Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

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.

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study

IMPORTANCE

Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps.

OBJECTIVE

To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals.

DESIGN

Multiexplanatory qualitative case study.

SETTING

Community and hospital cancer clinics in Israel.

PARTICIPANTS

Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants.

RESULTS

Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care.

CONCLUSIONS AND RELEVANCE

Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Usability of a mobile phone application to enhance activities of daily living in occupational therapy services for breast cancer survivors

Background/Objective: The use of new technologies in rehabilitation to evaluate and improve occupational performance and quality of life is increasing. Technological applications in the health field could help meet the needs of patients, including those of women breast cancer survivors. The main aim of this study was to design a mobile phone application "MAIA" focused on the perceived needs of women who have had breast cancer to achieve optimal performance in their daily lives in a meaningful way. Methods: A cross-sectional usability study using an online questionnaire was designed. Sociodemographic and occupational performance data were collected. System Usability Scale, Engagement in Meaningful Activities Survey, Occupational Balance Questionnaire, General Self-Efficacy Scale, Functional Assessment of Cancer Therapy - General and Disabilities of the Arm, Shoulder and Hand were administered. Descriptive statistics were used to describe categorical (frequencies and percentages) and quantitative variables (mean and standard deviation). Results: The sample was composed of seventy-eight women diagnosed with breast cancer. Nine activities of daily living were affected in more than 20% of women with breast cancer. The most affected were sleep and rest and functional mobility. Conclusions: Women survivors of breast cancer showed difficulties in daily life performance and participation. The MAIA App could be useful as a new online resource in occupational therapy for the rehabilitation of breast cancer survivors.

Factors That Influence Occupational Engagement of Young Adults Who Are Cancer Survivors: A Pilot Study

Cancer and its treatment can impact occupational engagement. However, occupational therapy-specific research studying young adult cancer survivors remains limited. The objective of this study to identify the type of occupations that young adult cancer survivors choose to engage in and to understand their decision-making process when choosing these occupations. A mixed-methods explanatory sequential design was used. Eleven participants, nine females and two males, between the ages of 18 and 35, were included. Several occupations were identified for engagement such as activities of daily living, leisure, work, sleep and rest, and health management. The predominant factor that influenced why occupations were chosen was that individuals purposefully selected occupations that allowed them to choose a path toward a more meaningful life. Information gained from this pilot study can be used to inform occupational therapy practitioners regarding services and interventions that promote occupational engagement for young adult cancer survivors.

The occupational impact of bowel cancer: Survivors' voices and advancing the role of occupational therapy assessment and intervention

INTRODUCTION

The aim of this study was to investigate the occupational impact (i.e., how engagement in occupation is affected) of having had bowel cancer and the role of occupational therapy with bowel cancer survivors and their significant others.

METHODS

Two rounds of semi-structured interviews were carried out with individuals who had completed treatment for bowel cancer, with interviews designed to gain insight into their occupational experiences post treatment. Thematic analysis was utilised to construct themes and patterns founded on the perceptions of participants. Analysis involved concurrent data collection and analysis, constant comparative analysis, and iterative analysis.

FINDINGS

Eighteen participants were interviewed, with occupational impact evident across multiple aspects of everyday life. Four themes were identified: Changes in eating habits, changes in toileting habits, changes in relationships, and rethinking occupational choices.

CONCLUSION

Findings of the occupational impact of having had bowel cancer reveal a possible role for occupational therapists with people affected by bowel cancer. Occupation focused assessments and self-management programmes are identified as a possible means of meeting the needs of this population, making use of the experiences of peers to provide a credible, relatable voice.

