Oncology Rehabilitation Overview

Course Information

• Course Code and Name: HEY413E REHABILITATION NURSING
• Course Week: 14
• Course Day and Time: Tuesday (12:00 to 13:50)
• Course Credits/ACTS: 2
• Examination Type: Mcqs
• Instructor's Name: Dr. Hina Zahoor
• Instructor's Email: [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
• AVESIS 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 Previous 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 Today's 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 (also known as prehabilitation)
• Restorative rehabilitation
• Supportive rehabilitation
• Palliative phase

Settings For Oncology Rehabilitation

• Post-acute care: Includes inpatient rehabilitation facilities, skilled nursing facilities, home health care agencies, and long-term care hospitals.
• Outpatient therapy: Involves 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 and Self-esteem
• Enhanced Survivorship
• Supportive Community

How Do You Rehabilitate Cancer Patients?

• Assessment
• Development of a rehabilitation plan
• Implementation of the rehabilitation plan
• Monitoring and adjustment of the rehabilitation plan
• Discharge planning and follow-up care

Assessment Tools

Health-related quality of life and/or quality of life: (e.g., European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the 36-Item Short Form Survey, and the Functional Assessment of Cancer Therapy), Activities of daily living and instrumental activities of daily living, Fatigue, Functional mobility, Exercise behavior, Cognition function (Neuropsychological tests, patient-reported outcome measures), Communication, Sexual function, Return to work

Types of Cancer Rehabilitation Professionals

• Physicians
• Physical Therapists
• Occupational Therapists
• Speech Therapists
• Psychologists
• Social Workers
• Nurse (People-Centered Integrated Care, Prevention and Early Detection, Nurse Navigation and Follow-up, Clinical Roles, Supportive and Palliative Care)

Cardiac Rehabilitation Nursing

• Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease that includes components of health education, advice on cardiovascular risk reduction, physical activity, and stress management.

• Cardiac rehab has three equally important parts: Exercise counseling and training, Education for heart-healthy living, Counseling to reduce stress.

Components and organization of cardiac rehabilitation

• Patient assessment
• Exercise training
• Physical activity counseling
• Tobacco cessation
• Nutritional counseling
• Weight management
• Aggressive coronary risk factor management, and
• Psychosocial counseling

Cardiac Rehabilitation Nursing Program Design

• Cardiac rehabilitation programs generally span three months, with sessions two or three times a week (usually 36 sessions over a 12-week time period).

• General dietary recommendations for cardiac patients include a reduced intake of saturated fats, cholesterol, and increased intake of polyunsaturated and monounsaturated fats to adequate repartition of calories for carbohydrates, protein, and fats, and increased fiber intake.

• Recent nutrition and cardiovascular disease studies recommend moderation and plant-based diets.

Weight Management

• According to the World Health Organization (WHO), if the waist circumference is 88 cm or more in women and 102 cm or more in men, there is central obesity.

• The value of waist circumference determined for Europe, in Turkish society, is risk accepted as > 80 cm for women and > 94 cm for men.

• If the body mass index is calculated and this value is > 25 kg/m2, individualized short and long-term targets are determined by considering other risk factors.

Blood Pressure Management

• High blood pressure is very prevalent among patients referred for cardiac rehabilitation.
• A decrease in systolic blood pressure by 10 mmHg can decrease cardiovascular mortality by 20-40%.
• A reduction of diastolic blood pressure by 5-6 mm Hg results in a reduction of stroke risk by 42% and Coronary heart disease events by 15%.
• Patients need to understand the importance of blood pressure control, the medications and their side effects, the measures of therapeutic life changes, and the use of blood pressure devices.
• Understanding the disease and its treatment improves compliance, reducing the risk associated with high blood pressure.

Diabetes Management

• Around 26% of patients referred to cardiac rehabilitation have diabetes.
• These patients often have a high cardiovascular risk profile and associated risk factors, such as smoking, hypertension, high cholesterol, being overweight or obese.
• Therapeutic education is very important for improving diabetes control, and cardiac rehabilitation programs use therapeutic education tools to help patients achieve better glycemic control.
• This has been shown to reduce the risk of cardiovascular morbidity and mortality, and HbA1c concentration should be maintained at below 7%.

Management of Psychosocial and Professional Issues

• Patients with heart disease often face psychological and social problems affecting their morbidity and mortality (up to 20% following myocardial infarction).
• Cardiac rehabilitation follow-up includes routine screening for anxiety, depression, substance abuse, family, and social problems.
• Social workers and other professionals in cardiac rehabilitation centers provide support.

Pulmonary Rehabilitation Nursing

• Pulmonary rehabilitation is a multidisciplinary approach improving physical and emotional well-being in patients with chronic respiratory diseases.
• It uses supervised exercise, education, support and behavioral interventions to improve daily functioning and enhance quality of life.
• Indications for Pulmonary Rehabilitation include Chronic Obstructive Pulmonary Disease (COPD), Interstitial Lung Disease (ILD), Cystic Fibrosis, Pulmonary Hypertension, Severe Asthma, Post-lung transplant, Post-surgical recovery (e.g., pneumonectomy), and Pulmonary Fibrosis.
• Benefits of pulmonary rehabilitation include improved exercise capacity, reduced breathlessness, improved survival, reduced hospitalizations, reduced anxiety and depression, improved health-related quality of life, and improved psychological wellbeing and self-management.

