Oncology Rehabilitation in Cancer Care

Course Information

• Course Code and Name: HEY413E REHABILITATION NURSING
• Course Week: 14
• Course Day and Time: Tuesday (12:00 to 13:50)
• Course Credit/ACTS: 2
• Examination Type: Mcqs
• Instructor's Name & Surname: Dr. Hina Zahoor
• E-mail & Phone: [email protected]
• Instructor's Room: 305
• Office Hours: 9.00 to 5.00
• GBS Link: https://gbs.gelisim.edu.tr/ders-detay-5-160-6267-1
• ALMS Link: https://lms.gelisim.edu.tr/almsp/u/Home/Index
• AVISIT Link: https://persis.gelisim.edu.tr/Default.aspx

Weekly Learning Outcomes

• Understand the importance of oncology rehabilitation in the cancer care continuum.
• Identify the different settings where oncology rehabilitation occurs.
• Recognize the key phases of the rehabilitation process for cancer patients.
• Understand the roles of various cancer rehabilitation professionals involved in the rehabilitation process.
• Gain knowledge of how oncology rehabilitation contributes to improving the quality of life for cancer survivors.

Notes

• Attendance is mandatory for all scheduled lectures.
• Be responsible. Come to class on time.
• Be disciplined. Avoid talking to friends in the class.
• Mobiles are not allowed in the class.

About the Last Lesson

• Principles of Neurological Rehabilitation
• Cognitive Rehabilitation Strategies: Nurturing Brain Function
• Targeted Exercise Programs for Neurological Recovery
• Assistive Technologies in Neurorehabilitation: Enhancing Independence
• Conditions That Can Be Treated With Neuro Rehab
• Case study

About the Today Lesson

• Oncological Rehabilitation Nursing 1&2

Daily Flow

• 12.00-12.50 / 1st Hour: Indication Phases
• 13.00-13.50/ 2nd Hour: Settings For Oncology Rehabilitation Rehabilitation process Types Of Cancer Rehabilitation Professionals

Oncology Rehabilitation Nursing 1&2

• Oncology rehabilitation is an area that has the potential to reduce cancer-related morbidity and healthcare costs.
• Often used interchangeably with cancer rehabilitation, oncology rehabilitation focuses on managing and improving the impairments and functional limitations experienced by individuals with cancer due to the disease itself or the side effects of the treatment they receive.
• The Rehabilitation 2030 call to action, launched by the World Health Organization in 2017, aimed to advance global access to rehabilitation for non-communicable diseases.

Indications

• Pain
• Fatigue
• Chemotherapy-Induced Peripheral Neuropathy (CIPN)
• Spasticity
• Cognitive deficits
• Psychosocial problems
• Sexual dysfunction
• Urinary dysfunction
• Speech impairment
• Swallowing impairment
• Chemotherapy Side Effects and Syndromes
• Symptoms of Lymphoedema
• Radiation Side Effects and Syndromes
• Paraneoplastic Syndrome
• Cardiovascular Disease
• Amputations
• Functional Limitations

Four Phases of Oncology Rehabilitation

• Preventative rehabilitation phase (prehabilitation): The time between cancer diagnosis and treatment. Interventions aim to reduce the impact of expected disability.
• Restorative rehabilitation: Focuses on restoring function for the cured/controlled patient.
• Supportive rehabilitation: Care to maximize functionality when individuals experience declines due to cancer.
• Palliative phase: Emphasizes comfort and function in the terminal stages of cancer.

Settings For Oncology Rehabilitation

• Post-acute care: Inpatient rehabilitation facilities, skilled nursing facilities, home health care agencies, and long-term care hospitals.
• Outpatient therapy: Patient visits at a therapy center for focused rehabilitation intervention.

Advantages of Cancer Rehabilitation

• Improved physical function
• Pain management
• Enhanced quality of life
• Increased energy and stamina
• Emotional and psychological support
• Improved body image
• Enhanced survivorship
• Supportive community

How Do You Rehabilitate Cancer Patients?

