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 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
• AVESIS Link: https://persis.gelisim.edu.tr/Default.aspx

Weekly Learning Outcomes

• Understand the importance of oncology rehabilitation in 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 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 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

Rehabilitation 2030

• 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: encompasses the time between the onset of cancer diagnosis and the beginning of oncological treatment.
• Restorative rehabilitation: focuses on restoring the cured or controlled patients with residual impairments to their previous level of function.
• Supportive rehabilitation: provides care to maximize functionality as individuals experience declines due to progressive or stable cancer.
• Palliative phase: Although palliative care is not limited to the end of life, this model uses this term to emphasize the care aiming at comfort and function in the terminal stage of cancer.

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 and Increased Energy
• Emotional and Psychological Support
• Improved Body Image and Self-esteem
• Enhanced Survivorship
• Supportive Community

Boosted Energy and Endurance

• Cancer treatments can be physically and emotionally exhausting.
• Procedures like chemotherapy and surgeries reduce energy and endurance.
• Rehabilitation programs design interventions to boost energy levels.

Emotional and Mental Support

• Rehabilitation programs offer emotional and mental support.
• Support addresses the challenges of undergoing cancer treatment.
• Focus extends beyond physical recovery to emotional well-being.
• Encourages resilience and a positive outlook during treatment.
• Aims to provide holistic care for overall patient recovery.

Improved Body Image and Self-confidence

• Cancer treatments can lead to changes and psychological distress.
• Rehabilitation programs address body image concerns and self-confidence.
• Support is provided to rebuild self-esteem during the recovery.
• Programs help patients cope with physical and emotional changes.

Enhanced Survivorship

• Rehabilitation programs focus on enhancing survivorship for cancer patients.
• Educate individuals about the long-term effects of cancer and treatment.
• Provide coping strategies for managing survivorship challenges.
• Empower patients to adapt to life post-treatment with confidence.
• Support holistic recovery and long-term well-being.

Nurturing Community

• Rehabilitation programs nurture a sense of community for cancer patients.
• Group therapies enabling individuals to connect with peers.
• Shared experiences foster solidarity and mutual support.
• Participants feel reassured they are not alone in their journey.
• Encourages emotional healing and a supportive recovery environment.

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: The 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: They play a critical role in coordinating the rehabilitation process, monitoring the patient's progress, and managing any medical issues related to the cancer and its treatment.
• Physical Therapists: They help patients improve their mobility, balance, strength, and flexibility. They also develop exercise programs to help patients regain their physical function and prevent the development of secondary health conditions.
• Occupational Therapists: They help patients with activities of daily living, such as bathing, dressing, and grooming, and provide assistive devices and adaptations to help them perform these tasks more easily and safely.
• Speech Therapists: They work with patients who have speech, communication, and swallowing difficulties as a result of cancer treatment.
• Psychologists: They help patients deal with the emotional and psychological impact of cancer and its treatment, including stress, anxiety, and depression.
• Social Workers: They help patients and their families with practical and emotional support, such as navigating the healthcare system, accessing financial and social resources, and coping with the social and emotional impact of cancer.
• Nurse: People-Centered Integrated Care, providing comprehensive care in line with the cancer care continuum, ensuring optimal communication with patients and the healthcare team.

Cardiac Rehabilitation Nursing

• Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease, which 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.
• Core components include: patient assessment, exercise training, physical activity counseling, tobacco cessation, nutritional counseling, weight management, aggressive coronary risk-factor management and psychosocial counseling.
• Cardiac rehabilitation programs generally span three months, with sessions two or three times a week (usually 36 sessions over a 12-week time-period).
• Dieticians organize practical workshops to teach patients healthy eating habits, label reading and cooking demonstrations.
• General dietary recommendations for cardiac patients include a reduced intake of saturated fats (<7% of total calories) and cholesterol (<200 mg/d), increased intake of polyunsaturated (about 10% of total calories) and monounsaturated fats (20% of total calories), and increased fiber intake (about 20-30 g/d).

Weight Management

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

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% and 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 learn the importance of blood pressure control, the medications and their side effects, measures of therapeutic life changes that will impact their blood pressure, and the use of blood pressure devices.

Diabetes Management

• About 26% of patients referred to cardiac rehabilitation have diabetes.
• Therapeutic education is a very important tool that helps improve diabetes control.
• Cardiac rehabilitation programs can help achieve a better glycemic control.

