Transcription:
How Can Rehabilitation Services Help Cancer Patients

 

Scott Webb (Host):  Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Rehabilitation Network. Offering a full range of physical rehabilitation services, the UM Rehab Network brings together a committed team of experts from across Maryland to help patients recover from illness or injury such as stroke, joint replacement or traumatic injury. The University of Maryland Rehabilitation Network bringing world class comprehensive rehabilitation services directly to your neighborhood. Today’s topic is the value of rehabilitation for cancer patients. I’m Scott Webb. My guest today is Christina Pedini. She is currently the Director of Rehabilitation at the University of Maryland Upper Chesapeake Health where she oversees rehab services at two hospitals and three outpatient centers. Christina, thanks for joining me. Let’s start here, what are the most common side effects cancer patients experience from different kinds of treatment?

Christina Pedini, MSPT, GCS (Guest):  There are many different things that patients can experience. Treatment for cancer is very broad. And so they may have surgery, they may have chemotherapy, they may have radiation and other medications and things that they can get. So, there are a wide range of treatments and all of those things can have side effects. There can be pain. There can be range of motion or restrictions in movement. There can be things that people have that affect their nerves. So, it might increase their risk for falls. There really are just so many different things that people don’t always think about that can be caused from the treatment that is great for cancer. It has improved rates of survival significantly but again; they do bring side effects with them.

Host:  Yeah, that’s interesting the side effects and I guess that’s really what we want to focus on today is about how rehab services can help those cancer patients especially with those side effects. So, let’s break these up individually and let’s start with physical therapy. What about older people who are going through cancer treatment. Can they benefit from physical therapy?

Christina:  Absolutely. So, in general, as people get older, we know that there are things that increase their risk like falls for example. Well with patients that have gone through cancer treatment; if they are over 65, 30 to 50% of them have been shown to be at risk for falls or have a fall. This is high and this is definitely higher in the cancer population, the older cancer population than it is in the general population. And lots of patients that have been through cancer treatment don’t know it and also physicians aren’t really aware that this is an additional risk for our seniors. And many people have been through cancer treatment. It may have been recent. It may have been longer ago. But that increases their risk and there’s definitely something that physical therapy can do to evaluate that risk and then actually treat the risk and decrease that risk for risk of falls so it’s really important.

Host:  Yeah, that is great to know that there are treatment options. And when we talk about occupational therapy and lymphedema specifically, is there anything that could be done to prevent issues during or after treatment?

Christina:  There is. And one of the things that actually we really recommend, and we do as part of our cancer treatments for breast cancer specifically is, we actually take a look at those patients even before they start their treatment to understand what is their baseline. And by baseline, I mean if someone is going to have surgery that involves removing a lot of lymph nodes, that can increase the risk for lymphedema and lymphedema is when you have swelling in any area of the body but an arm might be particularly at risk for that after breast cancer surgery and treatment because the flow of that fluid becomes interrupted out of the arm because of the surgery and or radiation in a particular area.

So, we take a look at those patients prior to surgery to see what are their measurements. If they are at increased risk for developing lymphedema, if they start to have some signs after the treatment and after the surgery; we get on it right away and start treatment so that the treatment is much easier, and we can actually hopefully prevent or minimize those complications of lymphedema.

Host:  One of the things I’ve learned from hosting these podcasts is really how important knowing your baselines are those baseline numbers are before anything really and how probably few of us really know exactly where we should be. It’s so important, right?

Christina:  Yeah, one of the things that we’ve done as well is taking a look for physical therapy as we discussed before; where someone should be as far as their risk for falls go. We have technology that can compare how a patient’s balance is and how it compares to age matched norms. So, age matched norm is if I am let’s say I’m 70; we were talking about older people. How should they perform in a balance test? And what would other people their age, how should they perform? We have the ability and the technology to be able to compare their risk for falls to other people if their age. So, it’s a pretty powerful tool and we do use that a lot of times for our older patients that have been through cancer treatment to help decrease that risk for falls, like we said before.

Host:  Yeah, that’s a very cool tool. I love that. When we talk about speech pathology and trouble swallowing and there’s definitely a strong correlation there; why would a cancer patient have to worry about swallowing?

Christina:  We actually have specialists within our system in the University of Maryland Rehab Network that are head and neck cancer specialists that are speech pathologists. And they know exactly all about the normal anatomy, what does the mouth and the tongue and all the over muscles that are used for swallowing; what should they look like and they understand the surgeries that patients may have to go through during this cancer treatment as well as radiation, chemotherapy. They can all have effects on that area and everything that is involved in the process of swallowing. So, when that changes, patients first of all it may be very painful initially, it’s difficult as they are going through treatment and they will sometimes have other ways that they are getting their nutrition. But to keep swallowing and to keep practice swallowing with a speech pathologist to know that they are safe. We always want to make sure that a patient isn’t at risk for developing pneumonia, if they are not swallowing properly. So, again, the speech pathologist makes recommendations for what is a safe diet, what can they do, what can’t they do.