• Assessment: Comprehensive evaluation of physical, functional, and emotional status.
• Development of a rehabilitation plan: Tailored plan based on assessment results.
• Implementation of the rehabilitation plan: Physical, occupational, speech therapy, and psychological counseling.
• Monitoring and adjustment of the rehabilitation plan: Ongoing patient monitoring and necessary adjustments.
• Discharge planning and follow-up care: Discharge plan and follow-up care to ensure progress and goal achievement.

Assessment Tools

• Health-related quality of life
• Functional Assessment of Cancer Therapy
• Activities of daily living
• Fatigue
• Functional mobility
• Exercise behavior
• Cognition function: Neuropsychological tests
• Communication
• Sexual function
• Return to work

Types of Cancer Rehabilitation Professionals

• Physicians: Coordinate and manage related medical issues.
• Physical therapists: Improve mobility, balance, strength, and flexibility.
• Occupational therapists: Help with daily tasks and provide assistive devices.
• Speech therapists: Address speech, communication, and swallowing difficulties.
• Psychologists: Address emotional and psychological impact of cancer.
• Social workers: Support patients and families with practical and emotional matters.
• Nurses: Comprehensive care, prevention and early detection, navigation, clinical assessment.

Cardiac Rehabilitation Nursing

• Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease.
• It includes components of health education, advice on cardiovascular risk reduction, physical activity, and stress management.
• Components include; patient assessment, exercise training, physical activity counseling, tobacco cessation, nutritional counseling, weight management, and aggressive coronary risk-factor management and psychosocial counseling.
• Programs generally span three months with sessions two to three times a week.
• Dieticians organize workshops on healthy eating, label reading, and cooking.

Weight Management

• WHO: Waist circumference of 88cm or more in women and 102cm or more in men indicates central obesity.
• Europe/Turkish Society: Waist circumference is considered a risk factor at >80cm for women and >94cm for men.

Blood Pressure Management

• High blood pressure is prevalent among cardiac patients.
• Reducing blood pressure by 10mm Hg systolic can decrease cardiovascular mortality by 20-40%. The reduction of diastolic blood pressure by 5-6mm Hg can reduce stroke risk by 42% and coronary heart disease events by 15%.

Diabetes Management

• Diabetes affects about 26% of cardiac rehabilitation patients.
• These patients often have other risk factors, such as smoking, hypertension, hypercholesterolemia, overweight, and obesity.
• Therapeutic education improves diabetes control, allowing for better glycemic control and possibly reduced cardiovascular morbidity and mortality.
• The goal is to maintain glycosylated hemoglobin (HbA1c) concentration below 7%.

Management of Psychosocial and professional Issues

• Patients with heart disease often experience psychological and social problems, which affect morbidity and mortality.
• Depression, anxiety, and denial occur in up to 20% of patients after myocardial infarction.
• Social workers and other professionals help patients navigate care, access resources, and cope with the social and emotional impact of the disease.

Pulmonary Rehabilitation Nursing

• Pulmonary rehabilitation (PR): Multidisciplinary approach to improve physical and emotional well-being of patients with chronic respiratory diseases.
• PR uses supervised exercise, education, support and behavioral intervention.

Indications for Pulmonary Rehabilitation

• Chronic Obstructive Pulmonary Disease (COPD)
• Interstitial Lung Disease (ILD)
• Cystic Fibrosis
• Pulmonary Hypertension
• Severe Asthma
• Post lung transplant
• Post surgical recovery (e.g., pneumonectomy)
• Pulmonary Fibrosis

Benefits of Pulmonary Rehabilitation

• Improved exercise capacity
• Reduced breathlessness
• Improved survival
• Reduced hospitalizations
• Reduced anxiety and depression
• Improved health-related quality of life
• Improved psychological well-being

Role of Nursing in Pulmonary Rehabilitation

• Nursing assessment: Thorough health history and clinical assessment, monitoring vital signs (oxygen saturation, heart rate, blood pressure), physical function (e.g., mobility, muscle strength, endurance), and psychological assessment (anxiety, depression, coping strategies).
• Key nursing interventions: Breathing techniques, exercise programs, patient education, psychosocial support, and nutritional support.

