In this #CRCWebinar learn all about how physical therapy can assist in the management of colorectal cancer. Alaina Newell, physical therapist, spends the hour discussing the benefits and misconceptions of this type of treatment in our webinar.

1. What Can Physical Therapy do to Manage
CRC Side Effects?

2. TODAY’S WEBINAR
 SPEAKER(S)
 Alaina Newell, PT, DPT
 Oncology Rehab
 QUESTIONS
 Ask a question in the panel on the RIGHT SIDE of your
screen
 WEBINAR ARCHIVE
 FightCRC.org/webinar
 TWEET ALONG
 Follow along via Twitter – use the hashtag #CRCWebinar
 POST WEBINAR
 Expect an email with links to the material & a survey. If you
fill it out, we’ll send you a Fight CRC bracelet.

3.  We are using LogMeIn GoToWebinar platform
 The side control panel can be adjusted using the
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 Questions are asked by opening the “Questions” tab
– the arrow opens the box
 Not all questions are addressed during the
presentation depending on time and quantity, but if
necessary will be followed up individually
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 The “Audio” tab allows you to select either your
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WEBINAR TECH

4. RESOURCES
TABOO-TY PODCAST MINI MAGAZINES YOUR GUIDE IN THE FIGHT

5. FIGHTCOLORECTALCANCERDISCLAIMER
The information and services provided
by Fight Colorectal Cancer are for
general informational purposes only.
The information and services are not
intended to be substitutes for
professional medical advice,
diagnoses or treatment.
If you are ill, or suspect that you are ill,
see a doctor immediately. In an
emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never
recommends or endorses any specific
physicians, products or treatments for
any condition.

6. AlainaNewell
PPT,DPT,WCS,CLT-LANA
Alaina received her Doctorate of Physical
Therapy from the University of Pittsburgh in
Pittsburgh, PA in 2012. She completed her
Women’s Health residency at UPMC and
joined the team in 2014.
Alaina is one of the few Board Certified
Women’s Health Clinical Specialists in the
Denver Metro area. She is also a Certified
Lymphedema Therapist from the
Lymphology Association of North America.
She enjoys treating a wide variety of
oncological diagnoses from melanoma,
pancreatic, bladder, ovarian to breast
cancer as well as Women’s Health needs
secondary to oncological diagnosis including
urinary urgency, gastrointestinal
dysfunction, pelvic pain and postural
dysfunction.

7. What Can Physical Therapy
do for you?
Alaina Newell PT, DPT
Board Certified Women’s Health Clinical Specialist
Oncology Rehabilitation Specialist
Certified Lymphedema Therapist- LANA

8. Course Outline
 Introduction
 Who, What, When Where and Why of PT for CRC Side effects
 Outpatient patient: impairment based treatment approach
 Treatment options for Top 5 Impairments
 Patient Resources

9. Oncology Rehab: Alaina Newell
Oncology Rehab
 An outpatient PT/OT/SLP clinic that specializes in therapy to mitigate the
development of long term sequelae associated with oncology treatment.
Alaina Newell PT, DPT, WCS, CLT-LANA
 Bachelors of Science in Neuroscience- University of Rochester, Rochester, NY
 Doctorate in Physical Therapy- University of Pittsburgh, Pittsburgh, PA
 Board Certified Women’s Health Specialist (WCS)- American Physical Therapy Association Board
 Certified Lymphedema Therapist (CLT) - Klose Training
 Lymphology Association of North America Certified CLT- LANA
 Oncology Rehabilitation Specialist – PORi

10. Who:
Licensed Physical Therapist
 Physical therapists are state licensed health care professionals with who can help patients reduce
pain and improve or restore mobility and movement.
 Education: Varies based on time of education with current highest level is a Doctorate of Physical
Therapy (DPT)
 Additionally, individuals may specialize in board certified fields. (WCS, NCS, GCS, OCS, etc)
 Or have specialized training (CLT-LANA, BCB-PMD, PORi, FDN, etc)
 Physical therapists can teach patients how to prevent or manage their condition to aid in
achieving long-term health and wellness through an individualized evaluation and plan.

11. WHEN:
Prior, During and/or After Treatment
 Care can begin at any stage of oncology treatment including before start of
surgery.
 PTs can provide education of anticipated impairments following surgery, aid in
home-set up, develop home exercise plans for before and acutely after surgery
 Oncology focused physical therapists have the medical background and
understanding of appropriate interventions and time periods while a patient
is in active treatment (chemotherapy, and/or radiation) to tailor treatment
plans
 If after the complication of treatment, a patient continues to have lingering
side effects, physical therapists can aid in the management of symptoms
(CIPN, weakness, fatigue, bowel/bladder dysfunctions, scar conditions, pain,
lymphedema)

