File #1File #1

Table of ContentsTable of Contents

IntroductionIntroduction

Presenter’s NotesPresenter’s Notes

Oncology Rehabilitation: Web-based Learning for Physical Therapists Who Provide Rehabilitation to Patients with Breast Cancer

Oncology Rehabilitation: Web-Oncology Rehabilitation: Web-based Learning for Physical based Learning for Physical Therapists Who Provide Therapists Who Provide Rehabilitation to Patients with Rehabilitation to Patients with Breast CancerBreast Cancer

Submitted by: Michael ColemanSubmitted by: Michael ColemanUniversity of Maryland School of MedicineUniversity of Maryland School of Medicine

Department of Physical Therapy and Rehabilitation SciencesDepartment of Physical Therapy and Rehabilitation Sciences

Doctor of Science in Physical TherapyDoctor of Science in Physical Therapy

Project approval by advisor, Frances E. Huber, EdD, PT, OCSProject approval by advisor, Frances E. Huber, EdD, PT, OCSAnd the Committee assigned to the ProjectAnd the Committee assigned to the Project

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Table of ContentsTable of Contents

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Cover Sheet……………………….……File #1……..……………………………………………….02 Table of Contents……………………..……………………………………………………………….03 Program objectives…………………………..………………………………………………………..06 Presenter’s introduction…………………………..…………………………………………………..08 Pre / Post test…………………………………………..………………………………………….…..11 Presenter’s Notes…………………………………Use folder entitled DScPT Notes…………14-15 Basic Breast Cancer………………..….File #2…..…………..………………………………….…02

Statistics…………………………………………………………………..……………………………04 Cancer defined………………………………………………………………………………………..06 Tissue Evaluation……………………………………………………………………………………..12

Signs of cancer and risk factors…….……………………………………………..…………….…..20Differential diagnosis…………………………………………………………………..………….…..24Breast cancer diagnosis and protection…….…………………………………………..…………..26Pathology and tumor staging……………………………………………………………….………..35

Survival…………………………………………………………………………………………………40 Time Out Test………………………………………………………………………………………….41The Cancer Team………………………..File # 3……………………...……………………….….…02

Medical interventions……………………………………………………………………………….....08Chemotherapy…………………………………………………………………………………………09

Hormone Therapy…………………………………………………………………………………….16Radiation…………………………………………………………….…………………………………19Surgery………………………………………………………………………………………………....28Time Out Test………………………………………………………………………………………….48Bone Marrow Transplants……………………………………………………………………………49Immunotherapy……………………………………………………………………………………..…57Intervention side effects………………………………………………………………………………61

Clinical trials and Tumor Markers……………………………………………………………………73 Time Out Test………………………………………………………………………………………….83

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Breast Cancer Rehabilitation…………………File #4……………....……………………………..…..……….02Statistics………………………………………………………………………………………..………..04Niche practice………………………………………………………………………………..………….08

Health Care Reform & ICD 9 Codes……………………………………………………..…………..13Psychology and Support Issues…………………………………………………….…..……….…... 18

Pain……………………………………………………………………………….……..…..……..……29 Time Out Test………………………………………………………………………..…………………39

Quality Life through Rehabilitation…………………..…………………………..…….……………...40Rehabilitation options…………………………………………….….…………..……………………..43Evaluation scales…………………………………………………….….……..……………………….46

Lab Values…………………………………………………………………………………………….…51General Breast Cancer Exercise Programs…………………….….…..…………………………….56Documentation……………………………………………………………………………………..…...70

Post-Surgical Rehabilitation Examples……..…………………………….……………………….…74 Out-Patient example………………………………………………………………………….………...99 Research…………………………………………………………………………………………….…108 Modality contraindications………………………………………………………………………….…121

Oncologic Emergencies……………………………………………………………………………….129 Time Out Test………………………………………………………………………………………….135Complications and Alternatives………………File #5…..…………………………………...…………….…...01

Lymphatic System……………………………………………………………………..….………….....02Nutrition………………………….………………………………………………………,,….…………..14Holistic Alternatives…………….…………………….………………………..…………..……………24Recurrence………………………..…………………….………………………..…………,,………….32

Presentation Conclusion……………………….File #6……………..………….…………..…………...……….02Case studies………………………………………………….…………….………..……….…...……..03Survival………………………………………………………………………….……..……………...….08Physical therapy cancer education…………………………….…..………………..………..…….….11Conclusion………………………………………………………….…..………………..………..……...16

Answers to Pre / Post Test………………………………………………………..……..……………….…..….…20References ……………………………File #7….Use folder entitled DScPT Reference List…..… 02

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Program DirectionsProgram DirectionsObjectivesObjectives&&IntroductionIntroduction

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How to complete this presentationHow to complete this presentation

• This doctoral level presentation is designed to be This doctoral level presentation is designed to be “user friendly” as well as motivating to“user friendly” as well as motivating to promote promote regular referrals to physical therapy for all patients regular referrals to physical therapy for all patients diagnosed with breast cancer.diagnosed with breast cancer.

• This program has been divided into 7 files to make This program has been divided into 7 files to make online learning beneficial.online learning beneficial.