Barriers to Pulmonary Rehabilitation

• Physical limitations
• Psychological factors
• Socioeconomic factors
• Cultural factors

Pulmonary Rehabilitation in Special Populations

• Older adults (COPD, ILD, pulmonary fibrosis). Modifying programs, addressing comorbidities (e.g., osteoporosis, cardiovascular disease), and managing polypharmacy and medication side effects are necessary in this group.
• Patients with Obesity Hypoventilation Syndrome: Focus on weight management and sleep hygiene, and addressing breathing difficulties and respiratory support.

Programme Design

• Six-week structure, with two sessions per week: Supervised exercise and education, and home training.
• Content of PR programme: Sessions focused on relevant health topics, individualized plans tailored to each patient after thorough assessment.
• Long-term benefits: Improve physical and psychological conditions, and promote long-term adherence to health enhancing behaviours.

Goal-Oriented Therapy

• Personalized goals: Patients define specific goals that the six-week programme addresses.
• Encouraging self-responsibility: Helps patient understand dependence, interdependence, and independence.
• Empowering patients: Encourages patients to take responsibility for achieving their treatment goals.

Pulmonary Rehabilitation Programme

• Relaxation
• Disease education
• Dietary advice
• Benefits advice
• Energy conservation
• Medication advice
• Chest clearance
• Breathing control techniques

Advance Care Planning in Pulmonary Rehabilitation (PR)

• Key components of ACP in PR: burden of treatment, therapies, and preferred place of death.
• Nurses' contributions to ACP: Provide compassionate guidance to patients and carers, helping them navigate complex decisions. Outcome of effective ACP: Ensures dignity, autonomy, patient centered approach to end of life care and reducing uncertainty and emotional distress for patients and their families.

Neurological Rehabilitation Nursing-1

• Neurological rehabilitation: Therapy to improve function and well-being, with tailored programs and adaptive equipment.
• Purposes of rehabilitation: Teach adaptive strategies, facilitate function in a normal environment.
• Approaches to Neurological Rehabilitation: Bobath approach, Carr and Shepherd approach, Gait re-education, Transfer rehabilitation, Mobility rehabilitation, Contracture management.
• Equipment: Assistive mobility devices (wheelchairs, walkers).

Neurological Rehabilitation Nursing-2

• Targeted exercise programs and adaptive equipment integration enhance recovery by addressing various aspects, ranging from physical function and well-being to emotional well-being.

Assistive Technologies in Neurorehabilitation

• Augmented reality tools and smart wearables improve rehabilitation programs to foster resilience and empowerment.

Conditions That Can Benefit from Neuro Rehab

• Traumatic brain injuries
• Spinal cord problems
• Parkinson's disease
• Other neurological issues (e.g., Alzheimer's, epilepsy, Huntington's disease).

Aims of Neurological Rehabilitation

• Prevent complications
• Teach adaptive strategies
• Facilitate function in a normal environment

Take-Home Topics for Review

• Indication
• Phases
• Settings for oncology rehabilitation
• Rehabilitation processes
• Types of cancer rehabilitation professionals

Questions and Suggestions

• Question and suggestion session.

Recommended Daily Studies

• McPherson, K, Gibson, BE & Leplege, A 2015, Rethinking Rehabilitation: Theory and Practice
• Hoeman, SP 2008, Rehabilitation Nursing: Prevention, Intervention and Outcomes

References

• List of references for all the discussed topics.

Test your knowledge on oncology rehabilitation and its significance in cancer care. This quiz covers various aspects, including phases of rehabilitation, roles of professionals, and indications for treatment. Understand the focus and goals of oncological rehabilitation nursing and the influence of assistive technologies.