12. WHERE:
Throughout the continuum of healthcare
 Physical Therapists work in ALL settings of health care with the exception of Hospice.
 Insurance coverage will only allow one setting at a time
 (ie. Unable to go to outpatient while receive homecare PT
 Physical Therapists DO aid patients during palliative care
 Goals are dependent based on the patient’s care setting, stage of disease, desires and
impairments

13. WHY:
Improve Quality of Life
 The majority of individual with CRC with survive >5 years and those diagnosed with local disease
have a >85% 5-year survival rate (Siegel, et al)
 Its estimated of the 14.5 million cancer survivors only 5% are directed toward s rehabilitation services
(ACS, 2016)
 Overall, CRC survivors experience good QofL BUT is GOOD, GOOD ENOUGH? (Adam , et al)
 NCCN and ACS: Guidelines for Exercise during active cancer treatment
 Reduces fatigue
 Prevents bone and muscle loss
 Improves QUALITY OF LIFE
 Physical therapy teaches patients how to return to exercise safely, effectively and injury prevention
during cancer treatment
 Physical therapy provides non-pharmaceutical interventions to address pain, bowel/bladder
dysfunction, shortness of breath, fatigue and other impairments

14. HOW:
Ask for a referral and Find a local therapist
 American Physical Therapy Association (APTA):
 Moving Forward: http://aptaapps.apta.org/findapt/default.aspx?navID=10737422525&UniqueKey=
 Oncology Section: http://oncologypt.org/consumer-resources/index.cfm
 Section of Women’s: http://www.womenshealthapta.org/pt-locator/

15. Outpatient assessment:
Impairment Based Treatment Approach
New Client with CRC Diagnosis
Chemotherapy? Surgery?
Radiation?
Cardiovascular
assessment
Neuropathy/
Balance assessment
Manual soft tissue management
Stretching program
Bowel/Bladder management
Sexual Health
Manual soft tissue management
Exercise program: strength, flexibility,
endurance and balance
Bowel/Bladder management
Sexual Health
Posture and Gait
Improve QUALITY OF LIFE through improved function and exercise
Immunotherapy?

16. Top 5 Impairments Physical Therapists Treat
 Chemotherapy Induced Peripheral Neuropathy (CIPN)
 Cancer Related Fatigue (CRF)
 Muscle weakness/Imbalance and Postural Dysfunction
 Soft tissue and Scar tissue management
 Bowel and Bladder Dysfunctions

17. Functional Impact of CIPN
• Damage to the peripheral nerves (nerves away from the brain and
spinal cord) from chemotherapy agents known to be neurotoxic.
• Symptoms including but not limited to: pain, burning, tingling,
numbness, balance difficulties, fine motor impairments (writing),
hypersensitivity, impaired bowel and bladder, decreased reflexes

18. CRF Reduces with Exercise
 A progressive cardiovascular exercise program based on heart rate
response (HR) and Rate of Perceived Exhaustion (RPE)
 General Guidelines: 150 minutes of exercise a week
 90 minutes: cardiovascular endurance training
 60 minutes: balance, strength and flexibility training

19. Muscle Weakness Leads to Impaired Posture
 Impaired posture can lead to
 difficulty breathing
 Slowed digestion
 Difficulty walking and balance
 Poor sleep
 Increase joint and muscle pains

20. Soft tissue/scar mobilization supports function
 Management in the mobility of soft tissue
and scars can aid in
 Reduced bowel obstructions
 Reduced pain
 Improve posture
 Increase abdominal muscle activation and strength
 Reduce urinary and fecal urgency, frequency and
incontinence
 Support positive body image

21. Bowel and Bladder Dysfunctions
 Urinary and/or Fecal
 Urgency
 Frequency
 Incontinence
 Incomplete empty
 Pain
 Hesitancy
 Treatment Options:
 Manual Therapy
 Corrective Exercises
 Biofeedback Training
 Dietary and Lifestyle changes
 Postural Awareness
 Toileting Mechanics

22. Resources
 Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104–
17. Epub 2014/03/19. pmid:24639052.
 American Cancer Society. Cancer Facts and Figures 2016. Atlanta: American Cancer Society; 2016
 Adams SV, Ceballos R, Newcomb PA (2016) Quality of Life and Mortality of Long-Term Colorectal
Cancer Survivors in the Seattle Colorectal Cancer Family Registry. PLoS ONE11(6): e0156534.
https://doi.org/10.1371/journal.pone.0156534
 Integrating physical activity in cancer care:
 https://www.ons.org/store/books/integrating-physical-activity-cancer-care-evidence-based-approach

23. Q
&
A
SNAP A #STRONGARMSELFIE
Bayer HealthCare will donate $1 for every photo posted (up to
$25,000).
Flex a “strong arm” & post it to Twitter or Instagram using the
hashtag #StrongArmSelfie

24. CONTACT US
CALL TOLL FREE
1.877.427.2111
FightCRC.org