Stuart M. Lichtman, MD
Geriatrics for the Oncologist is guest edited by Stuart Lichtman, MD, and developed in collaboration with the International Society of Geriatric Oncology (SIOG). Dr. Lichtman is an Attending Physician at Memorial Sloan Kettering Cancer Center, Commack, New York, and Professor of Medicine at Weill Cornell Medical College, New York. He is also President Elect of SIOG. Visit SIOG.org for more information about geriatric oncology.
With individuals aged 65 and older accounting for more than 50% of the U.S. population diagnosed with cancer,1 the demand for occupational and physical therapists to treat this population will increase in the years to come. Thus, it is essential for primary care providers to know that the interprofessional care team for older adults with cancer includes occupational and physical therapists, and referrals should be made when their services are needed.
When many people think of rehabilitation for cancer, it is often accompanied with thoughts of end-of-life care. However, we know that the overall cancer death rate has declined in the United States,2 and more and more individuals with cancer go on to live productive, fulfilling lives after diagnosis and treatment.3 Occupational and physical therapy helps facilitate recovery and improve quality of life for older adults with cancer. The setting can be in hospitals, rehabilitation centers, or in the homes of these patients.
For Living Skills
Whether older adults are actively receiving treatment for their cancer or in a survivorship phase, simple activities may be more challenging as a result of their cancer diagnosis. Everyday tasks such as lifting, carrying, or having the mental or physical endurance to work or engage in leisure activities, may be complicated.
Occupational therapists are skilled in modifying activities and environments to enable older adults with cancer to perform the tasks they want to do and maintain their quality of life. The role of occupational therapy in oncology is “to facilitate and enable an individual patient to achieve maximum functional performance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy.”4 Through energy-conservation strategies, activity adaptation, and cognitive retraining, occupational therapy can facilitate independence in activities of daily living for older adults with cancer.
Physical therapists “help patients reduce pain and improve or restore mobility.”5 The focus of physical therapy for older adults with cancer may also be to promote overall health, wellness, and fitness. Cancer-related fatigue may afflict older adults undergoing cancer treatment,6 and physical therapy may assist with prescribing individualized exercise programs to improve strength and endurance. Exercise has been shown to reduce the impact of cancer both before and after treatment for older adults.7
Pain management is another domain where physical therapy and oncology meet. Therapeutic modalities such as heat, ice, soft-tissue mobilization, and gentle stretching can restore joint range and comfort in older adults with cancer, enabling them to get through their daily routine better.
Many occupational and physical therapists who work with oncology patients are certified in lymphedema therapy.— Jeannine Nonaillada, PhD, OTR/L, BCG
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Since many cancer treatment regimens disrupt the lymphatic system, edematous extremities are often common sequelae for older adults with cancer. Many occupational and physical therapists who work with oncology patients are certified in lymphedema therapy. Lymphedema therapists fit and instruct patients on how to use compression garments and perform manual techniques, which can reduce swelling and discomfort to improve patients’ participation in daily activities.
For Cognitive Function
Occupational therapists are skilled in treating cognitive deficits, which can emerge for many older adults after receiving chemotherapy. “Chemo brain”8 leaves individuals with cancer feeling like they are in a mental fog, with diminished capacity for remembering details, inability to concentrate, and slower thought processing. Since cognitive abilities do slow down with normal aging processes, the impact of chemo brain can be more severe for older adults. Occupational therapy sessions targeting chemo brain may include a compensatory approach aimed at structuring routines with planners, calendars, and journals, where a remedial approach may focus on cognitive exercises such as memory training, puzzles and workbooks, and complex problem-solving.
For Peripheral Neuropathy
Chemotherapy-induced peripheral neuropathy is another side effect of cancer treatment that can hinder an older adult’s participation in daily tasks, especially if it is coupled with arthritis as a common comorbid condition in aging. Occupational therapists can prescribe exercise programs to improve sensory input, fine-motor coordination, and modify tasks to increase the level of patient participation so independence may be restored.
For Radiation Effects
Some physical therapists are skilled in pelvic floor therapy. Radiation to the pelvic area for certain genitourinary, gynecologic, or anal cancers can leave older adults with decreased hip range of motion, compromised sexual function, and incontinence.9 Through patient education, neuromuscular re-education, and postural exercises, physical therapy may improve functioning in this area.
For Risk for Falls
Neurologic cancers can cause dizziness and an increased risk for falls in older adults, who are already at high risk for falls with comorbid conditions. Physical therapists trained to provide vestibular rehabilitation programs can help older adults with balance disorders improve fear of falling, gait stability, and accurate use of assistive walking devices.
As the trend continues for keeping older adults in their own homes rather than admitting them to inpatient settings, on-site home safety evaluations by both physical and occupational therapists have been shown to be effective in reducing risk for falls among older adults with cancer10 and should be considered by physicians when such risk is a concern.
The rehabilitation needs of older adults are often heightened with a cancer diagnosis. Oncologists and other physicians on the primary care team need to be aware of appropriate screening for and referral to occupational and physical therapy services. Reasons for physical therapy referral may include pain, decreased strength, decreased range or motion, or loss of balance; reasons for occupational therapy referral may include an inability to perform activities of daily living, impaired cognition, decreased safety awareness, and compromised sensation. Rehabilitation for older adults during cancer treatment and older cancer survivors can be highly beneficial to recovery. ■
Disclosure: Dr. Nonaillada reported no potential conflicts of interest.
1. West LA, Cole S, Goodkind D, He W: 65+ in the United States: 2010. U.S. Census Bureau, June 2014. Available at https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf. Accessed May 2, 2016.
2. National Cancer Institute at the National Institutes of Health: Cancer Statistics. Available at http://www.cancer.gov/about-cancer/what-is-cancer/statistics. Accessed May 2, 2016.
3. de Moor JS, Mariotto AB, Parry C, et al: Cancer survivors in the United States: Prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev 22:561-570, 2013.
4. The American Occupational Therapy Association. The Role of Occupational Therapy in Oncology. Available at http://www.aota.org/-/media/corporate/files/aboutot/professionals/whatisot/rdp/facts/oncology%20fact%20sheet.pdf. Accessed May 2, 2016.
5. American Physical Therapy Association. Who are Physical Therapists? Available at http://www.apta.org/AboutPTs/. Accessed May 2, 2016.
8. American Cancer Society. Chemo Brain. Available at http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffects/chemo-brain. Accessed May 2, 2016.