But they try to keep them going through the process and through the treatment to keep them swallowing so that once they are done with everything and as they recover, they can get back to a normal diet as soon as it is safe and as soon as possible for that patient and get back to enjoying the things that they did before they had the treatments. So, it’s really important and it’s really a huge quality of life thing for the patients that have gone through these treatments.

Host:  That’s really good to know Christina that physical therapists involved here in this case the speech pathologists they are working with patients all the way through. They don’t just come in after the surgery and say okay what do we need to do to help you. That they are there from the beginning really developing a plan, right, for patients all the way through?

Christina:  Absolutely. And we actually have a multidisciplinary team that involves speech pathologists. The work right with the dietician, they have social workers and they work together to be able to make sure that the patients are supported through the process and getting all the supportive services that they need again, to have that full recovery after that treatment is done. It’s challenging to go through cancer treatment. But it’s all about surviving and thriving we say. It’s about that journey getting through it and then really being the best you can be after you’ve gone through this very challenging treatment.

Host:  Yeah, what a comfort it must be for patients to know that there are people there to help them throughout this process and kind of speaking about the process, are there certain kinds of cancer that tend to have more side effects than others and then which of them might benefit most from rehab?

Christina:  In the beginning, many times patients will go through surgery to remove a cancer if there’s a tumor or something that’s in a specific area. If that’s larger, that’s going to affect more tissues, there will be more scar tissue and just like any other surgery that you’ve had, I think everyone assumes that they have a knee replacement that they are going to need physical therapy to get through that. But sometimes people don’t really think that therapies can be helpful after surgeries for cancer because there’s so many other steps that they have to worry about.

But dealing with the tissues and the scarring and any strength that you may need to improve after surgery; all of the therapies physical, occupational, speech depending on the type of cancer could help you through that process and help you recover more fully. So, the other thing is the treatments. Specific types of like chemotherapy, there are different types of chemotherapy that may cause issues with nerves. We call that peripheral neuropathy. That’s a fancy term just to say that the nerves don’t always work quite as well so as I was saying, that’s one of the things that goes into that increased risk for falls. If my nerves are not quite as sensitive in my feet or my legs; then I might not be as sensitive to knowing oh, I’m a little off balance or I might feel less secure when I’m walking or running or doing something that I did previously prior to the treatment.

It depends on the type. It depends on the size of the cancer. It also depends on the type of treatment that is provided to then see what the effects are and all of the therapists, they can take a look at all the different areas that may be affected based on what treatments a patient had and then they can develop a plan and they can develop specifically something that will help that individual improve and feel better and get back to their normal life.

Host:  It does seem to me that more often than not, rehab is probably going to be able to help people and I’m wondering and I’m guessing there’s situations where maybe patients think they might benefit from rehab but the doctor isn’t suggesting or prescribing it; how do you suggest patients approach that conversation when they believe it will help them but maybe not everybody in the room agrees?

Christina:  First of all, I would say to tell a patient that any doctor can prescribe physical therapy or occupational therapy or speech therapy. So, they can write you a script for that service. It doesn’t just have to be an oncologist; it could be the regular medical doctor or another doctor that you really feel that listens to you and understands the things that you are trying to say. The other thing I would say is be as specific as possible. I think sometimes patients are first of all, afraid to disagree with the doctor and I don’t really think it’s about disagreeing, but I really think they are not always clear about what they really need and what they are having problems with. And we all know that physicians are really busy. They have a lot of patients they need to see and so, you have to be direct and you have to be specific.

So, if physical therapy is something that you felt you are in need of as a patient, I think to be specific and say something such as since I’ve been through treatment with chemotherapy, I’m unsteady and I’m afraid of falling. I would like to go see a physical therapist to help me with this. If you wanted to see occupational therapy because you were having difficulty with what you felt like was a little bit of swelling, you could say since I’ve been through treatment for breast cancer, my right arm seems more swollen than my left. I would like to go to an occupational therapist to evaluate it. Or if you felt speech therapy might be something you’d need, you could say since I’ve been through tongue cancer treatment, I’ve had trouble eating the foods I used to eat. I would like to go see a speech therapist to help me with this.

I think if you phrased it in that way, I think that any physician would agree that it’s worth a try to be able to help you live the life that you want to live and deal with the things that you’ve been dealing with. I don’t think as patients we are often that specific and I think it could really help.

Host:  I love that Christina. That’s great and so awesome of you to just really speak in specifics. Those are – to give patients an idea like this is exactly how you could say this to your doctor to get the outcomes that you are looking for. That’s awesome. Anything else you would like to add about the work you are doing, UM Upper Chesapeake Health, anything else we can tell patients or prospective patients?

Christina:  Let’s say ten years from now, although we’d like it to be as soon as possible, I would really like everyone to understand both patients, physicians, insurance companies, the community, all to understand how vital the role of rehabilitation is in the journey of someone’s cancer treatment. It really is important I think in the long run. It will help people live better, live longer. We know the survival rates of cancer are increasing significantly. But I also want to make sure that the quality of life is improved, and that people don’t deal with side effects that could be avoided.

Host:  Thank you so much for joining me today Christina. For more information about the UM Rehabilitation Network, visit www.umms.org/rehab-network. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.