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Description. Now in its second edition, this is the only book on occupational therapy in oncology and palliative care. It has been thoroughly updated, contains .
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- Occupational Therapy in Oncology and Palliative Care - Google Книги
- RCOT SS - Oncology and Palliative Care
Would you like to change to the United States site? The book explores the nature of cancer and challenges faced by occupational therapists in oncology and palliative care. It discusses the range of occupational therapy intervention in symptom control, anxiety management and relaxation, and the management of breathlessness and fatigue. The book is produced in an evidence-based, practical, workbook format with case studies.
New chapters on creativity as a psychodynamic approach; outcome measures in occupational therapy in oncology and palliative care; HIV-related cancers and palliative care. Request permission to reuse content from this site. Added to Your Shopping Cart. Other modifications include stair handrails, removal of hazardous objects and clutter, and use of nonslip mats [ 30 ].
Cancer-related cognitive impairment CRCI presents as difficulties related to memory, attention, information-processing speed, and organization, and can affect all age groups [ 32 ]. For example, women with breast CRCI report mild cognitive decline impacting their ability to function, making previously easy activities more difficult and causing distressing loss of independence in family life roles [ 33 ].
Occupational Therapy in Oncology and Palliative Care - Google Книги
For this issue, occupational therapy intervention will work toward adapting or remediating the functional impairment through different cognitive strategies. The occupational therapist will generally incorporate adaptive strategies so that the patient learns how to compensate for impaired memory or attention while performing particular tasks, or use restorative activities to improve cognition functions during the performance of specific tasks. For example, for a patient with memory and attention issues, an occupational therapist would help create individualized systems to set reminders for medications, schedule appointments, and handle to-do type tasks for shopping, cooking, and money management.
Cancer-related fatigue CRF is a commonly reported issue among cancer survivors that can disrupt daily routines and restrict participation in meaningful activity. Patients with CRF can benefit from energy conservation training taught in occupational therapy. This translates into practical strategies to manage fatigue for resumption of roles and routines [ 35 ]. Structured activity modification and prioritization, as well as use of a daily activity log to monitor task-based activity and energy patterns, are a part of this training. Patients thus have personalized adjustments e.
In breast and other cancers, surgery has the potential to cause short- and long-term physical impairments that are potentially modifiable with occupational therapy. Restricted upper-extremity range of motion, arm swelling lymphedema , pain, and numbness are all common impairments of the upper extremity in patients after surgery for breast cancer [ 36 ].
Disability related to arm range of motion was most often associated with ADL and IADL impairments such as putting on a sweater, making a bed, doing yard work, carrying groceries, and lifting anything weighing more than 10 pounds i. Occupational therapy for patients with limitations in their upper extremities could include a combination of exercise, stretching, and modalities to improve range of motion and muscle strength, followed by training in the performance of functional tasks and adaptation of the activity or environment, as needed.
Many tools commonly used and recommended by occupational therapists can improve independence e. Occupational therapists can help patients identify meaningful activities and apply activity modifications for successful completion, use stress management and relaxation techniques to decrease anxiety, and address concerns related to changes in body image. Lymphedema education includes the identification of risk for exacerbation and activities that may worsen the swelling, appropriate activity modifications, energy conservation techniques, self-massage, and management of the swelling with complete decongestive therapy.
Paclitaxel, docetaxel, vincristine, oxaliplatin, cisplatin, and taxanes can potentially cause chemotherapy-related peripheral neuropathy [ 39 ]. Patients with chemotherapy-induced sensory neuropathy report high levels of functional disability [ 22 ]. Adults report difficulty with housekeeping, distinguishing items in their hands tactile agnosia , and an increase in overall dependence on others [ 40 ].
Occupational therapy interventions for peripheral neuropathy focus on adaptation and remediation through sensory and functional activities e.
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For adults with cancer, occupational therapists also address how cancer-specific issues, such as fatigue, cognition, pain, and peripheral neuropathy, may affect changes in functional status and daily routines [ 42 ]. This type of intervention significantly reduced readmissions, overall disability, and improved functional outcomes in adults without cancer but with similar functional limitations [ 43 — 47 ].
