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The phases of cancer care therapy

MARIA YOST

This week is a significant week for physical therapists all over the country. The biggest event of the year is being held in Denver, Colorado: Combined Sections Meeting for the American Physical Therapy Association. This is where all of the specialty groups come together and present new techniques and new findings for our profession. It is truly an exciting time.

In the almost 24 years that I have been practicing physical therapy, I have seen a lot of changes. One of the areas that I have seen a lot of change is in the care of patients with cancer. I am a certified lymphedema therapist, and the changes have been significant in this area, but the changes are not isolated to the treatment of lymphedema. I see a shift in the care of cancer patients specifically.

Fifteen years ago, if you had asked me whether I treated patients with cancer, I would have said absolutely … but let’s wait until after their treatment is complete. Rehabilitation had a role in helping people return to a functional state after their treatment ended. We all knew that there were many effects of cancer treatment that impacted a person’s daily function, but we did not fully realize the way rehabilitation services could aide a person as they went through the process.

The mindset is much different now. Patients can receive rehab treatment at any phase of their care. According to the Commission on Cancer, our accrediting body for cancer care, there are four stages of cancer care: preventative, supportive, restorative and palliative. We have realized that rehabilitation services are indicated throughout the patient’s care.

The first phase is the preventative phase. Wellness and rehabilitation have an overall goal of prevention: weight management, nutrition counseling, promotion of healthy lifestyles. This is not patient specific, because it is before they are diagnosed, but it is the goal for a community to live healthy and prevent cancer from occurring at all.

The second phase is the supportive phase. Rehabilitation can help lessen the side effects of cancer treatment. This phase can include education and strategies to cope with side effects experienced. Occupational therapy can assess changes in cognitive function and help with lifestyle management. Physical therapy can assess balance and strength changes that occur from some chemotherapy medications. Speech therapy can perform swallowing assessment that can help with challenges experienced from radiation for head and neck cancers.

The third phase is the restorative phase. This phase is the push to restore function. This is where rehabilitation services have always had a place, but we now know that our scope is much more broad. Rehabilitation continues to assess and treat any deficits identified. During this phase, this could include cancer related fatigue, community re-entry and issues dealing with body image. Restoration includes confidence in performing an activity. This phase could include treatment of lymphedema.

The fourth phase is the palliative phase. This phase is, many times, related to end of life, but that is not always the case. It is a phase that supports and could be the assistance provided in any phase of treatment. This can include training for relaxation and maintaining quality of life. It can be a focused education for caregivers on positioning and pain management.

It is exciting to see the progress that has been made in all of these areas. It is exciting to meet with professionals across the country to see current literature and treatment strategies. Our patients will benefit, right here at home.

Maria Yost, PT, CLT, OCC, MBA, is the rehab manager for Vidant Beaufort Rehabilitation Services, which provides physical therapy, occupational therapy and speech therapy services. She is a physical therapist, a certified lymphedema therapist and has specialty certification in oncology care. She has been serving in Beaufort County and the surrounding areas for nearly 24 years.