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Presentation ConclusionPresentation Conclusion

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

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Presentation ConclusionPresentation Conclusion

• Case StudiesCase Studies

• SurvivalSurvival

• EducationEducation

• Join your peers and reach for progressJoin your peers and reach for progress

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Case StudiesCase Studies

The following are a few case studies that I The following are a few case studies that I have been involved with, over the years.have been involved with, over the years.

Case # 1Case # 1

Telephone call from patient; recent Telephone call from patient; recent bilateral TRAM procedure; physician bilateral TRAM procedure; physician

advised her to find a therapist; advised her to find a therapist; unsuccessful finding anyone with unsuccessful finding anyone with

experience in treating a TRAM patient; experience in treating a TRAM patient; networking, I was able to find her a networking, I was able to find her a

physical therapist in her hometown of St. physical therapist in her hometown of St. Louis, who was experienced in breast Louis, who was experienced in breast cancer care; received fax from patient, cancer care; received fax from patient,

notifying me of her satisfaction and notifying me of her satisfaction and success in P.T.success in P.T.

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Case #2Case #2

• 35 y/o model advised by her physician (surgeon) 35 y/o model advised by her physician (surgeon) that after her breast surgery she would be that after her breast surgery she would be unable to return to her career and must limit unable to return to her career and must limit exercises; telephone call from her physical exercises; telephone call from her physical therapist, who had read my publications; therapist, who had read my publications; discussed my thoughts on a quality of life discussed my thoughts on a quality of life program for this patient; advised therapist, if program for this patient; advised therapist, if desired, I would communicate with physician desired, I would communicate with physician about the benefits of therapy post-op; discussed about the benefits of therapy post-op; discussed program with physician, who hesitantly agreed program with physician, who hesitantly agreed with program; with rehabilitation, Result: patient with program; with rehabilitation, Result: patient able to resume full activities, including modeling.able to resume full activities, including modeling.

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Case # 3Case # 3

• 38 y/o female scheduled for breast reduction, 38 y/o female scheduled for breast reduction, advised by her physician that a mammogram was advised by her physician that a mammogram was not needed; independently patient decided to not needed; independently patient decided to undergo diagnostic test; diagnosed with a undergo diagnostic test; diagnosed with a intraductal carcinoma; patient completed left intraductal carcinoma; patient completed left modified mastectomy with a TRAM reconstruction modified mastectomy with a TRAM reconstruction and a reduction of the right breast; followed and a reduction of the right breast; followed individualized plan of treatment with positive individualized plan of treatment with positive response.response.

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Case #4Case #4• 33 y/o female noted a lump in her breast; 33 y/o female noted a lump in her breast;

advised by physician that she was too young to advised by physician that she was too young to be worried; because patient was worried she be worried; because patient was worried she independently went for a second opinion and independently went for a second opinion and mammogram; patient diagnosed with breast mammogram; patient diagnosed with breast cancer; right modified radical mastectomy cancer; right modified radical mastectomy followed by a TRAM procedure (8 hrs.), followed by a TRAM procedure (8 hrs.), hospitalized 6 days, only therapy received was hospitalized 6 days, only therapy received was for gait training due to weakness following bed for gait training due to weakness following bed rest. Program of out-patient rehabilitation rest. Program of out-patient rehabilitation progressed patient (out-pt. and home program) progressed patient (out-pt. and home program) to independence within two months. to independence within two months.

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SurvivalSurvival

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Survival Survival

• Over 8 million Americans alive with a history of cancer.

• 2.3 million with a history of breast cancer• 5 million diagnosed five or more years ago.• Five year survival rate generally considered

cured, meaning no evidence of disease and regular life expectancy.

• Report from American Cancer Society, Surveillance Research.

(www.cancer.org, 2005)

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Breast Cancer 5 Year Survival RatesBreast Cancer 5 Year Survival Rates by Stages:by Stages:

• Stage 0• 98-100%

• Stage I• 85-97%

• Stage II• 70-90%

• Stage III• 40-70%

• Stage IV• 5-20%

(Dollinger, 2002)

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EducationEducation

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• Hours vary, but generally minimal, due to the great amount of material that has to be covered for overall educational requirements.

