Where have we been, where are we now, where are we going? Every PT and PTA uses these questions to reflect on a patient’s progress, their own professional development, and the status of the profession that they love. This Lines blog post is the first in a series of three blogs which will contain some personal and professional reflections on how the physical therapy profession has grown into and embraced its role in treating people with cancer – also known as oncology rehabilitation. Yours truly, Lori Boright, and Deb Doherty have each composed a blog on the growth of the physical therapy profession in caring for people with cancer. I will be focusing on the past, Lori will speak to the present, and Deb will hop in her DeLorean and go 88 miles an hour to look into the future (for those that didn’t get that reference, its Back to the Future!...a classic 80s movie). Deb, Lori, and I are very passionate about this topic as we are the three co-editors of the just released book entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians. https://www.elsevier.com/books/oncology-rehabilitation/doherty/978-0-323-81087-6. In addition to Deb, Lori, and I being instructors at Oakland University, this book has LOTS of Michigan ties as over HALF (yes, you read that right) of the chapter authors have practiced in Michigan. I like to think of Michigan as the Oncology Rehabilitation Capital of the World (© Chris Wilson 2023) as we really have a strong professional network in our lovely state! If you or anyone you know needs oncology rehabilitation, Michigan truly is a great place to be!
Sadly, most PTs and PTAs know about the physical therapy treatment for persons diagnosed with cancer from what they WEREN’T ALLOWED to do with their patients, and this was hardwired into them in their entry-level education. Patient has cancer – don’t do modalities! Patient has cancer – don’t do manual therapy! Patient has cancer – they need rest, don’t exercise them! A lot of what we were taught was so well intentioned but so wrong… Now, indeed there are some cases where specific modalities or aggressive joint mobilizations might not be best for certain patients with certain circumstances but for the most part, they are people who need physical therapy and can benefit from a lot of our treatments and are not getting them! That was why we wrote our book, to educate people that all physical therapy treatments have a role for persons with cancer, it’s just the when and where that are important.
In the past, we didn’t have the answers to a lot of our questions about patient safety when it came to oncology rehabilitation. When in doubt, patient safety comes first; if we aren’t sure if a treatment will help a patient and there is a small or unknown chance of harm, the principle of ‘first do no harm’ always comes first – as it should! In a lot of organizations, oncology rehabilitation started from a lymphedema program because that was something that could not be ignored and was relatively safe to treat with very good outcomes. Of course, what did these lymphedema-trained therapists find once they were working with these patients? Lots of other problems caused by the cancer or its treatments – fatigue, weakness, stiffness, balance disturbances, pain, loss of range of motion, neuropathy, to name a few. Although likely hesitant to open up these other ‘cans of worms’, these therapists recognized and attempted to treat these other issues to improve their patient’s quality of life. Of course, this begs the question – if patients with lymphedema have a lot of these ‘other’ issues, how many patients without lymphedema also have these issues and why aren’t we seeing them? We probably should be. This is where advocacy, research, and education needed to come to the forefront! Over the past 25 years, there have been an ever-growing body of research showing that not only are physical therapy treatments like exercise and manual therapy not harmful, they are essential. We now have evidence-based Clinical Practice Guidelines on a variety of topics including lymphedema and cancer related fatigue. Many national organizations are now endorsing that every person with cancer needs to exercise. This exercise can reduce adverse effects of cancer and even…wait for it…improve survival rates and recurrence rates of cancer. Yes, something we do every day with patients can literally save lives. If the evidence is continuing to grow about the PTs/PTAs role in oncology rehabilitation, why doesn’t it happen consistently?
It’s not an understatement to say that cancer and its treatments are complex and evolving topics. There are lots of unique medical terms that we usually don’t encounter in physical therapy (neoadjuvant, consolidation, nadir…oh my!). Behind these terms are very complex treatments and dozens of other professionals who have decades of training in their highly specialized areas of practice. This can be intimidating for a PT or PTA who might know the right thing to do to address their patient’s impairment but doesn’t want to do the wrong thing. This is where each PT and PTA should consider filling their knowledge gaps as it relates to cancer. Don’t worry, this does not have to be an extensive, expensive process. Just an introductory course or two is usually a great start. Almost every PT online learning center has an intro to cancer rehab course.
Another issue is how much education is needed? For some reason, some therapists feel that they can’t treat a patient with cancer because they are not a specialist. This is not true. Now indeed, some patient cases are complex and do require the skills of a specialist but just like ortho or neuro, one does not have to be a specialist to see a straightforward patient with an orthopedic or neurologic condition – just a solid foundation in the principles of the area. The difference is we get this solid foundation in our entry level training for ortho and neuro, but not for cancer…yet! Lori and Deb have done an amazing job traversing the state of Michigan to speak to every DPT student in all of the entry level programs. I am also proud to have been the co-chair of a task force to establish a document as to what every new grad should come out of school knowing about cancer and cancer rehab that was just released in Feb 2023 and can be found on the Academy of Oncologic Physical Therapy’s website https://oncologypt.org/publications/#CPG. So there is hope that all PTs and PTAs will have some foundational knowledge of cancer in the future!
The specialty of oncology rehabilitation is no longer in its infancy! I would say that we are in our adolescence; yes, adolescence often comes with awkwardness and a sense of uncertainty BUT with adolescence also comes unbound potential and inspiration to change the world! This is why I’m excited about our profession’s efforts to address this major health issue. Cancer is the second leading cause of death in the US and our society and community are looking to us to address their movement issues from cancer. Our treatments are able to prevent, mitigate, or manage the various adverse effects of cancer and its treatment, improve quality of life, and even reduce the risk of recurrence. We have the tools and the knowledge to help people facing the fight of their lives, we can be part of the team that helps them during their journey – now we just have to step up to the plate. Join us for the next Lines blog post where Lori Boright will discuss the current state of oncology rehabilitation including the topics of education, residencies, and specialization.
Stay tuned!
Chris
Chris Wilson PT, DPT, DScPT is an associate professor and director of clinical education at Oakland University in Rochester, MI. He practices clinically at Corewell Health Acute Care Oncology and is a faculty member in the Corewell Health Oncology Residency for physical therapists. He is the co-editor of the book entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians published by Elsevier. He is a delegate for Michigan for the APTA House of Delegates and is the President-Elect of the Academy of Oncologic Physical Therapy.
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