Goals of Pulmonary Rehabilitation

• Improve exercise capacity.
• Enhance quality of life.
• Decrease symptoms (e.g., dyspnea)
• Prevent hospital readmissions.
• Enhance emotional well-being and self-management.

Components of a Pulmonary Rehabilitation Program

• Exercise training
• Inspiratory muscle training
• Psychosocial counseling
• Nutritional evaluation and counseling
• Education, including on proper use of prescribed drugs

Role of Nursing in Pulmonary Rehabilitation

• Thorough health history & clinical assessment
• Monitoring vital signs (oxygen saturation, heart rate, blood pressure)
• Assessment of physical function (mobility, muscle strength, endurance)
• Psychological assessment (anxiety, depression, coping strategies).

Key Nursing Interventions for Pulmonary Rehabilitation

• Breathing techniques (diaphragmatic breathing, pursed-lip breathing to reduce dyspnea)
• Exercise programs (supervised low-impact aerobic exercises like walking or cycling)
• Patient education (medication adherence, oxygen therapy management, energy conservation techniques, avoidance of environmental triggers)
• Psychosocial support (emotional support, coping strategies, referrals for psychological support)
• Nutritional support (adequate nutrition, especially for patients with weight issues)

Barriers to Pulmonary Rehabilitation Implementation in Nursing Practice

• Physical limitations (low exercise tolerance, dyspnea, fatigue)
• Psychological factors (anxiety, depression, lack of motivation)
• Socioeconomic factors (limited healthcare access, financial constraints)
• Cultural factors (lack of understanding or mistrust of healthcare interventions)

Pulmonary Rehabilitation in Special Populations (Older Adults, Obesity Hypoventilation Syndrome)

• Older Adults (COPD, ILD, Pulmonary Fibrosis): Modifying programs for older adults to lower intensity, focus on functional independence, and address comorbidities.
• Managing polypharmacy and medication side effects.
• Patients with Obesity Hypoventilation Syndrome: Focus on weight management and sleep hygiene to address breathing difficulties and the role of CPAP/BiPAP in respiratory support.

Programme Design for Pulmonary Rehabilitation

• Six-week structure (two sessions per week, supervised exercise and education, home training)
• Content focused on seminars and discussions about health topics
• Patient-specific individualized plans

Goal-Oriented Therapy (Pulmonary Rehabilitation)

• Personalized goals (e.g., reduce breathlessness, increase mobility)
• Self-responsibility (understanding dependence, interdependence, independence)
• Empowering patients (taking maximum responsibility, fostering independence and confidence).

Pulmonary Rehabilitation Program

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

Advance Care Planning in Pulmonary Rehabilitation (PR)

• Burden of treatment (evaluating physical, emotional, and psychological impact of ongoing treatments).
• Therapies (discussing options like ventilation)
• Preferred place of death (understanding and documenting patient wishes).

Neurological Rehabilitation Nursing-1 &2

• Neurological rehabilitation is a therapy process to improve function and well-being for people with neurological conditions. It aims to restore health, independence and functionality, using the best rehabilitation strategies.
• Phases of Neurological Rehabilitation include: Long-Term Acute Care Hospital (LTACH), Acute Rehab, Subacute Rehabilitation in Skilled Nursing Facilities, Long-Term Care Facility or Nursing Home, Home with services
• Conditions that benefit from neurological rehabilitation include traumatic brain injuries, spinal cord problems, Parkinson's disease, and other neurological issues.

Aims of Neurological Rehabilitation

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

Approaches to Neurological Rehabilitation

• Bobath approach (neuro developmental treatment)
• Carr and Shepherd approach (functional movements)
• Gait re-education (identifying variations to improve gait)
• Transfer rehabilitation (teaching techniques for transfers)
• Mobility rehabilitation (developing independent movement)
• Contracture management (releasing tight muscles)
• Equipment and adaptations assessment (using devices like wheelchairs)

Targeted Exercise Programs for Neurological Recovery

• Functional Movement Training: Emphasizing activities mirroring daily life, facilitating a seamless transition to everyday activities.
• Tailored Workouts: Customized exercise programs tailored to each patient's needs.
• Adaptive Equipment Integration: Integrating adaptive tools to overcome physical limitations, promote optimal recovery and an inclusive therapy process.

Assistive Technologies in Neurorehabilitation: Enhancing Independence

• Augmented Reality Tools: Interactive renewal tools using augmented reality to enhance engagement and boost patient participation

• Smart Wearables: Monitoring patient movement and progress through intelligent wearables providing real-time data for personalized care plans.

• Robot-assisted Therapy: Robotics aiding improvement of independence through controlled movements, offering support to patients with specific motor challenges, and embodying individualized and comprehensive treatment approaches.

References, Research, and Resources

• Multiple cited academic articles, covering various aspects of rehabilitation research

Test your knowledge on the various aspects of oncology rehabilitation, including its phases, goals, and common side effects associated with cancer treatments. This quiz covers crucial concepts like prehabilitation and supportive rehabilitation services. Explore how rehabilitation can enhance patients' quality of life post-treatment.