The Essential Role of Occupational Therapy to Address Functional Needs of Individuals Living with Advanced Chronic Cancers

OBJECTIVE

Medical progress in cancer care has led to increased life expectancy outcomes across all stages of cancer, including in advanced cancers. People now living with advanced chronic cancers have unique, ongoing functional and quality-of-life needs. This article explores the functional considerations of individuals living with advanced chronic cancers in terms of managing chronic palliative care needs, assessing and intervening for functional issues, and consistently using occupational therapy in shared service provision together with medical and nursing teams. The unique and changing functional needs of these individuals may be effectively addressed through consideration of chronic palliative approaches to care; earlier access to occupational therapy services to facilitate continued engagement in everyday activities; and shared service provision with nursing to address both medical wellness and functional status.

DATA SOURCES

These include key databases (Pubmed, CINAHL), international guidelines, and professional guidance documents.

CONCLUSION

Individuals living with advanced chronic cancer have ongoing and fluctuating functional needs that should be addressed in palliative care service provision. The inclusion of occupational therapy as part of inter- and multidisciplinary teams can facilitate maximization of function for individuals living with advanced chronic cancer.

IMPLICATIONS FOR NURSING PRACTICE

Timely early referrals to occupational therapy can address functional issues as they arise, and can prepare individuals for future functional considerations.

The effect of play-based occupational therapy on symptoms and participation in daily life activities in children with cancer: A randomized controlled trial

Introduction

This study aimed to investigate the effect of play-based occupational therapy on symptoms and participation in daily life activities in hospitalized children with cancer undergoing chemotherapy.

Method

A total of 25 children (mean age = 9.28 ± 0.95 years, range = 7–12 years) with cancer undergoing chemotherapy were enrolled and randomly assigned to a play-based occupational therapy group ( n = 12) or control group ( n = 13). The intervention group received eight 1-hour play-based occupational therapy sessions, and the control group received traditional occupational therapy services. Participation in daily life activities, therapy-related symptoms, pain, anxiety, and fatigue were evaluated.

Results

Total mean scores of participation in daily life activities in the intervention group in the diversity of activities ( p = 0.001, d = 1.39), intensity of participation ( p = 0.001, d = 1.86), with whom done ( p = 0.005, d = 1.22), enjoyment ( p = 0.003, d = 1.33), and parents’ satisfaction ( p = 0.003, d = 1.33) were significantly higher than the control group. Symptoms decreased in both groups; however, this trend had a significant difference in the intervention group for the therapy-related symptom checklist ( p = 0.001, d = 1.68), pain ( p = 0.001, d = 1.61), anxiety ( p = 0.001, d = 1.58), and fatigue ( p = 0.002, d = 1.39) scores.

Conclusion

A 2-week course of inpatient play-based occupational therapy is an effective approach in the reduction of cancer symptoms, therapy-related symptoms, and the participation facilitation, of children with cancer in daily life activities.

Hybrid Tele and In-Clinic Occupation Based Intervention to Improve Women's Daily Participation after Breast Cancer: A Pilot Randomized Controlled Trial

BACKGROUND

Women after breast cancer (BC) cope with decreased daily participation and quality of life (QOL) due to physical, cognitive, and emotional symptoms. This study examined a hybrid occupation-based intervention, Managing Participation with Breast Cancer (MaP-BC), to improve daily participation in their meaningful activities.

METHODS

Thirty-five women after BC phase were randomly allocated to the MaP-BC intervention (n = 18) or control (n = 17) group (standard care only). Assessments were administered at baseline (T1), 6-week (T2), and 12-week (T3) post-T1.

MAIN OUTCOME

perceived performance and performance-satisfaction with meaningful activities according to the Canadian Occupational Performance Measure.

SECONDARY OUTCOMES

retained activity levels (Activity Card Sort), QOL (Functional Assessment of Cancer Therapy-Breast), cognitive abilities (Montreal Cognitive Assessment and Behavior Rating Inventory of Executive Function), and upper-extremity functioning (Disability of Arm, Shoulder, Hand). Results showed significant interaction (group x time) effects for the primary outcome in performance, F(2,66) = 29.54, p = 0.001, ɳP2 = 0.472, and satisfaction, F(2,66) = 37.15, p = 0.000, ɳP2 = 0.530. The intervention group improved more in performance, t = 5.51, p = 0.0001, d = 1.298, and satisfaction, t = -5.32, p = 0.0001, d = 1.254, than the control group between T1 and T2. Secondary outcomes demonstrated within-group improvements.