• File 1 IntroductionFile 1 Introduction• File 2 Basic Breast Cancer InformationFile 2 Basic Breast Cancer Information• File 3 The Cancer TeamFile 3 The Cancer Team• File 4 Breast Cancer RehabilitationFile 4 Breast Cancer Rehabilitation• File 5 Complications / Alternatives File 5 Complications / Alternatives

• File 6 ConclusionFile 6 Conclusion• File 7 ReferencesFile 7 References

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Program ObjectivesProgram ObjectivesUpon completion the therapist will be Upon completion the therapist will be able to:able to:

• demonstrate an in-depth understanding of breast cancer. demonstrate an in-depth understanding of breast cancer. • understand medical interventions and side effects of understand medical interventions and side effects of

cancer care. cancer care. • have an awareness of the emotional aspects of a breast have an awareness of the emotional aspects of a breast

cancer diagnosis.cancer diagnosis.• gain knowledge to establish treatment goals for breast gain knowledge to establish treatment goals for breast

cancer.cancer.• understand how the lymphatic system can influence understand how the lymphatic system can influence

breast care.breast care.• understand how survivorship leads to rehabilitation.understand how survivorship leads to rehabilitation.• explore opportunities in breast cancer rehabilitation. explore opportunities in breast cancer rehabilitation.

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Introduction:Introduction: • I would like to welcome you to a self study program for I would like to welcome you to a self study program for

physical therapists who provide or would like to provide physical therapists who provide or would like to provide rehabilitation to patients diagnosed with breast cancer. rehabilitation to patients diagnosed with breast cancer. With over 30 years experience as a physical therapist, With over 30 years experience as a physical therapist, I have found that many patients have not received I have found that many patients have not received quality rehabilitation after the cancer diagnosis.quality rehabilitation after the cancer diagnosis.

• I believe the physical therapist plays a vital role in I believe the physical therapist plays a vital role in promoting a higher quality life for the breast cancer promoting a higher quality life for the breast cancer patient. Due to early detection, diagnostic techniques, patient. Due to early detection, diagnostic techniques, treatment plans and increased exercise research, we treatment plans and increased exercise research, we are able to promote realistic goals for the increased are able to promote realistic goals for the increased number of cancer survivors.number of cancer survivors.

• This program has been designed to promote This program has been designed to promote confidence and expertise in the treatment of breast confidence and expertise in the treatment of breast cancer. I personally feel that anyone that treats breast cancer. I personally feel that anyone that treats breast cancer patients, must have a complete understanding cancer patients, must have a complete understanding of cancer. of cancer.

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• Again, I welcome you to Again, I welcome you to this program. I hope it will this program. I hope it will be a stimulating experience be a stimulating experience and will motivate you in a and will motivate you in a very rewarding specialty of very rewarding specialty of rehabilitation for the patient rehabilitation for the patient diagnosed with breast diagnosed with breast cancer.cancer.

Thank you.Thank you.

Michael S. Coleman, PTMichael S. Coleman, PT

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Pre / Post TestPre / Post Test

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PRE / POST STUDY TEST (Answer on a separate sheet of paper)Oncology / Breast Cancer Review 1.Define cancer: ______________________________________________________________________2.List the seven warning signs of cancer. C_____________________________________________________________________A_____________________________________________________________________U_____________________________________________________________________T_____________________________________________________________________I______________________________________________________________________ O_____________________________________________________________________N_____________________________________________________________________3.List 5 risk factors of breast cancer.______________________________________________________________________4.What does TNM mean in the diagnosis of breast cancer?______________________________________________________________________5.List the professionals that make up the Cancer Team.____________________________________________________________________________________________________________________________________________6.Where would you go for update physical therapy information concerning breast cancer?______________________________________________________________________7.Why should physical therapy be involved with breast cancer patients?

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8.Where is the best location to treat a breast cancer patient?A. Hospital B. Out-patient facility C. Home care D. All facilities listed9.List five benefits of exercise after medical interventions for breast cancer._______________________________________________________________10.Describe the types of surgery completed for cancer.Diagnostic_______________________________________________________Curative________________________________________________________Palliative________________________________________________________Prophylactic_____________________________________________________11.What medical intervention might follow a lumpectomy?_______________________________________________________________12.What modalities would you choose to treat lymphedema?_______________________________________________________________13.Where are two of the three major lymph node regions?_______________________________________________________________14.List five contraindications of exercise following breast cancer._______________________________________________________________15.How would you market breast cancer rehabilitation to physicians and the general public?_______________________________________________________________Comments: _____________________________________ (Answers: File #6) SUPPORT THE ONCOLOGY SECTION of the A.P.T.A.

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Presenter’s NotesPresenter’s Notes

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DScPT Presenters NotesDScPT Presenters Notes

• Open folder entitled Open folder entitled DScPT NotesDScPT Notes

• Each file corresponds with Each file corresponds with presentation slides according to file presentation slides according to file and slide numbers.and slide numbers.

• Copy each set of notes to follow Copy each set of notes to follow along with slide show presentation.along with slide show presentation.