OT and Oncology

OT and Oncology

Oncology is described as an emerging practice area in the world of OT, and currently not many OT/As are working with people with cancer and their families. There are certainly efforts to change this, but for right now many people – both within and outside the profession – are very unfamiliar with how occupational therapy can help people with cancer. How does oncology fit with occupational therapy? Read on to find out!

You’re in luck, because the American Cancer Society has prepared this handy video to help explain the role of rehab in oncology! Just watch the first 45 seconds.

…If you actually watched that video and you have any idea about what OT is or does, you might be feeling a little upset right now. My first thought after watching this video was “Call the police! We’ve been robbed!” It’s not that PTs don’t help clients improve function, but let’s be honest…the speaker in this video is saying some things that sound suspiciously like what OT is all about!

Unfortunately, there are not enough OT/As in oncology, which is why videos like the one on the American Cancer Society website exist. Although it’s great that somebody in the world of oncology is talking about the importance of meaningful activities and function, OTs offer unique services that the PT in this video probably does not. Occupational therapists are skilled in helping people not only cope with the physical aspects of disease and treatment, but helping people with cancer and their families build skills for rethinking life and participation, cope with psychological changes that take place, adapt their environments to make life easier, and participate in meaningful activities that can support their physical and mental health. In short, occupational therapy practitioners can help people with cancer live their lives to the fullest wherever they are in their treatment and recovery.

In recent years, medical professionals and other healthcare providers have come to view caring for people with cancer quite differently than it was viewed in the past. Rather than treating acute medical problems and focusing mainly on diagnosis and treatment, practitioners involved in oncology have taken on a much more holistic view that aligns well with the beliefs and foundations of occupational therapy practice. The paragraph below briefly outlines the changes that have been made in oncology treatment, and how rehabilitation professionals can make important contributions to the care of people with cancer:

Although exponential growth of knowledge [in oncology] provides unique opportunities for providers to deliver the most effective and safest interventions for their patients…in turn they have less time to focus on equally important areas such as functional and cognitive deficits before, during, and after treatment. Recognizing the need for a more patient-centered approach, the Commission on Cancer (COC) of the American College of Surgeons has placed a significant emphasis on survivorship care plans… and helped develop cancer program standards in 2012 to help ensure that accredited cancer centers use a more multidisciplinary treatment team to provide patient-centered care for individuals living with cancer…

 

With a renewed focus on both survivorship and quality of life, the medical community now recognizes that rehabilitation can serve an important role in improving care for the more than 14 million people currently living with cancer. Rehabilitation specialists can provide specialized services, including preventive, restorative, supportive, and palliative, that address both functional and cognitive deficits.

 

Rehabilitation is uniquely positioned to serve as a resource for healthcare providers and payer sources to provide access to efficient and cost-effective care…The cancer patient population has been underserved regarding rehabilitation options, but the opportunities for growth and development within cancer rehabilitation are tremendous.

Source: “Cancer care rehabilitation is a game changer for patients,” CARF International, 2014

As part of these collaborative multidisciplinary teams, OTs can contribute to the quality of life of people with cancer at all points in the diagnosis and treatment process. This means OTs can help people with cancer even BEFORE treatment begins – and this can be just as important as helping people after they begin to experience debility, weakness, and functional changes as a result of treatment. We can also help clients and families make changes to their lives WHILE they are being treated and help them find solutions AFTER they return home.

This diagram from CARF International, a well-known accreditor of health and human services, outlines the ways in which rehabilitation professionals (like OTs!) can support cancer patients and their families across the continuum of care, as a part of healthcare teams:
CARF Model Oncology
Note how well the diagram aligns with the principles of the OT Practice Framework!

It is crucial to continue advocating for the role of OT in oncology, because we can truly make a difference in the lives of people with cancer and their families. Often – not always! – doctors and other medical personnel are so focused on treating the cancer and providing surgical intervention that the person’s functioning as an individual, a mother, or a friend is neglected, or perhaps even forgotten. And in many other cases, professionals simply don’t know when to refer to an OT. By stepping up to the plate to fill in these gaps, occupational therapists can help support all aspects of a person’s physical and psychological recovery, not just those that may typically be considered, such as medication management and wound care.

In order for OTs to make a place for themselves in the world of oncology, we need to change the culture not just in the medical community, but within the profession as well. If we don’t know what we can do, how are we supposed to convince anyone else that we can help? If you want to use your skills as an OT/A to help people with cancer, you’ll need to take initiative – this practice area is breaking new ground, and you may find yourself up against opposition (or just plain ignorance) when you first start out.

To that end, here are some suggestions for how you can increase your awareness of the contributions OT can make and support OT practice in this area (see the Resources list at the end of this post for more information):

  • Participate in a survey to support research related to what type of assessments are being utilized by OT practitioners in an oncology setting
  • Make yourself aware of typical challenges that people with cancer face and how OT can help. For example, many people being treated for cancer develop mouth sores. Although OT/As may not be experts in feeding and eating, they can help clients find adaptive equipment, strategies, or routines that make eating easier for people with this painful condition.
  • Take a continuing education course about OT’s role with cancer
  • Read journal articles about OT interventions and treatment with people with cancer
  • If you work in a facility that serves cancer patients, talk openly with your coworkers and supervisors about how occupational therapists can be an important part of the oncology treatment team. Be clear about how OT/As ADD VALUE to the treatments that clients with cancer are already receiving, and make a strong case for how OT/As can help (If you can provide examples by actually working with cancer patients to improve their function, even better!)
  • Reach out to OT/As who are experienced in this practice area for information, resources, and support
  • Join social networks and virtual or local groups related to cancer treatment to learn more about how OT can support clients with cancer