CONCLUSION

MaP-BC, a comprehensive occupation-based hybrid intervention tailored to women's functional daily needs after BC, improved participation in meaningful activities within a short period.

Functional, work-related rehabilitative programming for cancer survivors experiencing cancer-related fatigue

Introduction

Cancer-related fatigue negatively impacts 50–90% of cancer survivors. In North America, approximately 50% of return-to-work interventions initially fail for survivors, with cancer-related fatigue often cited as a barrier to workability. Occupational therapy-driven cancer-related fatigue work-related programming for survivors is sparse, despite many published reviews calling for interdisciplinary interventions; to address work-related performance, specific functional interventions are likely to be needed. Further exploration and a broader understanding of survivors’ cancer-related fatigue management, participation in rehabilitative programmes, and plans for return to work are necessary to target survivor needs better.

Method

Drawing on social theory, this exploratory descriptive study utilised content and thematic analysis of interviews from 12 survivors to explore and describe the perspectives of survivors experiencing cancer-related fatigue yet desiring to work.

Results

Content analysis reflected distinct differences in fatigue-related terminology. Thematic analysis identified three themes specific to cancer-related fatigue and workability: valuing physical wellness, perceived cognitive impacts of cancer-related fatigue on function and workability, and the lack of transition from physical exercise to functional work-related activities.

Conclusion

Survivors identified gaps in care related to managing cognitive symptoms and the need for functional, work-related interventions to manage cancer-related fatigue. With their expertise in function, occupational therapists are well positioned to facilitate work-specific interventions, within cancer-specific exercise programming.

Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies

OBJECTIVE

Patients with breast cancer face cognitive impairment that affects their quality of life; partially attributable to treatment. Our aim was to detail the prevalence and change of cognitive impairment during the course of treatment. We also investigated the effect of therapy (chemotherapy [CT]) vs. radiotherapy and/or endocrine therapy vs. healthy controls).

METHODS

This article reviews longitudinal cohort studies published to date in Medline and Embase that (i) assess cognition before and after therapy, (ii) report prevalence cognitive impairment or change, and (iii) use standardized and valid neuropsychological tests. We used the original authors' criteria for cognitive impairment.

RESULTS

The title and abstract of 891 articles were screened, resulting in the identification of 90 potentially relevant articles while applying the eligibility criteria. After full-text examination, 17 studies were included. Prevalence of cognitive impairment range from 25% before therapy, through 24% after therapy to 21% at maximal 1-year follow-up (FU). Compared to their pretreatment cognitive functioning, 24% of patients decline after treatment and 24% at 1-year FU. Some studies also reported cognitive improvement showing that 15% and 31% of patients improve, respectively. In general, patients undergoing CT have a higher chance of cognitive impairment and decline than no-CT patients and healthy controls.

CONCLUSIONS

This study shows that one out of four breast cancer patients shows cognitive impairment prior to treatment administration CT and a significant number of patients decline during the course of disease, suggesting that cognitive impairment is not exclusively related to CT and/or no-CT therapies. This study shows that assessment of cognitive functioning, ideally over time, is crucial and may help the implementation of personalized rehabilitation pathways.

Cancer-related fatigue in head and neck cancer survivors: Energy and functional impacts

BACKGROUND

Survivors with head and neck cancer (HNC) report cancer-related fatigue (CRF) as a devastating, prevalent health issue that limits activity engagement and adversely influences quality of life.

OBJECTIVE

To explore HNC survivors' written responses and descriptors regarding CRF, and offer potential healthcare strategies based on findings.

