Occupational therapy intervention for cancer patients following hospital discharge: How and when should we intervene? A systematic review

Does the Canadian Occupational Performance Measure (COPM) Capture the Complex Experiences of Cancer Survivors? A Mixed Methods Approach

Occupational therapy practitioners are uniquely positioned to address the needs of cancer survivors. This study aimed to understand the complex needs of survivors using The Canadian Occupational Performance Measure and in-depth interviewing. A convergent, mixed methods approach was utilized with a purposive sample of 30 cancer survivors. The results indicate that while the COPM can be a practical tool to address basic occupational performance problems, the in-depth interviews exposed these challenges are intricately connected to identity, relationships, and roles. Implications for occupational therapy practitioners include a critical approach to evaluation and interventions to capture the complex needs of survivors.

Occupational Therapy After Breast Cancer Reconstructive Surgery: A Predictor for Opioid Prescriptions

Occupational therapy practitioners have a unique and vital role among interprofessional health care teams toward facilitating occupational participation among breast cancer survivors. This study investigated the relationship between acute medicine occupational therapy services after breast cancer reconstructive surgeries (BCRS) and a number of prescription refills 90 days after surgery. This retrospective study ran binary logistic regression analyses on 562 women after BCRS for refills of opioid and non-opioid medication. Both models were statistically significant, χ2(7df) = 23.001, p = .002; χ2(7df) = 32.312, p < .001, indicating the ability to distinguish who received opioid or non-opioid refills, respectively. While younger age was a significant predictor across both models, occupational therapy was only significant for opioid refills; each was associated with fewer refills. Early occupational therapy treatment after BCRS is associated with fewer opioid prescriptions 90 days after surgery, therefore enhancing occupation throughout this timeframe is beneficial.

Improving personalised care and support planning for people living with treatable-but-not-curable cancer

People living with treatable-but-not-curable (TbnC) cancer encounter cancer-related needs. While the NHS long-term plan commits to offering a Holistic Needs Assessment (HNA) and care plan to all people diagnosed with cancer, the content, delivery and timing of this intervention differs across practice. Understanding how people make sense of their cancer experience can support personalised care. A conceptual framework based on personal narratives of living with and beyond cancer (across different cancer types and all stages of the disease trajectory), identified three interlinked themes: Adversity, Restoration and Compatibility, resulting in the ARC framework.Our aim was to use the ARC framework to underpin the HNA to improve the experience of personalised care and support planning for people living with TbnC cancer. We used clinical work experience to operationalise the ARC framework and develop the intervention, called the ARC HNA, and service-level structure, called the ARC clinic. We sought expert input on the proposed content and structure from patients and clinicians through involvement and engagement activities. Delivered alongside standard care, the ARC HNA was piloted with patients on the TbnC cancer (myeloma and metastatic breast, prostate or lung) pathway, who were 6-24 months into their treatment. Iterations were made to the content, delivery and timing of the intervention based on user feedback.Fifty-one patients received the intervention. An average of 12 new concerns were identified per patient, and 96% of patients achieved at least one of their goals. Patients valued the space for reflection and follow-up, and clinicians valued the collaborative approach to meeting patients' supportive care needs. Compared with routine initial HNA and care plan completion rates of 13%, ARC clinic achieved 90% with all care plans shared with general practitioners. The ARC clinic adopts a novel and proactive approach to delivering HNAs and care plans in a meaningful and personalised way.

Art-Based Workshops for Women: An Opportunity for Reflection on Identity and Transformation following Cancer Treatment

Individuals experiencing cancer often report feelings of abandonment by the healthcare system after medical treatment has ended. Specifically, women with cancer have expressed the need for support beyond traditional medical and rehabilitation periods, especially with the process of reconstructing the self in the context of enduring illness. Occupational therapists could play a critical role in providing opportunities for self-reflection and transformation through occupation for this population. Art-based occupations may be especially useful for providing space for self-reflection and personal change. This article describes the experiences of women living with cancer who participated in community art-based workshops that focused on the themes of identity and transformation. The project consisted of mixed-media workshops that were held at a community-based facility providing supportive programs for people living with cancer. Eleven women participated in the workshops led by an art-based rehabilitation researcher and a visual artist. Workshops were audio-recorded, and photographs of the participants' artwork were taken. Individual postworkshop interviews were conducted with the participants, within 4 to 6 weeks following the last workshop. Interpretive description was used to capture four themes with implications for personal change, transformation, and occupational therapy: (1) revealing: therapeutic potential; (2) sharing: vulnerability and new perspectives; (3) transforming: the self; and (4) creating: regular practices. The findings point to ways occupational therapists can form new partnerships with other disciplines and professionals to generate positive outcomes for people living with cancer.

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial

Background: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb’s functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. Methods: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. Results: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η² ≤ 0.080). In the rest of the variables, no significant differences were found. Conclusions: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.