2009)
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“In an impairment-driven cancer rehabilitation
model, identifying current and anticipating future
impairments are a critical first step in improving
healthcare outcomes and decreasing costs. The
opportunity to assess baseline status and
intervene to treat or prevent impairments begins
almost immediately after diagnosis and
continues throughout the care continuum.”
(Silver & Baima, 2013)
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What is the role of OT?
•
The role of occupational therapy in oncology is
“to facilitate and enable an individual to achieve
maximum functional performance, both
physically and psychologically, in everyday living
skills regardless of his or her life expectancy”

American Occupational Therapy Association. (2011). The role of occupational therapy in
oncology. Retrieved from www.aota.org/Practitioners/PracticeAreas/MentalHealth/FactSheets/OT-Role-
Contributions of OT on the cancer rehab
team
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
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Holistic approach: physical, cognitive, psychological and
emotional
Cognitive assessment and treatment: function based
Environmental adaptation: assist clients to cope and adapt
Custom splinting
 Head and neck cancer, orthopedics, plastics
reconstruction
Edema management
 Scrotal edema: custom scrotal-support fabrication
 Head and neck cancer: custom head support
Interdisciplinary communication*
Address BADL participation and quality of life
Pain and symptom management
Seating and positioning adaptations
 Wheelchair and commode modifications for clients
following complex orthopedic surgery/plastics
reconstruction
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Multi context areas of OT assessment

BADL/IADL performance examinations: FIM is used on inpatient floors

Changes in roles, routines and habits:
 How has the treatment process affected occupational participation
(MOHOST)

Fatigue: Brief Fatigue Inventory - developed at MD Anderson

Pain: (0-10) scales, MOHOST and certain questions on the Disability of Arm
Shoulder Hand to give more functional information

Shortness of Breath: University of CA San Diego Shortness of Breath Scale

Vision- Bi-Vaba (Brain Injury Visual Assessment Battery for Adults)

Cognition:
• Top Down: A-ONE, EFPT, Multiple Errands Test
• Bottom up: Test of Everyday of Attention, Rivermead Memory

Additional Measures: Disability of Arm Hand and Shoulder (DASH), Manual
abilities measure (MAM), Lower Extremity Functional Scales
Treatment strategies
•
Remediation versus adaptation

•
BADL/IADL resumption

•
A combination of both is used, while some remediation does occur
we find that most treatment plans are based on adaptations to
current situations
Modification of activity, environment, use of adaptive equipment
Lifestyle redesign




Energy conservation
Fatigue management
Pain management
*Focus not on symptoms themselves but to adapt lifestyle to
accommodate for certain symptomology that may be transient or
chronic
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Gaps in the literature

Limited support of OT as a discipline in the treatment
of:
Cancer related cognitive impairments
Cancer related fatigue or pain management
Lymphedema (differentiating OT from PT in this specialty area)





Exercise versus general activities that are client
centered using the MET system
Functional benefits of activity engagement
Role of OT in improving functional performance of cancer survivors



OT interventions that increase return to work, role
resumption
Distinct OT contributions for the patient with cancer
throughout the cancer continuum
…So we draw from other disciplines

Management of cancer related cognitive dysfunction
- draw from Psychology and Neuro-psychiatry



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Adaptation of cognitive rehab programs that have been used with
TBI and stroke
Cancer related fatigue management - draw from
Psychology and nursing
Behavioral management – draw from Psychology
Pain management – draw from Psychology and
nursing
Lymphedema – draw from strong PT evidence
Exercise parameters – draw from strong PT
evidence
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Areas for future growth –
OT in oncology
•
•
•
By 2024, it is predicted that there will be 18,914,670
cancer survivors in the U.S. (www.cancer.org)
Cancer rehabilitation is an emerging trend in health care
How can OT contribute to cancer survivorship…
 Symptom management – coping skills and adaptation
 Assessment and treatment of cognitive dysfunction
 Return to work/re-engagement
 Endurance training – activity tolerance
 Re-claim activity participation and demonstrate the
impact on QOL!
References

www.cancer.org

www.cancer.net

www.mskcc.org

www.mdanderson.org

American Occupational Therapy Association. (2011). The role of occupational therapy in oncology.
Retrieved from www.aota.org/Practitioners/PracticeAreas/MentalHealth/Fact-Sheets/OT-Role-

Silver, J. K. & Baima, J. (2013). Cancer Pre-habilitation: An opportunity to decrease treatmentrelated morbidity, increase cancer treatment options, and improve physical and psychological
health outcomes. American Journal of Physical Medicine Rehabilitation 92(8), 715-727.

Stubblefield M.D. & O’Dell M.W. Cancer rehabilitation: principles and practice. New York: Demos
Medical Pub; 2009.
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Opportunities

Research Opportunities:





More research is needed in cancer rehab- OT specifically but
rehab as a whole
Exercise needs to be incorporated in some
meaningful/functional way, from an OT perspective
Major gaps on return to work and sexuality
OT needs to keep their position with Lymphedema, and
functional outcomes need to be connected to that research
Clinical Opportunities:



-Cognitive function among cancer survivors
-Connecting existing pulmonary rehab programs to cancer
related breathlessness
-Return to work for cancer survivors has the potential for being
an important area for OTs to make their mark
Systematic Review: Wrapping it all up


Follow up comments
Audience comments and questions?
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