METHODOLOGY

In written format, similar to responses on intake forms in outpatient-clinics, 25 HNC survivors provided descriptions of their CRF experiences and their perspectives on its impact. An exploratory descriptive research design was utilized, drawing on social theory for content analysis and thematic development.

RESULTS

Two main themes regarding CRF arose from the data: (1) CRF as a barrier to daily function; and (2) uncontrollable and unpredictable energy fluctuations.

CONCLUSIONS

To enhance outcomes of CRF symptom management in HNC survivors, a healthcare approach that targets the functional implications of CRF, and utilizes energy cultivation strategies when communicating about the negative impacts of CRF (including limited function and fluctuating energy levels) may be beneficial for HNC survivors. Further research into the effects of CRF on function for HNC survivors is warranted.

Managing daily life among people with advanced cancer living at home: Responding to uncertainties related to shifting abilities, home care, and treatment

Introduction

People with advanced cancer are increasingly expected to live at home and manage the consequences of illness and treatment. The purpose of this study was to explore how people with advanced cancer manage the influence of home care and treatment on occupations and habits.

Method

Constructivist grounded theory guided the collection and analysis of data from 22 people with advanced cancer. Data were collected using in-depth interviews and participant diaries.

Findings

Uncertainty about abilities to engage in occupation and home care and treatment delivery disrupted participants’ daily life. Participants employed various strategies to manage uncertainties and to preserve a sense of agency and control.

Conclusions

This study provides insights into how people with advanced cancer manage and respond to the impact of illness, home care, and treatment in their daily life. The findings may aid occupational therapists to develop and deliver interventions that allow their patients to maintain a sense of agency in their daily life.

Women's Experiences After Ovarian Cancer Surgery: Distress, Uncertainty, and the Need for Occupational Therapy

IMPORTANCE

Despite the growing literature on the association of functional, physical, and quality-of-life (QOL) deficits with poor postoperative outcomes, there is a gap in the literature identifying women's occupational performance needs after ovarian cancer surgery.

OBJECTIVE

To describe the experiences of women hospitalized after ovarian cancer surgery to identify potential areas for intervention. Goals were to (1) identify functional needs and limitations at time of discharge as measured by the typical acute care occupational therapy evaluation and semistructured interview and (2) understand the women's perspectives of their needs for occupational therapy and a safe return to home.

DESIGN

Single-arm, cross-sectional descriptive study. Mixed-methods data collection and analysis.

SETTING

Academic cancer center.

PARTICIPANTS

Women with ovarian cancer (N = 11) who had completed surgery.

INTERVENTION

Semistructured interviews and patient-reported outcome measures (PROMs) completed postsurgery.

OUTCOMES AND MEASURES

PROMs included the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List, the PROMIS® Global Physical Health (GPH) and Global Mental Health (GMH) scales, and the Possibilities for Activity Scale-Women (PActS-W).

RESULTS

The mean NCCN Distress score was 6.0 (standard deviation [SD] = 3.1, with the top three concerns being pain (80%), worry (80%), and fatigue (78%). Mean GPH and GMH T scores were 38.0 (SD = 8.8) and 48.2 (SD = 8.4), respectively. Women scored a mean of 39.2 (SD = 11.2, range = 26-58) on the PActS-W. Thematic analyses found that the women were uncertain about potential functional limitations and significantly distressed.

CONCLUSION AND RELEVANCE

Women with ovarian cancer experienced high levels of uncertainty and distress after surgery. Integrating in-home or community-based occupational therapy into routine care could decrease functional distress and uncertainty and help women manage concerns related to pain, worry, and fatigue.

WHAT THIS ARTICLE ADDS

This study suggests that occupational therapy evaluation and intervention are needed to decrease distress and improve QOL of women upon discharge after ovarian cancer surgery.

