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Physiotherapy & Cancer Care Mind Map 2, SO WHAT? What are the…
Physiotherapy
&
Cancer Care
Mind Map 2
SO WHAT?
NOW WHAT?
SERVICE DEVELOPMENT
MY DEVELOPMENT & CHANGES TO PRACTICE
Education about exercise guidelines to cancer patients on SAGE ward
How will I do this?
Utilising education resources to provide to patients
Education on recommended activity guidelines, as per COSA statement
Ensure education is tailored to the individual
Education on reduced risk of falls, mortality
Education on falls and
cancer patient
Balance, strength, flexibility training interventions
Education on increased risk of falls and fractures
Written resources
Communication
Courageous conversations
Using Peer Supervision:
Discussing case study with senior cancer care physio
Participating in oncology journal club
Consolidation of knowledge
Peer supervision
Continue reflective practice
Educate other junior clinicians
Attend PD opportunities at the hospital
SO WHAT?
What are the recommendations for exercise?
Aerobic:
150 minutes of moderate intensity exercise
or 75 minutes of vigorous-intense exercise each week
Resistance:
Two to three resistance exercise sessions involving moderate – vigorous intensity targeting major muscle groups
Cormie et al. (2017)
31% lower chance of death in those who engaged in leisure activity (colorectal cancer)
40-50% lower risk of recurrence and death from breast cancer
21-35% lower risk of cancer recurrence
SO WHAT?
What are the management options and side effects? (Campbell et al 2019)
Surgery
Gastrointestinal changes - altered GI function
Endocrine changes - changes in body composition
Altered lung function or pneumonitis (lung surgery)
Cognitive changes (brain surgery)
Reduced ROM
Fatigue
Lymphodema (removal of lymph nodes)
Pain
Chemotherapy
Cardiac damage / increased CVD risk
Endocrine changes (changes in body composition - weight gain, muscle loss/weight loss), worsening bone health
GI changes
Impaired immune function
Metabolic changes
Peripheral neuropathy, cognitive changes
Pulmonary changes
Fatigue
Pain (general, myalgia/arthralgia)
Radiation
Cardiac damage / increased CVD risk
Worsening bone health
Changes in body composition
GI changes - diarrhoea, altered GI function
Impaired immune function
Cognitive changes
Altered lung function
Skin changes (redness, burns, reduced ROM)
Fatigue
Lymphodema
Pain (general, myalgia)
Hormonal Therapy
Cardiac damage / increased CVD risk
Endocrine changes (changes in body weight and composition)
Impaired immune function/anaemia
Cognitive changes
Metabolic syndromes
Fatigue
Pain and myalgia
Immunotherapy
Cardiac changes / increased CVD risk
Changes in body composition
GI changes - nausea, diarrhoea
Impaired immune function
Metabolic syndrome
Skin changes (rashes)
Fatigue
Pain
NOW WHAT?
Opportunities for Service Development
Advocate for the role that Physio has to play across the cancer care continuum
Increase awareness within and outside profession and educate wider community
Education for health professionals (indication, guidelines, referrals and safety)
Integration of qualified exercise professional into the clinical team
Educational resources for patients
NOW WHAT?
Opportunity for Service Delivery: Outpatient Exercise Class
Barriers
Patient
Nutrition (cachexia)
Pain
Medical advice
Anaemia
Fatigue and energy
Dyspnoea
Availability between appointments
Time
Transport
Location
Health literacy
Motivation
Prioritisation of exercise
Service
Access to resource
Funding
Therapist availability and time
Medical advice and culture
Facilitators
Patient
Group class environment
Education on evidence from reliable source
Service
Opportunity for education of MDT
Opportunity to involve other AH members
Large patient cohort
Evidence based intervention
Potential to improve outcomes for patients to reduce health expenditure
SO WHAT?
What are the side-effects that exercise has therapeutic effect on?
Strong evidence:
Anxiety
Fatigue
Depressive symptoms
Health related quality of life
Lymphodema
Physical function
Moderate Evidence:
Bone health
Sleep