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Prakash Chandran (Host):  Going through cancer treatment can be a difficult and tiring process, but did you know that physical therapy can help cancer patients maintain and restore physical and emotional wellbeing before, during and after treatment? We’re going to learn about it today with Sara O’Hara, a Physical Therapist and Certified Lymphedema Therapist at Harrington Hospital.

This is Healthy Takeout, the podcast from Harrington Hospital. I’m Prakash Chandran. So, first of all Sara, I’ve heard that physical therapy for cancer patients is called oncology rehab. What exactly does that mean?

Sara O’Hara, DPT, CLT (Guest):  So, it can be pretty dynamic based on what the patient needs. So, for example, some patients are having some weakness and deconditioning due to their disease or their treatment. Other patients may have pain, limitations in their mobility, their range of motion of their joints, maybe some swelling or lymphedema in their limbs. So, we kind of assess what the patient is coming in for and kind of tailor the treatment based on that.

Host:  Okay, that makes sense. And just a lay question here. What exactly does lymphedema mean?

Sara:  So, lymphedema is basically an abnormal collection of fluid that’s protein rich and it a lot of times happens after a biopsy or after a cancer treatment. Breast cancer is where you see it most commonly. So, if you saw somebody who had lymphedema, a lot of times they would have one arm that’s really swollen compared to the other.

Host:  Okay so let’s talk about some of the most common things that you see in physical therapy for oncology rehab.

Sara:  So, I would say lymphedema is definitely up there. Physical or occupational therapists could become certified and treat those patients. And their treatment would be pretty intense in the beginning. It’s usually not a painful condition but it can be debilitating and affect the way simples things are done like dressing and bathing if they have limited range of motion or even how your clothes fit. So, with patients at the beginning with that we would do a massage technique to try to help redistribute the fluid, do multilayer bandaging for some compression and then towards the end of their treatment they would be fitted with a garment like a compression sleeve to wear during the day and a separate one for night time.

Host:  Okay and you know I don’t think that this is something that’s commonly known, physical therapy during cancer treatment. I’m curious as to your thoughts around how important it is.

Sara:  I think it’s really important. A lot of times, the oncology population can be somewhat missed in the whole treatment process. When patients are being treated for cancer, they follow very closely with the oncology team, but they may not want to bring up issues like they’re having pain or they’re feeling deconditioned or balance, hearing issues, things like that. So, a lot of times, these patients aren’t being referred to us.

Host:  Yeah, I totally get that. But I’m curious as to if physical therapy for cancer patients is more recognized now than a few years ago?

Sara:  I think it is at least in our organization. I know that we have been trying to become more involved. We do have a cancer center that’s located on the same campus of our hospital. So, our rehab department has been trying to have more of a presence there, talking to social workers, nurses, and the physicians over there just to remind what services we do provide and just providing some screening tools so they can see which patients may benefit. And maybe just think about some aspects of their care that they may be weren’t because they’re focused on saving lives and they might not be focused on the fact that the patient has trouble getting out of bed or there’s a little loss of balance at night when they get up to go to the bathroom.

Host:  Yeah, that completely makes sense. But that is such an important part to the way a patient might feel, right, just being able to do things themselves. I think just from an emotional standpoint, it probably helps them just feel good about getting back to some sense of normalcy wouldn’t you say?

Sara:  Absolutely. And a big part of it now is survivorship. So, as of 2015, all facilities are required to have a plan of care for survivorship so even after somebody is done actively being treated; they should still have a plan to get them back on their feet so to say. So, a lot of YMCAs have programs called Live Strong where they’ll do, I believe it’s 12 weeks and they’ll teach people how to use their different equipment and show them what classes are available to them. So, that’s really helpful.

Host:  So, I’m curious as to the type of certifications that therapists are required to have in order to help treat a patient with cancer. Is this like something that a normal physical therapist can do?

Sara:  Yes. So, if the patient needs lymphedema therapy, you should be seen by a certified lymphedema therapist. So, either a physical or occupational therapist but if it is for strengthening, pain management, things like that, you don’t need a certification in order to treat those patients.

Host:  And we touched on this a little bit earlier, but I’m curious to hear your thoughts around why physical therapy should be considered just as important as nutrition and infusion services during a patient’s care.

Sara:  That’s a really good question. So, obviously, the nutrition element is huge because a lot of these patients are losing weight between their treatment and also their disease. And a lot of them have loss of bone mass and muscle mass. So weightbearing activity and exercise can actually help increase bone density, impact exercises can help stimulate the formation of bone and weight training can actually delay some of the loss of the bone mineral density and the loss of muscle mass. So, I think they really work hand in hand in a way if your nutrition status improves, and you are also doing these exercises to improve your bone health and your muscle mass; then you should be able to function a lot more efficiently.

Host:  What are some easy recommendations or exercises or stretches that one can begin to do to rebuild strength and mobility?

Sara:  So, I think one of the key take aways is kind of any exercise that you can tolerate is great. It doesn’t have to be any super intense workout at least to start. Even walking or riding a stationary bike or a regular bike can be good for that aerobic exercise. There are some studies that show that strengthening after breast cancer, so two days a week for six to 12 months can help increase your muscle mass and it’s safe to do. Really a combination of weight training and weightbearing exercise along with the aerobic exercise is great and a few times a week. You could do 60 minutes twice a week for strengthening. You could do light cardio every day and kind of increase as you can tolerate it. core strengthening and postural exercises are also very important.

Host:  Yeah, all of those definitely makes sense and I think you were mentioning the important thing is just to start exercising and start to move around. You don’t have to do anything crazy but just getting movement involved in your everyday routine is very important. If a cancer survivor is thinking about physical therapy, what questions should they ask ahead of time?

Sara:  Sure, I think it’s really important for the patient to communicate what their goals are and really identify what they’re having difficulty with and what their prior level of function was. Somebody that was really active, going to the gym, or participating in any sports or things like that is really important for us to know that and know that that’s what you’d like to get back to versus maybe an elderly patient who walks to their mailbox or walks around the grocery store whatever. We’re going to have different goals and different treatment plans with those patients.

Host:  So, I want to talk about any success stories when we’re talking about physical therapy. Are there any types of cancer that see the best success rates when it comes to adding physical therapy into their regimen?

Sara:  Off the top of my head, I can’t think of any one that may do better than others. But one of my colleagues has taken some extra lymphedema training for patients with head and neck cancer and some of them really have a lot of difficulty especially first thing in the morning with even being able to swallow or speak because when they are laying down at night, they have so much swelling in their neck. So, she’s done a lot of work with proper garments and massage techniques to help with the lymphedema there and I know she has said that when it works for those patients, she’s seen a really huge improvement in their quality of life.

Host:  Well Sara, I really appreciate your time today. That’s Sara O’Hara, a Physical Therapist and Certified Lymphedema Therapist at Harrington Hospital. Thanks for checking out this episode of Healthy Takeout. Head to www.harringtonhospital.org/services/rehabilitationservices to get connected with Sara O’Hara or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.