Physical Therapy: A Component of the Cancer Care Plan


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Physical Therapy: A Component of the Cancer Care Plan

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  • Introduced April 1, 2009
  • Physical Therapy: A Component of the Cancer Care Plan

    1. 1. Physical Therapy – A Component of the Cancer Care Plan Chris Marrow MPT Sibley Hospital Outpatient Rehabilitation Department
    2. 2. What is your plan? <ul><li>Many people fail to see that, from a cancer survivor’s perspective, a “system” of care for cancer simply does not exist. </li></ul><ul><li>Seldom do people with cancer have any kind of a written or electronic plan for their care. </li></ul><ul><ul><li>(National Coalition of Cancer Survivorship) </li></ul></ul><ul><ul><li> </li></ul></ul>
    3. 3. Comprehensive Cancer Care Improvement Act (CCCI) <ul><li>CCCI - (H.R. 1844, introduced by Reps. Lois Capps (D-CA) and Charles Boustany (R-LA)) </li></ul><ul><li>Physical Therapy / Occupational Therapy can allow you to safely start or resume an exercise program and should be part of the plan. </li></ul>
    4. 4. Why Exercise? <ul><li>Improved mental and physical strength </li></ul><ul><ul><li>Annals of Behavioral Medicine, Courneya et. al </li></ul></ul><ul><ul><li>Statistical analysis of 24 studies </li></ul></ul>
    5. 5. Why Exercise <ul><li>Improved Quality of Life: </li></ul><ul><ul><li>Stamina </li></ul></ul><ul><ul><li>Strength </li></ul></ul><ul><ul><li>Self-esteem </li></ul></ul><ul><ul><li>Less fatigue during/after chemotherapy and radiation </li></ul></ul><ul><ul><li>Decreased pain </li></ul></ul>
    6. 6. Why Exercise <ul><li>Prevention of lymphedema </li></ul><ul><ul><li>Increase in chance of lymphedema in women with a body mass index (BMI) over 40 </li></ul></ul><ul><ul><ul><li>(The study, &quot;Post-Op Swelling and Lymphoedema Following Breast Cancer Treatment,&quot; was published in the Journal of Lymphoedema , Vol. 3, No. 2.) </li></ul></ul></ul><ul><ul><li>Exercise helps decrease body fat </li></ul></ul>
    7. 7. Physical Therapy’s role in the continuum of care for the post-op breast cancer patient <ul><li>Patient Education </li></ul><ul><li>Lymphedema Prevention and Management </li></ul><ul><li>Range of Motion Restoration </li></ul><ul><li>Postural Awareness/Correction </li></ul><ul><li>Strengthening </li></ul><ul><li>Reverse/Halt side effects of radiation and chemotherapy </li></ul><ul><li>Return to Exercise and Recreation safely </li></ul>
    8. 8. Lymphedema <ul><li>Education on lifelong risk factors </li></ul><ul><li>Baseline limb circumferences taken on first visit </li></ul><ul><li>Lymph drainage massage as indicated </li></ul><ul><li>Precautions </li></ul><ul><ul><li>After axillary node dissection, no upper body resistive exercises for 6 weeks </li></ul></ul><ul><ul><li>VERY SLOW progression of exercise </li></ul></ul>
    9. 9. Prevention of Lymphedema <ul><li>Patient Education is Key </li></ul><ul><ul><li>Use of compressive sleeve </li></ul></ul><ul><ul><ul><li>Air travel </li></ul></ul></ul><ul><ul><ul><li>Exercise </li></ul></ul></ul><ul><ul><li>Burns, bites, abrasions </li></ul></ul><ul><ul><li>Blood pressure cuffs </li></ul></ul><ul><ul><li>Racquet sports, golf, bowling </li></ul></ul><ul><ul><li>Shaving </li></ul></ul><ul><ul><li>Slow progression of exercise </li></ul></ul>
    10. 10. Range Of Motion and Posture <ul><li>Scar tissue, fibrotic tissue common </li></ul><ul><li>Minimum Shoulder AROM needed prior to strengthening </li></ul>
    11. 11. Range Of Motion and Posture <ul><li>Forward-head, rounded-shoulder posture is common </li></ul><ul><li>Self check </li></ul>
    12. 12. Range of Motion and Posture <ul><li>Axillary Web Syndrome (Cording) </li></ul><ul><li>Limits overhead motion </li></ul><ul><li>From Axilla down arm </li></ul><ul><li>Can go as far as thumb </li></ul>
    13. 13. Reconstructive Surgery <ul><ul><li>TRAM flap – loss of rectus abdominus, need to do core exercises to prevent loss of lumbar stabilization </li></ul></ul><ul><ul><li>Lat flap – loss of latissimus dorsi, leading to weakness in muscles supporting shoulder blade. </li></ul></ul><ul><ul><li>Expanders – can lead to spasm of pectoralis major </li></ul></ul>
    14. 14. Radiation and Chemotherapy <ul><li>Fibrotic tissue </li></ul><ul><ul><li>decreased range of motion </li></ul></ul><ul><li>Heart and lungs / cardiomyopathy </li></ul><ul><ul><li>Need for cardiovascular exercise </li></ul></ul><ul><ul><li>Low impact if neuropathy in feet </li></ul></ul>
    15. 15. Radiation and Chemotherapy <ul><li>Sudden Menopausal onset </li></ul><ul><ul><li>Risk of Osteoporosis </li></ul></ul><ul><ul><li>DEXA scan important </li></ul></ul><ul><li>Peripheral Neuropathy </li></ul><ul><ul><li>Avoid impact exercises (if in feet) </li></ul></ul><ul><ul><li>Do balance exercises (if in feet) </li></ul></ul>
    16. 16. What Next ? <ul><li>Talk to your doctor about your plan </li></ul><ul><ul><li>If PT/OT indicated, get a prescription </li></ul></ul><ul><li>Seek care from a PT or OT experienced in cancer care </li></ul>