And just in case you’ve been wondering about what OTs in this setting might actually do with clients, here are a few examples I’ve heard from my classmates and guest speakers about OT interventions for people with cancer:

Client Issue OT Intervention
Neuropathy and sensory changes in the hands as a result of chemotherapy, preventing safe participation in skydiving activity (client could not feel ripcord)

 

Help client improve tactile discrimination and motor skills and brainstorm adaptations and solutions to this issue (i.e. add larger handle to cord).
Poor knowledge of wound care procedures, and toileting and

clothing management after extensive pelvic surgery related to labial cancer

Provide education and training in wound cleaning protocol; Teach client toileting strategies that keep surgical site clean and free of infection; discuss clothing adaptations to prevent pain or discomfort
Fatigue Teach energy conservation strategies and help clients utilize them effectively to cope with fatigue; modify client’s home or other environments to support continued participation in meaningful activities with less fatigue; helping clients incorporate energy conservation strategies into lifestyle
Cognitive problems experienced after chemotherapy (also called “chemo brain”) Teach clients strategies to compensate for memory loss and increased difficulty with complex tasks like medication management (i.e. working with client to set phone alarms as reminders to take medicine)
Exposed flesh or wounds after surgery Fabricating splints to help with recovery and continued functioning after surgery or discharge

  • Creating a chest plate for a man who had a large mass removed from his sternum and needed physical protection for this region of his body
  • Creating pediatric chestplates to protect chemotherapy ports as child returned to school, played sports, and participated in family activities

These are just a few examples of how OTs can help clients continue in the roles and activities that are meaningful for them while they are living with a cancer diagnosis. In spite of the important role OTs can play, there are still many unmet needs of cancer patients and their families, including ADLs, physical health, fatigue, informational needs, sexual problems, social participation, and relational issues.

The need for OT/As in this practice areas is great, and the needs of clients with cancer and their families are even greater. Occupational therapy practitioners are able to offer cost-effective, valuable services to help people with cancer lead productive, enjoyable lives no matter where they are in their treatment or recovery, and it’s up to us to make sure that we have a place on the teams where this treatment is taking place.

—–

Many thanks to Dr. Mackenzi Pergolotti, PhD, OTR/L, for inspiring this post, being a stellar advocate for OT, and encouraging future therapists to dedicate their time and talents to improving the lives of people with cancer and their families.


RESOURCES

AOTA Resources

CAOT Oncology Group: Networking and connections for Canandian therapists or members of CAOT.

Blog Posts about OT in Oncology

OTs with Experience in Oncology

The best way to learn about OT’s role with people with cancer is to ask an experienced therapist! Consider reaching out to one of these practitioners with specific questions about OT and oncology.

  • Sheila Longpre, MOT, OTR/L: Instructor at Nova Southeastern University (FL)
  • Lauro Munoz, : Chairperson of the Physical Disabilities SIS and Rehabilitation Regulatory Supervisor at University of Texas MD Anderson Cancer Center
  • Mackenzi Pergolotti, PhD OTR/L: Post Doctoral Fellow, Cancer Care Quality Training Program at the University of North Carolina at Chapel Hill

Continuing Education & Practice Resources

I am including these links as a reference for readers. I make no claims about the quality, content, or utility of these programs and/or resources.

Journal Articles & Research


If you know of any other resources related to OT in oncology or have experience in this practice area please share in the comments!

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6 thoughts on “OT and Oncology

  1. teraanne November 29, 2015 at 9:41 pm Reply

    I am almost done with my lvl II FW and have worked with sever oncology patient’s. Another area that I have had to tackle that you did not mention above was vision — if the pt has a brain tumor and even ROM if a pt had a breast expander/implant. Thanks for addressing this important topic!

    • lej1123 November 30, 2015 at 7:10 pm Reply

      Those are really good points — most of the clients I observed in the oncology units had significantly decreased strength, coordination, and ROM after surgeries or just lying in bed for extended periods of time. OTs were really important for not only strengthening and ROM, but preventive treatments/strategies to help clients avoid worsening.

      Thanks for commenting, and good luck finishing up your Level II!

  2. teraanne November 30, 2015 at 8:42 pm Reply

    Thank you! I have posted some OT resources on my blog. Feel free to check it out. #OTteamwork

    • lej1123 November 30, 2015 at 8:45 pm Reply

      I did check it out! Thanks for sharing! 🙂 #iloveOT

  3. Lauro Munoz January 26, 2016 at 12:11 pm Reply

    Thank you for this. I am very glad that you mentioned the areas that OT has a very distinct contribution in. We are critical as a discipline in the are of oncology rehab. Please feel free to contact me with any questions that you guys may have.

    Lauro Munoz, OTR, MOT

    • lej1123 January 27, 2016 at 1:01 am Reply

      Thanks for commenting! I think the work that you and others do in this field can be very underappreciated, but it is very important. I’m glad I was able to learn more about OT’s role in this practice area during my education.
      I appreciate you volunteering to be a resource for myself and others, and I’ll be in touch if I have any more questions!

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