• Breast Cancer education is limited at Breast Cancer education is limited at many educational facilities. many educational facilities.

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Telephone SurveyTelephone SurveyAverage Hrs. of Oncology Taught at Random Universities

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A B C E F G H I J K L M N O P Q R SUniversity Participation

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Cancer education presented in physical therapy curricula

(Study completed by Coleman, 2005)

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““I found that, working with I found that, working with breast cancer patients is very breast cancer patients is very educational and challenging, educational and challenging, but this specialty can be most but this specialty can be most exciting and rewarding”exciting and rewarding” M.S. Coleman M.S. Coleman

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PotentialPotential

• Now that you have reviewed the basic oncology Now that you have reviewed the basic oncology portion, as well as the breast cancer interventions portion, as well as the breast cancer interventions associated with physical therapy, you should be associated with physical therapy, you should be motivated by the research and various therapy motivated by the research and various therapy regimes which have been reviewed. Incorporating regimes which have been reviewed. Incorporating everything together, I hope you are ready to provide everything together, I hope you are ready to provide quality care to the patient diagnosed with breast quality care to the patient diagnosed with breast cancer. cancer.

• The American Cancer Society reports that exercise The American Cancer Society reports that exercise programs for breast cancer patients, “Are popping up programs for breast cancer patients, “Are popping up all over the U.S.”. Let the new programs be run by all over the U.S.”. Let the new programs be run by physical therapists, like yourself.physical therapists, like yourself.

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Conclusion of presentationConclusion of presentation

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Conclusion: Conclusion:

Objectives CoveredObjectives Covered •Presented the reality of cancer.•Statistics of growth and progression of this disease.•Medical team approach, including physical therapy. •Why patients diagnosed with cancer need rehabilitation. •Wellness / Cancer should be synonymous.•The Physical Therapist’s Role.•The need to promote Quality care through continual education.

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Your peers can assist youYour peers can assist you

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Join the Oncology SectionJoin the Oncology Section Network made up of active physical therapist

throughout the USA, working in cancer rehab.• Educate the patient, health care provider and the public of the benefits of cancer rehabilitation.

• Share Knowledge with other professionals.• Participate in research studies.• Contribute knowledge through research and case studies to quarterly publications.

• Special Interest Group available: HIV/AIDS• Become a member of a section, of the APTA, that could use your help in developing quality care for the patient diagnosed with cancer.

• Spread the word about early detection and care.

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Answers to the pre/post testAnswers to the pre/post test

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Answers to pre/post testAnswers to pre/post test1. Cancer is a large group of diseases characterized by uncontrolled

growth and spread of abnormal cells and if not controlled can lead to death.

2. C – Change in bowel or bladder habitsA – A sore that does not healU – Unusual bleeding or dischargeT – Thickening or lump in breast or elsewhereI – Indigestion or difficulty swallowingO – Obvious change in wart or moleN – Nagging cough or hoarseness

3. Family history; Long menstrual cycles; age at first pregnancy; education & socioeconomic class; stress; obesity; live in Northern U.S.; history of colon or other female cancers.

4. Tumor size; Node involvement; Metastasis5. Physical Therapist plus entire medical team6. Oncology Section of the A.P.T.A.7. Promote Quality of Life8. D. All facilities listed9. Increase muscle protein; joint mobility and strength; decrease edema,

pain, anxiety, and depression. Enhance Immune system and decrease infections.

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Continue test answersContinue test answers

10. Diagnostic: Biopsy / Obtain tissue for diagnosis Curative: Remove cancer with attempt to cure Palliative: Improve Quality of Life Prophylastic: Prevent future disease11. Radiation12. Questionable; Know the contraindications of modalities before taking a

chance when treating Lymphedema.13. Inguinal; Axilla; Popliteal14. Unusual fatigue; dizziness; unusual weakness; nausea; platelets; white

blood cell counts.15. Demonstrate the progress that has been reported with research and

prolonged quality of life, for the patient receiving breast cancer rehabilitation.

Michael S. Coleman, Michael S. Coleman, P.T.P.T.

COLEMAN COLEMAN CONSULTINGCONSULTING

user521159@aol.comuser521159@aol.com