Rehabilitation may not be the first idea that comes to mind when we think of oncology. However, rehabilitation professionals play a valuable role in all stages of cancer treatment, from diagnosis to survivorship. According to the Canadian Physiotherapy Association and the Canadian Association of Occupational Therapists both physiotherapy and occupational therapy make valuable contributions to the treatment of cancer. These depend on the patient’s medical treatments, stage of recovery and their unique concerns and goals. In general, the expertise of these rehabilitation professionals minimizes the sequelae of cancer treatments, helps patients and survivors to optimize physical, social and vocational functioning and, importantly, establishes independence.
On Feb 4th, World Cancer Day, we highlight the innovative work of two Physical & Occupational Therapy alumni, Amanda Grilli and Kyla Johnson, and their forward-thinking perspectives on the field.
Amanda Grilli PT, MSc, CLT-CS
Physiotherapist, Complex Lymphatic Therapist, Oncology Program Coordinator, Kinatex Sports Physio, founder of thepinkpros.com.
- What is the referral process for a physiotherapist to become involved in the care of a person with cancer?
In private practice, the majority of patients are actually self-referred, after finding our services online or hearing about us from family and friends. Unfortunately, only about one-third of patients are referred by their oncologist or another treating physician. In spite of research strongly supporting the role of physiotherapy during and after cancer treatments, there is a lack of awareness amongst cancer patients, survivors, and other healthcare professionals about the benefits of physical therapy in the setting of oncology. In addition, accessibility to the specialized service also remains limited.
This lack of awareness and accessibility is very concerning as it implies that many individuals affected by cancer may not be getting the care and education that they require to live well after cancer.
- What is a typical physiotherapy intervention with a patient with cancer?
Physical therapy plays a vital role in all stages of one’s cancer journey. As a physiotherapist, my role is to help individuals minimize the short- and long-term side effects associated with cancer treatments, so that their independence, physical functioning and quality of life can be maximized. With the use of hands-on techniques, such as myofascial release, soft-tissue mobilization, scar massage and manual therapy, we can help individuals restore their mobility following surgery and radiation, reduce any pain associated with peripheral neuropathy and surgery, and improve their overall physical well-being both during and after cancer treatments.
As exercise experts, physiotherapists are also trained to help cancer patients and survivors return to physical activity safely and with confidence. Under our guidance, patients can improve their balance and coordination deficits, in addition to any impairments in strength and movement. Furthermore, if edema or lymphedema is a primary concern, then manual lymphatic drainage, decongestive exercises and/or compression bandages and garments will also be utilized by a Complex Lymphatic Therapist.
The role of a physiotherapist in cancer care goes beyond symptom management; we have the privilege of supporting and guiding individuals through their cancer journey, and that is incredibly rewarding.
- Recently, you started a website and a focused social media presence, tell us more about what inspired you to take this step. Have you received positive or negative feedback to this form communication?
Early on in my career, I saw a gap in the continuum of care in oncology. I recognized that many people affected by cancer were experiencing a discontinuity of care after their cancer treatments; many felt isolated and frustrated due to a lack of knowledge and resources available to address their cancer-related side effects. Furthermore, many were suffering in silence with their symptoms due to a misconception that nothing could be done to alleviate their impairments.
To try and bridge this knowledge and care gap, I decided to launch my website and Instagram page, The Pink Pros. The site provides educational resources, exercises and self-care practices targeted to women affected by breast cancer. Through social media, my aim is to educate and empower women, helping them overcome their cancer-related side effects and ultimately take back control of their well-being and health. I also aim to address some of the popular misconceptions that I have observed over the years, in hopes of shedding light on the benefits of cancer rehabilitation.
Since the launch, I am very humbled to say that I have received quite a bit of positive feedback, from breast cancer patients and survivors, and other healthcare professionals. Knowing that I am helping women to navigate through their cancer journey with less uncertainty and more knowledge, is ultimately what drives my passion for the field and my devotion to providing education both in clinic and online.
- What do you hope for five years from now?
Through social media, I hope that I can continue to educate, empower and support a large community of individuals affected by cancer, especially those who may not have access to such specialized services and resources within their area.
Also, since knowledge about cancer rehabilitation still remains limited among the general public and other healthcare professionals, I do hope that my educational resources highlight the integral role of physiotherapy in the continuum of cancer care, and possibly improve the referral pathways for people with cancer. I will continue to advocate for my profession and for those touched by cancer, in hopes of ensuring coordinated cancer care for all.
Kyla Johnson OT, MSc
Occupational Therapist, Oncology department, Segal Cancer Centre, Jewish General Hospital
Course lecturer, School of Physical & Occupational Therapy, McGill University
1. What is the process for an Occupational Therapist to become involved in the care of a patient with cancer?
At the Segal Cancer Centre, the patient is most often referred by the oncologist or nurse in the Oncology Department. We are fortunate to have an Oncology rehabilitation team. In most hospital settings this is not the reality. There are two challenges in the area of Occupational Therapy (OT) and cancer rehab; the lack of therapists specialized in the field and the lack of awareness amongst other health care professionals of how OT can be of benefit to patients at different stages of their cancer journey.
2. What is a typical OT intervention with a patient?
Occupational Therapists help people to do the things they need or want to do. In the oncology setting these interventions can range from recommending and providing physical adaptive equipment, to managing the cognitive changes that frequently arise from cancer treatment. OTs help prevent long term dysfunction, help people reintegrate into their lives after cancer, and improve the quality of life while in treatment and afterwards.
Occupational Therapists can be involved at all stages of the cancer journey; from living well despite the side effects during treatment such as fatigue and peripheral neuropathy, to regaining abilities and activities following cancer treatment, such as returning to work, engaging in meaningful activities and important roles in more palliative contexts.
My hope for the future is that access to OT services will be easier for more people who are diagnosed with cancer.
3. You mentioned the challenge of lack of OT in the field of Oncology, how are you addressing this challenge?
Over the last few years, I have been teaching in the Occupational Therapy program, giving lectures on the topic of oncology as well as return to work after cancer. I feel this is important education for future OTs on their role in cancer rehabilitation as well as other chronic illnesses. I enjoy teaching the students and increasing their awareness of the role of OT in this way.
I’m also currently developing an online curriculum with the aim to educate rehabilitation professionals on cancer care and am excited to reach a broader audience through my new website www.TheCancerOT.com.
OT has much to offer people affected by cancer. I do hope that the true value of OT can be better appreciated through educating the general public as well as other healthcare professionals on the role of OT in oncology,
4. Do you have a positive patient experience(s) you would like to share?
I recently worked with a female patient, helping with her struggles of post-treatment side effects including significant fatigue, pain from surgery, and decreased confidence in her cognitive abilities. Together we developed goals towards improving her function, and slowly but surely, this person was able to regain her wellbeing, through a combination of rehabilitation and compensatory strategies. She’s now back to exercising, cooking for her family and has lately returned to work.
Witnessing and participating in the nurturing of hope and the return to roles and activities, indeed to life, is a great honour.