Occupational Therapy Group Interventions in Oncology: A Scoping Review

Importance: Patients with cancer frequently experience difficulties with everyday activities. This scoping review explores occupational therapy group interventions in oncology, an area relevant to occupational therapy practitioners, but one that has limited evidence.

Objective: This scoping review examines the association between occupational therapy–based oncology groups and improved functional activity of daily living outcomes for adults with cancer. It poses the following research question: Are occupational therapy groups associated with improved functional outcomes for adults with cancer?

Data Sources: Searches of MEDLINE, CINAHL, AMED, OTseeker, Health Source: Nursing/Academic Edition, and OTDBase were completed for peer-reviewed articles published from 1997 to 2018.

Study Selection and Data Collection: Inclusion criteria were articles published in English and occupational therapy–based groups for adults with cancer.

Findings: Eight articles matched the inclusion criteria. The articles reviewed were 2 randomized controlled trials, 1 case study, 1 descriptive exploratory research study, 1 mixed-methods study, 2 pretest–posttest studies, and 1 longitudinal prospective comparative study.

Conclusions and Relevance: Occupational therapy groups led to a significant increase in occupational performance and satisfaction, an improvement in functioning, and a decrease in fatigue. Engagement in important roles and occupations and sharing the experience with others were also highly valued. This review provides support for the implementation of group-based occupational therapy interventions in oncology. Further research is required in this area, particularly in the inpatient setting with men included in the sample.

What This Article Adds: This scoping review demonstrates the benefits of group-based occupational therapy interventions for adult patients with cancer.

Reasons for and outcome of occupational therapy consultation and treatment in the context of multidisciplinary cancer rehabilitation; a historical cohort study

INTRODUCTION

The aim of this study was to investigate reasons why people consulted an occupational therapist following cancer treatment, and to examine the outcome of occupational therapy interventions, in the context of multidisciplinary rehabilitation.

METHODS

Data from 181 patients were collected retrospectively. The International Classification of Human Functioning and Health (ICF) was used to describe the reasons for occupational therapy consultation. Patients had completed the Canadian Occupational Performance Measurement (COPM) before and after the occupational therapy intervention. Change scores were calculated with a 95% confidence interval and a two-sided p-value obtained from a paired t-test.

RESULTS

The reasons for occupational therapy consultation were predominantly within the ICF domain "Activities and Participation". On average, patients improved 3.0 points (95% CI 2.8-3.2) on the performance scale of the COPM, and 3.4 points (95% CI 3.2-3.7) on the satisfaction scale (both: p = <.001).

CONCLUSION

The result of this study supports the added value of occupational therapy to cancer rehabilitation, and emphasise the positive effect of occupational therapy on everyday functioning. Controlled clinical studies are needed to strengthen the evidence.

Development of a comprehensive pediatric oncology rehabilitation program

Comprehensive cancer rehabilitation programs are essential to enhance patient outcomes. Services vary by institution, and few oncology programs have comprehensive cancer rehabilitation programs. Current rehabilitation program recommendations focus on the needs of adults; the unique needs of children and adolescents with cancer also require attention. Pediatric oncology rehabilitation is an emerging area of practice, and more pediatric institutions are exploring how to develop consistent and streamlined services. To assist practitioners in program development and to raise awareness of the rehabilitation needs of this population throughout the continuum of care, we describe the development of a multidisciplinary pediatric cancer rehabilitation program.

Cancer care and occupational therapy: A scoping review

INTRODUCTION

Cancer can disrupt participation in everyday activities, suggesting a place for occupational therapy; however, there is a need to articulate the nature, scope and available evidence supporting the occupational therapy role within cancer care. In this scoping review, we identify the breadth of practice and evidence for occupational therapy in cancer care, across all stages of the disease trajectory (diagnosis to palliation/survivorship) throughout the lifespan.

