INTRODUCTION TO CANCER REHABILITATION AND SURVIVORSHIP

Summer Research Student ProgramStephanie Phan, Clinical Lead

Cancer Rehabilitation and Survivorship Program

Objectives

• Explore the meaning of cancer survivorship and related terms

• Identify common cancer survivorship concerns for patients and families

• Introduce ELLICSR and Cancer Rehab & Survivorship

• Comprehensive Assessment and 8-week Group Cancer Rehab Program

• Review other services and resources

Cancer Survivorship and Related Terms

Who is a cancer survivor?

• Anyone who has ever received a cancer diagnosis. Cancer survivorship starts at diagnosis.

• Anyone who completed definitive cancer treatment (surgery, radiation, systemic therapy) with the exception of targeted therapies and hormonal therapy. Cancer survivorship starts at treatment completion.

• Anyone who has ever been touched by cancer including patients, family members, friends, and caregivers. Cancer survivorship starts at diagnosis.

Cancer Survivorship and Related Terms

• No single definition

• Health care professionals: living with, through and beyond cancer

• Individuals with cancer: disease free after treatment completion

• Stigma

Cancer Survivorship and Related Terms

Persistent Effects versus Late Effects

Long-lasting (persistent) effects refer to any side effects or complications of treatment for cancer that continue beyond the end of treatment

Late effects of cancer treatment appear months or yearsafter treatment has ended

Cancer Survivorship Issues

Common late and persisting effects

• Neurocognitive changes

• Cancer related fatigue

• Lymphedema

• Peripheral neuropathy

• Depending on the system affected: endocrine, CV, GI, GU, hematological/immune, MSK, neurologic, pulmonary

Cancer Survivorship Issues

• Fear of cancer recurrence

• Return to work/school

• Body image/sexual health

• Relationships

• Psychological distress

Cancer Survivorship Self-management

Cancer Survivorship Clinics are based on the self-management model

Self-management requires ability to manage• Disease (medical management)• Emotional consequences (emotional management)• Changes of daily life (role management)

Patients need:• Knowledge (i.e. disease, resources)• Attitudes (i.e. motivation, confidence)• Skills (i.e. self-care skills, self-management skills)

All patients self-manage to some extent.

ELLICSR, Health, Wellness and Survivorship Centre

Mission: To maximize the quality of life, health & wellness of all who are impacted by cancerGoals (HEAT): Harness the power of survivor communitiesEnable survivors to become empowered experts in the management of their health & wellbeing Accelerate research & innovation in survivorship programs & services Transform care by integrating evidence-based self-management support

Survivorship Centre located on 2nd floor of Princess Margaret

• Fatigue Clinic

• Lymphedema Clinic

• Function and Mobility Clinic

• Neurocognitive Clinic

• Physiatry Consult

• Return to Work Consult

• Sexual Health Consult

Cancer Rehabilitation and Survivorship Program Redesign• Every patient gets a Comprehensive Assessment by an

inter-disciplinary team within a reasonable timeframe• Informed, collaborative decision is made at the end of

the visit re: care plan• Opportunity to refer patients to a group-based cancer

rehabilitation program that may eliminate need for multiple individual follow-ups

• Part of standard of care for every cancer patient

Cancer Rehabilitation

• Pain• Fatigue• Deconditioning• Reduced physical strength• Reduced range of motion of joints• Decreased cardiovascular capacity• Lymphedema• Bone Loss• Mood disorders including depression and anxiety• Decreased work productivity • Decreased social functioning• Heart disease (future)• Diabetes (future)• Second malignancies and recurrence of primary malignancy

Adverse effects of cancer treatment that may be reduced with Rehab Intervention

“Cancer rehabilitation, involves helping a person with

cancer to help himself or herself to obtain maximum

physical, social, psychological, and vocational functioning

within the limits imposed by disease and its treatment”

(Crome)

Medical

Physical

Functional

Psychosocial/Cognitive

• Physiatrist• RN

• OT• PT• RD• RMT• RN• RKin

• OT• PT• SW

• Neuropsychologist• OT• Psychologist• SW

Impairment-Focused Cancer Rehabilitation

Therapeutic exerciseLymphedemaMSK (ROM, strength)Neurological deficitBalance impairmentNutrition needs

FatigueDifficulties with ADLsReturn to work/schoolSexual health

Brain FogLiving Well with CaPsychosocial counseling/triage

Pain Neurological problemComplex medical Hx

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr)

Fatigue (1hr)

Mood (1hr)

Relaxation (1hr)

Diet (1hr)

Mindful Eating (1hr)

Brain Health (1 hr)

Graduation (2hrs)

Intro & Goals (1hr)

8-week Group Cancer Rehabilitation Program

Other Services and Resources

• Lymphedema Awareness

• Healthy Steps

• Getting Back on Track

• What You Can Do About Brain Fog

• Relaxation Therapy Sessions

• Sex and Intimacy

• Survivor’s Kitchen

• Nutrition Classes

• Living Well With Cancer

Classes/Group format

Check Patient and Family Calendar

http://www.uhn.ca/PatientsFamilies/Health_Information/Pages/default.aspx

Other Services and Resources

Community Programs and Partners

• Community Connections (ELLICSR)• Wellspring• Gilda’s Club• Willow• Rethink• Taking Charge (Mount Sinai Hospital & ELLICSR)• Canadian Cancer Society Driving Services• After Cancer Treatment Transition Clinic (ACTT)• Toronto Rehabilitation Institute• Young Adult Cancer Canada (YACC)

Contact Information

Cancer Survivorship ClinicsMadelyn Fler: 16-2363………………………………………ELLICSR: 18-8621

Resources

• ELLICSR website http://ellicsr.ca/

• ELLICSR Kitchen website http://www.theprincessmargaret.ca/en/PatientsFamilies/SupportServices/Kitchen/Pages/about-us.aspx

• Patient and Family Calendar http://www.uhn.ca/PatientsFamilies/Health_Information/Pages/default.aspx

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Acknowledgement

• The Princess Margaret Cancer Foundation