Patients with primary and metastatic brain tumors made significant functional gains with inpatient and outpatient rehabilitation [ 48 ], and the presence of metastatic disease did not appear to influence gains [ 49 ]. In a novel, telemedicine-based occupational therapy intervention, women worked through their reported functional challenges [ 50 ]. The longitudinal findings demonstrated improved QOL, active coping and reframing of problems, and decreased self-blame [ 51 ].
Cancer-related functional impairment is a slow process and can be difficult to recognize [ 52 ]. Obvious impairments and referrals to occupational therapy occur most often during an inpatient hospital stay where functional decline may be more apparent with issues of hemiplegia, hip fracture, or amputation [ 53 ]. When disablement is slowly developing and without a structured and consistent assessment of function, cognition, and falls, it can be difficult to determine quickly, in a busy outpatient oncology office visit, when to refer to occupational therapy [ 52 ].
Incorporating a few, brief patient-reported measures or questions that specifically relate to interventions, such as occupational therapy, could help with determining which patients will benefit from these services. The following are examples of validated screening tools: Quick screening questions can include the following:. These simple questions can easily identify patients who could benefit from a referral to occupational therapy.
In addition, completing a comprehensive GA can provide a wealth of information regarding other supportive care needs, including nutrition, pharmacy, geriatrics, or psychiatry. Most medical centers have occupational therapy services, and if an institution does not have an occupational therapy department, a referral or prescription may be given to the patient to obtain occupational therapy services through a home-care agency or an outpatient clinic.
Once a referral is made, patients can contact any rehabilitation facility or hospital-based occupational therapy department to find outpatient offices in their area. Patients who are leaving the hospital and need additional therapy services may receive occupational therapy either in inpatient rehabilitation or in subacute rehabilitation centers often found in nursing homes.
Table 3 describes different occupational therapy settings and levels of care. For adults over the age of 65 years who have Medicare, outpatient occupational therapy is covered under Part B, and most patients also have supplemental insurance to help cover the cost of coinsurance for outpatient care.
To best assist patients in getting optimal therapy, defining the reason for referral in terms of needs or specific concerns e. Occupational therapy is often obtained in combination with other rehabilitation services such as physical therapy and speech and language pathology. Physical therapy and speech and language pathology are vital parts of the rehabilitation team but differ from occupational therapy in their primary focus. Physical therapy has a strong emphasis on strength and endurance capacity, whereas speech and language pathology focuses on swallowing and speech production.
Research specifically examining the benefits of occupational therapy in adults with cancer is emerging as clinical care in this area continues to grow [ 50 , 58 — 61 ]. There is an ongoing randomized controlled trial looking at the effectiveness of both occupational and physical therapies provided in the outpatient setting specifically designed for older adults with cancer [ 62 ].
There is also an ongoing study that is developing novel occupational therapy interventions for women after they have had ovarian cancer surgery. These and other emerging studies that are focused on adults of all ages will help further define the important role of occupational therapy in cancer care. An analysis of the National Health Interview Survey confirmed that cancer survivors are significantly more likely to report being in fair or poor health, have three or more chronic comorbid conditions, psychological problems, one or more limitations in ADLs or IADLs, and poorer functional status when compared with similar age adults without a cancer diagnosis [ 2 ].
Occupational therapy is designed to help people with these impairments and other needs improve their overall QOL by facilitating engagement in meaningful everyday activities. As more cancer rehabilitation programs are developed and the scope of occupational therapy becomes better understood by all consumers, accessing an occupational therapist will become more standard practice.
Occupational therapists treat each patient holistically and use creative solutions to improve the overall cognitive and functional capacity of older adults with cancer, making the occupational therapist a critical member of the interprofessional cancer care team. Mackenzi Pergolotti, Hyman B. Data analysis and interpretation: Mackenzi Pergolotti, Grant R. Williams, Claudine Campbell, Lauro A. Final approval of manuscript: The other authors indicated no financial relationships.