METHODS

Five electronic databases were searched in June 2018, for English language articles. Key words were: cancer care, OR oncolog*, OR oncologic care, OR neoplasms, OR cancer survivors, OR terminal cancer, OR cancer rehabilitation, AND occupational therap*. No date restrictions were imposed. Included were: all styles of literature including grey literature, all types of cancers and all age brackets. There were no restrictions on place of origin of papers. Following the Arksey and O'Malley (2006; International Journal of Social Research Methodology, 8: 19-32) framework for scoping reviews, the first author screened titles and abstracts, and all three authors reviewed sets of the included articles. Conflicts were discussed until consensus was reached.

RESULTS

After evaluating 305 titles and abstracts and 111 full-text articles, 89 papers were retained. Articles included research studies (n = 43), reviews (n = 15), grey literature (n = 16), practice analyses (n = 14) and an editorial (n = 1). The occupational therapy roles described were diverse, but largely descriptive in nature, with little evidence of outcomes from treatment. Furthermore, the majority of papers addressed adult populations, with few considering children, adolescents or young adults. Most papers focused on specific stages of the disease, and none addressed the disease along its full trajectory.

CONCLUSION

Despite identifying a diverse range of occupational therapy roles in cancer care throughout the disease trajectory and across the lifespan, the need for professional discourse and research within our profession was highlighted. This was particularly evident for adolescents and young adults with cancer.

The Who, What, Why, When, Where, and How of Team-Based Interdisciplinary Cancer Rehabilitation

OBJECTIVE

To review the key components necessary for successful application of rehabilitation principles to oncology survivors.

DATA SOURCES

Validated databases, including PubMed, MEDLINE, and Scopus.

CONCLUSION

Rehabilitation is an essential component of cancer care that addresses functional needs for oncology survivors and is best accomplished via an interdisciplinary team. Interdisciplinary care, provided by nursing, physiatry, rehabilitation therapy, and exercise physiology, are critical components for comprehensive intervention. Challenges exist in implementing services, but opportunity also exists within the post-acute care sector.

IMPLICATIONS FOR NURSING PRACTICE

Nurses play an important role in the screening, assessment, and treatment of cancer-related functional impairments.

A Secure Occupational Therapy Framework for Monitoring Cancer Patients' Quality of Life

Once diagnosed with cancer, a patient goes through a series of diagnosis and tests, which are referred to as "after cancer treatment". Due to the nature of the treatment and side effects, maintaining quality of life (QoL) in the home environment is a challenging task. Sometimes, a cancer patient's situation changes abruptly as the functionality of certain organs deteriorates, which affects their QoL. One way of knowing the physiological functional status of a cancer patient is to design an occupational therapy. In this paper, we propose a blockchain and off-chain-based framework, which will allow multiple medical and ambient intelligent Internet of Things sensors to capture the QoL information from one's home environment and securely share it with their community of interest. Using our proposed framework, both transactional records and multimedia big data can be shared with an oncologist or palliative care unit for real-time decision support. We have also developed blockchain-based data analytics, which will allow a clinician to visualize the immutable history of the patient's data available from an in-home secure monitoring system for a better understanding of a patient's current or historical states. Finally, we will present our current implementation status, which provides significant encouragement for further development.

ECCO Essential Requirements for Quality Cancer Care: Primary care

BACKGROUND

ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.

The implications of women's activity limitations and role disruptions during breast cancer survivorship

Early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles. This study aimed to explore the challenges of women and their partners as they attempted to resume activities and roles, identify unmet needs and make recommendations regarding a suitable framework to support women and partners to recommence valued activities and important roles during early survivorship. Qualitative methods utilising in-depth interviews of women (n = 18) and their partners (n = 8), and two focus groups (n = 10) were completed in Perth, Western Australia, between June 2014 and April 2015. These methods were used to facilitate women and partners' views regarding the resumption of previously meaningful activities and important life roles during early survivorship. Questions addressed their individual and shared experiences concerning self-care, leisure, social and productive activities and important roles. Thematic analysis was employed to determine themes. Women and partners reported significant impact on their ability to engage in valued activities, resulting in changes to participation in meaningful roles. Three themes were determined: (1) ambiguity regarding survivorship prevents resumption of activities and previous roles, (2) breast cancer continues to impact a couples' relationship during survivorship, and (3) support is needed to assist women and partners to resume activities and important roles. This research provides evidence suggesting that the ongoing symptoms of breast cancer treatment continue to impact many women and their partners, as they attempt to resume functional activities and important life roles during early survivorship. Disruption to these valued activities and roles may influence women and their partner's health and well-being during early survivorship and extend beyond this period. Rehabilitation following cessation of treatment could be offered as required to facilitate access to multi-disciplinary services and supports for both individuals and couples.

