What Can Physical Therapy do to Manage

CRC Side Effects?

TODAY’S WEBINAR

SPEAKER(S) Alaina Newell, PT, DPT

Oncology Rehab

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WEBINAR TECH

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TABOO-TY PODCAST MINI MAGAZINES YOUR GUIDE IN THE FIGHT

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RThe information and services provided

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Alaina received her Doctorate of Physical Therapy from the University of Pittsburgh in Pittsburgh, PA in 2012. She completed her Women’s Health residency at UPMC and joined the team in 2014.

Alaina is one of the few Board Certified Women’s Health Clinical Specialists in the Denver Metro area. She is also a Certified Lymphedema Therapist from the Lymphology Association of North America.

She enjoys treating a wide variety of oncological diagnoses from melanoma, pancreatic, bladder, ovarian to breast cancer as well as Women’s Health needs secondary to oncological diagnosis including urinary urgency, gastrointestinal dysfunction, pelvic pain and postural dysfunction.

What Can Physical Therapy do for you?

Alaina Newell PT, DPTBoard Certified Women’s Health Clinical Specialist

Oncology Rehabilitation Specialist

Certified Lymphedema Therapist- LANA

Course Outline

Introduction

Who, What, When Where and Why of PT for CRC Side effects

Outpatient patient: impairment based treatment approach

Treatment options for Top 5 Impairments

Patient Resources

Oncology Rehab: Alaina Newell

Oncology Rehab

An outpatient PT/OT/SLP clinic that specializes in therapy to mitigate the development of long term sequelae associated with oncology treatment.

Alaina Newell PT, DPT, WCS, CLT-LANA Bachelors of Science in Neuroscience- University of Rochester, Rochester, NY

Doctorate in Physical Therapy- University of Pittsburgh, Pittsburgh, PA

Board Certified Women’s Health Specialist (WCS)- American Physical Therapy Association Board

Certified Lymphedema Therapist (CLT) - Klose Training

Lymphology Association of North America Certified CLT- LANA

Oncology Rehabilitation Specialist – PORi

Who: Licensed Physical Therapist

Physical therapists are state licensed health care professionals with who can help patients reduce pain and improve or restore mobility and movement.

Education: Varies based on time of education with current highest level is a Doctorate of Physical Therapy (DPT)

Additionally, individuals may specialize in board certified fields. (WCS, NCS, GCS, OCS, etc)

Or have specialized training (CLT-LANA, BCB-PMD, PORi, FDN, etc)

Physical therapists can teach patients how to prevent or manage their condition to aid in achieving long-term health and wellness through an individualized evaluation and plan.

WHEN:Prior, During and/or After Treatment

Care can begin at any stage of oncology treatment including before start of surgery.

PTs can provide education of anticipated impairments following surgery, aid in home-set up, develop home exercise plans for before and acutely after surgery

Oncology focused physical therapists have the medical background and understanding of appropriate interventions and time periods while a patient is in active treatment (chemotherapy, and/or radiation) to tailor treatment plans

If after the complication of treatment, a patient continues to have lingering side effects, physical therapists can aid in the management of symptoms (CIPN, weakness, fatigue, bowel/bladder dysfunctions, scar conditions, pain, lymphedema)

WHERE:Throughout the continuum of healthcare

Physical Therapists work in ALL settings of health care with the exception of Hospice.

Insurance coverage will only allow one setting at a time

(ie. Unable to go to outpatient while receive homecare PT

Physical Therapists DO aid patients during palliative care

Goals are dependent based on the patient’s care setting, stage of disease, desires and impairments

WHY:Improve Quality of Life

The majority of individual with CRC with survive >5 years and those diagnosed with local disease have a >85% 5-year survival rate (Siegel, et al)

Its estimated of the 14.5 million cancer survivors only 5% are directed toward s rehabilitation services (ACS, 2016)

Overall, CRC survivors experience good QofL BUT is GOOD, GOOD ENOUGH? (Adam , et al)

NCCN and ACS: Guidelines for Exercise during active cancer treatment

Reduces fatigue

Prevents bone and muscle loss

Improves QUALITY OF LIFE

Physical therapy teaches patients how to return to exercise safely, effectively and injury prevention during cancer treatment

Physical therapy provides non-pharmaceutical interventions to address pain, bowel/bladder dysfunction, shortness of breath, fatigue and other impairments

HOW:Ask for a referral and Find a local therapist

American Physical Therapy Association (APTA):

Moving Forward: http://aptaapps.apta.org/findapt/default.aspx?navID=10737422525&UniqueKey=

Oncology Section: http://oncologypt.org/consumer-resources/index.cfm

Section of Women’s: http://www.womenshealthapta.org/pt-locator/

Outpatient assessment:Impairment Based Treatment Approach

New Client with CRC Diagnosis

Chemotherapy? Surgery?

Radiation?

Cardiovascularassessment

Neuropathy/Balance assessment

Manual soft tissue managementStretching programBowel/Bladder managementSexual Health

Manual soft tissue managementExercise program: strength, flexibility, endurance and balanceBowel/Bladder managementSexual HealthPosture and Gait

Improve QUALITY OF LIFE through improved function and exercise

Immunotherapy?

Top 5 Impairments Physical Therapists Treat

Chemotherapy Induced Peripheral Neuropathy (CIPN)

Cancer Related Fatigue (CRF)

Muscle weakness/Imbalance and Postural Dysfunction

Soft tissue and Scar tissue management

Bowel and Bladder Dysfunctions

Functional Impact of CIPN

• Damage to the peripheral nerves (nerves away from the brain and spinal cord) from chemotherapy agents known to be neurotoxic.

• Symptoms including but not limited to: pain, burning, tingling, numbness, balance difficulties, fine motor impairments (writing), hypersensitivity, impaired bowel and bladder, decreased reflexes

CRF Reduces with Exercise

A progressive cardiovascular exercise program based on heart rate response (HR) and Rate of Perceived Exhaustion (RPE)

General Guidelines: 150 minutes of exercise a week

90 minutes: cardiovascular endurance training

60 minutes: balance, strength and flexibility training

Muscle Weakness Leads to Impaired Posture

Impaired posture can lead to

difficulty breathing

Slowed digestion

Difficulty walking and balance

Poor sleep

Increase joint and muscle pains

Soft tissue/scar mobilization supports function

Management in the mobility of soft tissue and scars can aid in

Reduced bowel obstructions

Reduced pain

Improve posture

Increase abdominal muscle activation and strength

Reduce urinary and fecal urgency, frequency and incontinence

Support positive body image

Bowel and Bladder Dysfunctions

Urinary and/or Fecal

Urgency

Frequency

Incontinence

Incomplete empty

Pain

Hesitancy

Treatment Options:

Manual Therapy

Corrective Exercises

Biofeedback Training

Dietary and Lifestyle changes

Postural Awareness

Toileting Mechanics

Resources

Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104–17. Epub 2014/03/19. pmid:24639052.

American Cancer Society. Cancer Facts and Figures 2016. Atlanta: American Cancer Society; 2016

Adams SV, Ceballos R, Newcomb PA (2016) Quality of Life and Mortality of Long-Term Colorectal Cancer Survivors in the Seattle Colorectal Cancer Family Registry. PLoS ONE11(6): e0156534. https://doi.org/10.1371/journal.pone.0156534

Integrating physical activity in cancer care:

https://www.ons.org/store/books/integrating-physical-activity-cancer-care-evidence-based-approach

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