National Center for Biotechnology Information , U. Journal List Oncologist v. Published online Feb Mackenzi Pergolotti , a, b Grant R. Williams , b Claudine Campbell , c Lauro A. Munoz , d and Hyman B. Disclosures of potential conflicts of interest may be found at the end of this article. Received Aug 17; Accepted Dec This article has been cited by other articles in PMC. Abstract Adults with cancer may be at risk for limitations in functional status and quality of life QOL. Functional status, Occupational therapy, Activities of daily living, Quality of life.
Introduction Occupational therapy is a patient-centered service whose interventions focus on improving health, well-being, and functional capacity [ 1 ].
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Occupational Therapy Occupational therapy uses a variety of techniques and tools to improve functional capacity. Summary of relevant research evaluating the needs for occupational therapy. Open in a separate window. Specific Factors Amendable to Occupational Therapy Intervention Many impairments related to cancer and its treatments are amendable to occupational therapy. Qualifying conditions and potential interventions for occupational therapy.
Falls Older adults with cancer are at a higher risk for falls compared with those without cancer [ 23 ]. Cognitive Function Impairment Cancer-related cognitive impairment CRCI presents as difficulties related to memory, attention, information-processing speed, and organization, and can affect all age groups [ 32 ]. Cancer-Related Fatigue Cancer-related fatigue CRF is a commonly reported issue among cancer survivors that can disrupt daily routines and restrict participation in meaningful activity.
RCOT SS - Oncology and Palliative Care
Upper-Extremity Impairments In breast and other cancers, surgery has the potential to cause short- and long-term physical impairments that are potentially modifiable with occupational therapy. Chemotherapy-Induced Peripheral Neuropathy Paclitaxel, docetaxel, vincristine, oxaliplatin, cisplatin, and taxanes can potentially cause chemotherapy-related peripheral neuropathy [ 39 ].
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Functional Impairments For adults with cancer, occupational therapists also address how cancer-specific issues, such as fatigue, cognition, pain, and peripheral neuropathy, may affect changes in functional status and daily routines [ 42 ]. How to Assess the Need for Occupational Therapy Referral Cancer-related functional impairment is a slow process and can be difficult to recognize [ 52 ].
Quick screening questions can include the following: Has the patient had any falls in the last 6 months? Has the patient experienced changes in memory, attention, or focus that have impacted participation in routine daily activities? How to Obtain Occupational Therapy for Your Patient Most medical centers have occupational therapy services, and if an institution does not have an occupational therapy department, a referral or prescription may be given to the patient to obtain occupational therapy services through a home-care agency or an outpatient clinic.
Settings and levels of rehabilitation. Cancer Rehabilitation Team Occupational therapy is often obtained in combination with other rehabilitation services such as physical therapy and speech and language pathology. Emerging Research Research specifically examining the benefits of occupational therapy in adults with cancer is emerging as clinical care in this area continues to grow [ 50 , 58 — 61 ]. Conclusion An analysis of the National Health Interview Survey confirmed that cancer survivors are significantly more likely to report being in fair or poor health, have three or more chronic comorbid conditions, psychological problems, one or more limitations in ADLs or IADLs, and poorer functional status when compared with similar age adults without a cancer diagnosis [ 2 ].
Muss Provision of study material or patients: Mackenzi Pergolotti Data analysis and interpretation: Muss Final approval of manuscript: American Occupational Therapy Association. Standards of practice for occupational therapy. Accessed December 15, Cancer survivors in the United States: Age, health, and disability. The role of occupational participation and environment among Icelandic women with breast cancer: Scand J Occup Ther.
Value of functional status as a predictor of mortality: Results of a prospective study. Risk factors for early and late mortality in hospitalized older patients: The continuing importance of functional status. Functional transitions among the elderly: Patterns, predictors, and related hospital use. Am J Public Health. Predicting chemotherapy toxicity in older adults with cancer: A prospective multicenter study. The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. Occupational therapy in palliative care: Is it under-utilised in Western Australia?
Aust Occup Ther J. Kealey P, McIntyre I. An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: A patient and carers perspective. Eur J Cancer Care Engl ; Occupational therapy for independent-living older adults.