Occupational therapy practice in oncology care: Results from a survey

The everyday landscape of occupational therapy (OT) in oncology is underexplored, hindering targeted improvements. The purpose of the present study was to identify the OT interventions commonly provided and reimbursed in oncology. A survey utilizing snowball sampling was disseminated online to OT working in oncology care; 167 surveys were received from 21 states in the United States. Results found that over 90% of therapists reported focusing on physical impairment, weakness, fatigue, and activities of daily living. Interventions for emotional/social support, self-advocacy, quality of life, lifestyle management, and cognitive impairment were not directly billed. More than 90% of therapists reported that, in the absence of barriers, they would address quality of life, emotional difficulties, lifestyle management, and home safety. Overall, the findings suggested that OT in the United States primarily provide physical interventions for oncology patients. However, they also provide psychosocial services and client/caregiver education, but often do not bill directly for this care. Reimbursement structures should be modified to allow for the direct billing of mental/psychosocial and educational interventions in OT for cancer care.

Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition

Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.

A Descriptive Report of Early Mobilization for Critically Ill Ventilated Patients with Cancer

BACKGROUND

Early mobilization protocols have been successfully implemented to improve function in critically ill patients; however, no study has focused on the oncology population.

OBJECTIVES

To investigate the feasibility of early mobilization and describe the rehabilitation interventions and discharge outcomes in a cohort of critically ill patients with cancer.

DESIGN

Retrospective review.

METHODS

A retrospective analysis of patients with cancer who participated in occupational and physical therapy while on mechanical ventilation utilizing an institutional early mobilization protocol from June 2010 - July 2011, was completed. Demographic and clinical variables were abstracted, as well as occupational and physical therapy interventions.

RESULTS

A cohort of 42 cancer patients on mechanical ventilation in the mixed medical/surgical intensive care unit of a comprehensive cancer center received early mobilization during the study period. The majority of participants demonstrated improved cognitive and functional status from the intensive care unit to hospital discharge. There were no reported adverse events during the occupational and physical therapy sessions. Among the 30 hospital survivors, 53% required continued rehabilitation services in their home environment and 40% were transferred to a rehabilitation facility.

LIMITATIONS

Due to the small sample size, these findings are not generalizable to all critically ill cancer patients. There was no post-acute care follow-up of cognitive and physical functional performance.

CONCLUSION

Early mobilization appears feasible in addressing the cognitive and functional needs of oncology patients in the intensive care unit.

Taking Our Seat at the Table: Community Cancer Survivorship

Cancer survivors are at risk for occupational performance issues related to activities of daily living, instrumental activities of daily living, work, and social and community participation. Occupational therapy practitioners can address these performance issues by offering services within existing community cancer survivorship programs that focus on adaptive and compensatory strategies to facilitate meaningful lifestyles and optimize health and well-being. Occupational therapy services do not currently exist at these community sites, nor are occupational therapy practitioners recognized as providers in existing community cancer survivorship programs. Recognition of practitioners’ distinct value in cancer survivorship, advocacy for occupational therapy services in the community, development of supporting documentation for occupational therapy’s role in community survivorship, and research on the efficacy of interventions in community cancer survivorship are needed to expand occupational therapy’s role with this growing population.