How To Treat Patients With Cancer As An Occupational Therapist
According to The National Cancer Institute, the number of people living beyond a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million by 2024.
If you are an occupational therapist working in inpatient rehab, acute care, home health, or even outpatient settings, you will likely treat patients with a cancer diagnosis at one point or another.
Individuals diagnosed with cancer can have increasing limitations in their functional status, affecting their ability to participate in basic and instrumental activities of daily living. In some cases, the cancer itself will affect nerve and muscular function. In other instances, the patient may be most affected by side effects from chemotherapy and radiation. This can cause increased pain or neuropathy, decreased strength, activity tolerance, mobility, balance, or cognition.
Since occupational therapy can be such an important tool in improving cancer patients’ quality of life, it is important to consider the benefits OT can offer to achieve improved quality of life for this population of patients. Improving the patient’s quality of life through OT will also indirectly improve the families that assist with care of these patients.
As stated above, cancer can contribute to a multitude of factors affecting quality of life and independence with ADLs. Occupational therapists can incorporate the following approaches to address these deficits.
Remediation Following Cancer-Related Deficits
Cancer treatments and cancer itself can lead to a myriad of difficulties. Occupational and physical therapists, and speech therapists if applicable, can take a team approach to address these deficits.
Fatigue and decreased activity tolerance are extremely common and make daily tasks much more of a challenge. This can best be addressed with home exercise programs encouraged to gradually increase endurance over time. Your patient may not have the ability to complete a full exercise program at one time, so a program may be modified to be completed in several small time periods throughout the day.
Even after the patient’s cancer treatment is complete, they may experience long-term effects of the treatments. These may continue to limit participation which may last for months or years and may affect ongoing participation in daily activities (The Role of Occupational Therapy in Oncology, AOTA, 2011).
Occupational therapy practitioners are special in the fact that we are well-versed in environmental modifications, adaptations, and compensatory strategies to make individuals diagnosed with cancer’s lives easier on a day to day basis. These adaptations can include home modifications like shower/tub seats, grab bars, or adaptive equipment for dressing, but also modifications for decreased cognitive functioning.
There are many energy conservation/work simplification strategies to address cancer-related fatigue. The best recommendation may be to have the patient prioritize tasks. There are many work and household jobs that could be done either by someone else, or may not need to done at all.
Once tasks have been prioritized, then thought should be given to tasks that can be completed at the same time. For example, if the patient needs to get lunch in the kitchen, perhaps they can plan to get medicines at the same time so that they don’t have to make two trips. It may be beneficial to strategically place chairs throughout the house to allow the patient to complete tasks while sitting.
OT can also help patients with a cancer diagnosis by addressing the psychosocial aspects of the disease. The patient may be worried if they will be able to return to their job or their hobbies. By incorporating patient-specific goals and tasks into the treatment plan, the patient can be reassured that returning to their previous life is a possibility.
Consider the example of a patient who loves to run, but is currently unable to do this because of fatigue. Encouraging the patient to begin a progressive walking program, running in water (though not in a public pool if they are immuno-compromised), or spending short periods of time on an elliptical, may be helpful to the patient. This is not just for the increased endurance, but also for helping them to see that they can reach their personal goal.
Education with the caregiver is crucial to a good outcome for every cancer patient. The patient may be dealing with extreme fatigue and may not be able to complete every work or household task they were doing before. This will require the caregivers to complete all other necessary tasks. If caregivers understand why the patient is having difficulty, and can be educated on how long this symptom lasts, they may be more inclined to help for a long period of time.
Caregivers will often assist with driving patients to appointments, making sure home exercise programs are completed as well as assisting with activities of daily living. Some caregivers are inclined to do all these tasks for the patient with no assistance from the patient. While this may be necessary in some instances, many times it will be most beneficial if the patient is involved.
So instead of the caregiver fully dressing the patient, they may provide assistance to the patient, allowing the patient to complete the task on their own as much as possible. This approach encourages the patient to be as independent as much as possible, and will ultimately relieve the caregiver of this task. Educating the caregiver that this approach is best for the patient (and the caregiver as well) will increase the likelihood that they will follow through with this at home.
How to Obtain a Referral for Occupational Therapy Services
If you are a patient or family member interested in receiving occupational therapy services, you can obtain a referral or prescription for occupational therapy services. If you are in the inpatient/hospital setting, it’s an easy order to obtain as there are generally already occupational therapists and physical therapists working in the oncology and medical units that can start the process.
Outpatient doctor’s orders will most likely be written by either a family practice physician or by the oncologist.
When a patient is diagnosed with cancer, their lives may change immeasurably. There are many different physical, mental, and emotional changes that will affect the patient being able to live their lives in the same manner they did before. It is our job as occupational therapists to first understand who the patient is and what is most important to them. Based on our deep analysis and understanding of their condition, it is our responsibility to help the patient get back to their normal lives as they see it – despite the effects the cancer might have. I hope the ideas shared here will help you feel more prepared to do so.
Additional Resources and References
Pergolotti M, Deal AM, Lavery J, et al (2015): The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer.