Considerations for Oncology Rehabilitation – Clinical Preparation Module

Background

During my second clinical rotation I had the opportunity to work on the Oncology Team at an inpatient rehabilitation facility. I was surprised to find out my clinical instructor was on the oncology team, as the only exposure I had of treating cancer patients was a short VoiceThread recording during the 2^nd year of school. Prior to this rotation, I was not aware there were medical care teams in rehabilitation centers dedicated to treating cancer patients, and I did not realize the impact physical therapy could have on a patient’s tolerance to cancer treatment. During my rotation, I learned physical therapy can be utilized at any point in a patient’s diagnosis and treatment, and I saw the impact physical therapists can have on a patient’s quality of life and function. Individuals with cancer can have a vast array of impairments which can affect their neurological, musculoskeletal, and cardiopulmonary systems, in addition to the psychological toll that affects their overall health. When contemplating what to do for my capstone project, this clinical rotation came into mind, as I wanted to expose PT students to the growing field of oncology rehabilitation and to better prepare them to treat this population on clinical rotations and thereafter.

Statement of Need

In 2019, there were 16.9 million cancer survivors in the United States, and the number of cancer survivors continues to increase.¹ Most cancer survivors face significant declines in function, quality of life, and increases in pain and fatigue. Cancer rehabilitation has been shown to improve tolerance to cancer treatment and improve quality of life, physical function, pain, and anxiety and depression symptoms.^2,3

Oncology rehabilitation is a growing, yet underutilized, field. A systematic review in 2021 found 2-9% of cancer patients were referred to rehabilitation services to treat their impairments.⁴ One reason for this is due to a lack of awareness among providers, physical therapists, and patients of the benefits of physical therapy for cancer related impairments. Within the last few years, the APTA has recently approved a specialist certification for physical therapists in the area of oncology. With the increasing number of cancer survivors and growing field of oncology physical therapy services, students need increased education on treating this population.

Through reflecting on my experience as a student on a rotation treating oncology patients, talking to my committee members, and carrying out research, I compiled up to date information to address common struggles among PT students including difficulties writing goals for this population, coping with the heavy psychological aspect of treating patients with cancer, and understanding how to carry out treatment sessions with patients who have extreme levels of fatigue. This module addresses essential aspects of oncology rehabilitation, providing a baseline knowledge for students to apply to acute and inpatient rehabilitation settings.

Purpose

The purpose of this module is to create a resource for students going out on clinical rotations in oncology rehabilitation. The module supports clinical instructors who are willing to work with students by providing a resource to oncology physical therapists at UNC hospitals and Carolinas Rehabilitation in Charlotte to share with their students prior to their rotation. This resource will also be available on the UNC DPT Lounge to provide students in our program an opportunity to increase their understanding of physical therapy considerations for oncology patients.

Products

The products in this module include a narrated PowerPoint presentation, which is posted on YouTube for ease of distribution to students, a post-presentation quiz, and a resource handout. The link below takes you to a 1-page document, where you will find the links to the presentation, quiz, and handout. The presentation covers topics including the Dietz Model for Cancer Rehabilitation, common cancer diagnoses seen in rehabilitation, an overview of cancer medical treatment, common cancer related impairments, lab values, treatment interventions, goal writing, and emotional support. The presentation is intended to be an introduction for students on what to consider when treating a patient with cancer. The post-presentation quiz is a short online quiz to gauge their understanding on some of the main topics. The handout provides more detail on some of the topics discussed in the presentation, which can be printed out and placed on their desk during the rotation. There are also links to a few resources for students who want to want to dig into the research and look at specific diagnoses, in addition to a resource discussing what is expected of an entry-level PT treating persons with cancer.

Considerations for Oncology Rehabilitation – Clinical Preparation Module

Evaluation Component

A Google forms quiz has been created for students to take after watching the presentation as part of the module to determine their understanding of some of the main concepts. Additionally, a feedback form has been created for anyone who views the project. The link is listed below:

Evaluation of Capstone Materials – Cook

I have reviewed the presentation resources by Plack and Driscoll to create and edit my Capstone PowerPoint.⁵ These materials provided some helpful tips which I implemented to create an effective presentation, such as avoiding too many bullets and words on a slide, minimizing distractions like animations or excessive visuals, and having too many slides. The recorded and narrated presentation makes the information more learner friendly. Other helpful advice includes thinking about the needs of my audience, which will be physical therapy students going on a rotation. To do this, I reflected on how I felt going into my oncology rehabilitation rotation and talked to current physical therapists with experience treating oncology patients about their students’ struggles.

Self-Assessment/Reflection

My personal learning objectives for this project were to increase my understanding of appropriate interventions for cancer patients, increase my awareness of cancer related impairments, increase my understanding of how rehabilitation can help cancer patients at different stages, and improve my ability to conduct a literature review and consolidate evidence. Some of the difficulties in completing this project were staying on track and determining what information was most applicable to students going on rotations in the acute and inpatient settings. By the end of the project, I have seen improvements in my ability to conduct a literature review, and I have a greater understanding of what to consider when treating cancer patients. I believe I was able to create a high-quality product that will educate students and clinicians on the numerous benefits of physical therapy for cancer patients and will help PT students prepare for their upcoming rotation treating oncology patients. Overall, I am very proud of the products I have created and I plan to take this knowledge with me into my career to educate other healthcare professionals on the benefits physical therapy has for oncology patients.

Acknowledgements

I would like to thank my Capstone advisor and committee members for helping me create this module. Lisa Johnston, thank you for being my advisor for this project, and being willing to meet with me every other week to help me stay on track. Allison Joslin, thank you for being a fantastic clinical instructor and demonstrating the positive impact physical therapy can have on patients and their family. Thank you for your suggestions and feedback on my capstone project. Korre Nikolaidis, thank you for meeting with me and providing your clinical expertise to improve my capstone project. Thank you for helping me consider what would be the most beneficial material for PT students to understand prior to a clinical rotation in oncology.

1. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors [published correction appears in CA Cancer J Clin. 2013 May;63(3):215]. CA Cancer J Clin. 2012;62(4):243-274. doi:10.3322/caac.21142
2. Maltser S, Cristian A, Silver JK, Morris GS, Stout NL. A Focused Review of Safety Considerations in Cancer Rehabilitation. PM R. 2017;9(9S2):S415-S428. doi:10.1016/j.pmrj.2017.08.403
3. Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019;69(6):468-484. doi:10.3322/caac.21579
4. Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin. 2021;71(2):149-175. doi:10.3322/caac.21639
5. Plack MM, Driscoll MA. Systematic Effective Instruction: Keys to Designing Effective Presentations . In:Teaching and Learning in Physical Therapy: From Classroom to Clinic. Thorofare, NJ, USA: Slack Incorporated; 2011:67-116.