OT and cancer

Occupational Therapy, Cancer, and Acute Care

This post describes cancer and how OTs can intervene with patients with cancer more effectively.

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 OT’s ROLE IN CANCER CARE

 WHAT IS CANCER? What an OT should know… 

Cancer is a disease of uncontrolled cell growth.  OTs are seeing more cancer patients due to increasing survival rates among cancer patients.

Once cancer develops it is explained in terms of “stages”.  These stages explain how much the cancer has spread.  Knowing the stage should help OTs decide on treatment approaches.

  • One of the most common staging systems is the TNM system.  It describes the tumor, the lymph nodes, and metastasis. This system is often generalized into stages I-IV.
  • See The National Cancer Institute for more information on cancer staging. Keep in mind that the higher the stage number, the more severe the disease is.

Most frequent cancer treatments:

  • Radiation. This produces cell death by damaging DNA. OTs need to consider activities that maintain muscle flexibility and strength since radiation may cause atrophy.
  • Chemotherapy.  These are anticancer drugs. OTs should be careful of bodily fluids and wear gloves.
  • Biotherapy/immunotherapy/biological response modifiers. Also includes hormone therapy (often used in breast/prostate cancer).
  • Surgery. Surgery is mainly used to remove benign tumors. This depends on client’s age, functional status, tumor size/location, and type of cancer. OTs need to make sure that they understand surgical precautions.  Ask the medical team for clarification.
  • Transplantation.  This may be necessary when other treatments have failed and cancerous organs are removed..

General considerations for OTs working with cancer patients in acute care:

  • Verify blood counts and coagulation profiles.
  • Monitor vital signs.
  • Pay attention to bulbs, tubes, drains, and lines. The OT should know where each tube and line comes from and goes to – swipe your hand along the side of the bed or chair to double-check.
  • Maintain precautions for hygiene and infection prevention. The OT should remember to use universal precautions.
  • Consult with physicians. Before working with a patient, the OT should get medical clearance and notify medical staff with any changes:
    • MMT may be contraindicated in some cancer patients.
    • Verify weight-bearing status.
    • Verify any contraindications.
  • The OT should always monitor for signs of oncological emergency (see below).
  • Monitor for fatigue.  OTs can instruct patients on fall prevention and safety. They can also modify the environment for success.
  • Assess need for adaptive equipment, positioning, and splinting,
  • OT should collaborate w/ client to determine which occupations are most important to them.
  • Help clients adapt to cancer-related losses through occupation.
  • Pick interventions that allow participation in meaningful occupations.

 Specific OT recommendations for the most common symptoms: 

Additional information that an OT should know when working with cancer patients:

ONCOLOGICAL EMERGENCIES: KNOW WHAT TO LOOK FOR!

  • Superior Vena Cava Syndrome- results in dilated neck veins, face and UE Lymphedema (look for changes in facial features).
  • Electrolyte Disorders– results in hypercalcemia (some symptoms to look out for:  muscle weakness, bone pain, confusion, lethargy, fatigue).
  • Tumor Lysis Syndrome may cause acute renal failure, tachycardia, decreased BP, and arrhythmias (be sure to check vital signs!).
  • Spinal Cord Compression results in back pain, muscle weakness, and abnormal gait.
  • Severe Thrombocytosis- increases risk of spontaneous bleeding (be careful of hand holds).
  • Increased Pressure or Fluid Accumulation– results in cardiac tamponade (monitor for chest pain, check BP – will cause BP to decrease, rapid breathing, discomfort that isn’t relieved) or malignant pleural effusion (may experience dyspnea, chest discomfort, or shortness of breath).

FINAL CONSIDERATIONS FOR OTs:

-Cancer causes psychosocial concerns for the client, caregivers, and family members.

  • Clients experience uncertainty about the future. OTs can help them determine what is most important and focus on those things that improve quality of life.
  • They may have emotional distress due to a loss of control.  OTs can use activities that facilitate a feeling of control.
  • They may have negative reactions to not being able to participate in meaningful/desired occupations. OTs can help them re-frame their ability to participate.
  • They reflect on their personal meaning of life, death, and illness.
  • They may lack social support. OT can make referrals to community agencies that can help.
  • Keep in mind that psychosocial distress can come up as physical symptoms. Provide education about physical symptoms of stress and teach/practice coping strategies.

REMEMBER TO BE CLIENT CENTERED, EMPATHETIC, SENSITIVE, & HOLISTIC

Acknowledgement:  This blog post would not be possible without the help of Andrea Matanovic, a student in the MOT program at CSU when this was written.  She has a passion for acute care and hopes to be working in an acute care setting soon!

References

Mendoza, TR, Wang, XS, Cleeland, CS, et al (1999). The rapid assessment of fatigue  severity in cancer patients: use of the Brief Fatigue Inventory. Cancer, 85( 5): 1186– 1196.

Smith-Gabai, H. (ed.) (2011). Occupational Therapy in Acute Care. Rockville, MD:  American Occupational Therapy Association.

Stubblefield, M. D., Schmitz, K. H., & Ness, K. K. (2013). Physical functioning and rehabilitation for the cancer survivor. Seminars in Oncology, 40(6), 784–795.https://doi.org/10.1053/j.seminoncol.2013.09.008

Cover photo courtesy of Jon Bunting (www.flickr.com)

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