Management of Psychosocial and Professional Issues

• Patients with heart disease are often confronted with psychological and social problems that can affect both morbidity and mortality.
• Depression, anxiety, and denial occur in up to 20% of patients following myocardial infarction.
• During cardiac rehabilitation follow-up, patients undergo a routine screening to identify anxiety, depression, substance abuse and familial or other social problems.

Pulmonary Rehabilitation Nursing

• Pulmonary rehabilitation is a multidisciplinary approach designed to improve the physical and emotional well-being of patients with chronic respiratory diseases.
• Pulmonary rehabilitation is the use of supervised exercise, education, support, and behavioral intervention to improve how people with chronic lung disease function in daily life and enhance their quality of life.

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 wellbeing

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

Role of Nursing in Pulmonary Rehabilitation

• Thorough health history and clinical assessment
• Monitoring vital signs: Oxygen saturation, heart rate, and blood pressure
• Assessment of physical function: Mobility, muscle strength, and endurance
• Psychological assessment: Anxiety, depression, and coping strategies
• Breathing Techniques to reduce dyspnea
• Exercise Programs
• Patient Education: Medication adherence, Oxygen therapy management, Energy conservation techniques, and Avoidance of environmental triggers
• Psychosocial Support: Provide emotional support, coping strategies, and referrals for psychological support
• Nutritional Support

Barriers to Pulmonary Rehabilitation

• Physical limitations: Low exercise tolerance, dyspnea, fatigue
• Psychological factors: Anxiety, depression, and lack of motivation
• Socioeconomic factors: Limited access to healthcare, financial constraints
• Cultural factors: Lack of understanding or mistrust of healthcare interventions

Pulmonary Rehabilitation in Special Populations

• Older Adults (COPD, ILD, Pulmonary Fibrosis): Modifying programs, addressing comorbidities, managing polypharmacy, and medication side effects
• Patients with Obesity Hypoventilation Syndrome: Focus on weight management and sleep hygiene, addressing breathing difficulties, and CPAP/BiPAP in respiratory support.

Programme Design

• National guidelines recommend a six-week PR program with two sessions per week.
• The program incorporates supervised exercise and education, and patients are expected to undertake home training.
• Content of the PR program involves seminars and discussions on health topics. This leads to the creation of personalized plans tailored to each patient.

Goal-Oriented Therapy

• Each patient defines specific goals (e.g., reducing breathlessness, understanding their disease, or increasing mobility).
• The six-week program is structured around these goals.
• This helps patients understand and clarify dependence, interdependence, and independence.

Pulmonary Rehabilitation Program Components

• 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 (Advance Care Planning) in PR: Burden of Treatment, Therapies, Preferred Place of Death
• Nurses' Contributions to ACP: Provide compassionate guidance, facilitate the creation of a care pathway, and ensure dignity, autonomy.
• Outcome of Effective ACP: Ensures dignity, autonomy, and a patient-centered approach to end-of-life care, and reduces uncertainty and emotional distress.

Neurological Rehabilitation Nursing-1

• Neurological rehabilitation is a program that helps patients with neurological conditions recover or increase functionality within their environment.

• The goal is to restore health, independence, and functionality as much as possible.

• Phases of Neurological Rehabilitation: 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: Traumatic brain injuries, Spinal cord injuries, Hemorrhagic strokes, Ischemic strokes, Subdural hematoma, and Transient ischemic attacks (TIAs), Structural or neuromuscular disorders, Functional disorders, Brain Infections, and Neurodegenerative diseases

• Aims of Neurological Rehabilitation: Prevent complications, 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, and Equipment and adaptations assessment

Neurological Rehabilitation Nursing-2

• Targeted Exercise Programs for Neurological Recovery
• Emphasizing daily life activities
• Tailored Workouts: Customized exercise

Assistive Technologies in Neurorehabilitation: Enhancing Independence

• Augmented Reality Tools: Interactive renewal tools.
• Smart Wearables: Monitoring and enhancing patient movement and progress is made seamless.
• Robot-assisted Therapy: Robotics, controlled movements, precise support for individual needs

Test your knowledge on the key concepts and goals of oncology rehabilitation in cancer care. This quiz covers the rehabilitation process, the roles of professionals involved, and the benefits for patients. Understand how rehabilitation enhances energy levels and body image among cancer survivors.