Oncology Rehabilitation

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features the
00:11 --> 00:13latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation
00:21 --> 00:23about oncology rehabilitation with
00:23 --> 00:25Scott Capozza and Suzanne Burbank.
00:25 --> 00:27Scott is a physical therapist for the
00:27 --> 00:29Smilow Cancer Hospital survivorship Clinic,
00:29 --> 00:32and Suzanne is an occupational
00:32 --> 00:33and lymphedema therapist.
00:33 --> 00:35Doctor Chagpar is a professor
00:35 --> 00:36of surgical oncology.
00:39 --> 00:41Maybe we'll start by each of you
00:41 --> 00:43introducing yourself and telling us
00:43 --> 00:45a little bit more about what you do.
00:45 --> 00:47Scott. maybe we'll start with you.
00:48 --> 00:49Sure. Thanks doctor Chagpar.
00:52 --> 00:55I'm a physical therapist by trade.
00:55 --> 00:57I started in the survivorship
00:57 --> 01:00clinic way back when it started back in 2006.
01:00 --> 01:04I work in the
01:04 --> 01:05multidisciplinary clinic,
01:05 --> 01:07and that's where I really got my
01:07 --> 01:09experience working with individuals
01:09 --> 01:11with cancer.
01:11 --> 01:13And then several years ago,
01:13 --> 01:15I realized that I was seeing these
01:15 --> 01:17patients in survivorship clinic
01:17 --> 01:19and realizing that some of them
01:19 --> 01:22really needed to have more of a hands on
01:22 --> 01:24rehab approach.
01:24 --> 01:25Terrific. Suzanne, how about
01:25 --> 01:27you tell us a little bit more
01:27 --> 01:29about yourself and what you do.
01:29 --> 01:31Thank you so much. I actually started
01:32 --> 01:3411-12 years ago,
01:34 --> 01:36I guess now as an occupational therapist
01:36 --> 01:39with a completely different focus in my mind
01:39 --> 01:41as to what I wanted to work
01:41 --> 01:43with the patient population,
01:43 --> 01:45but overtime I was exposed to
01:45 --> 01:48lymphedema therapy which is a
01:48 --> 01:50subspecialty of oncology rehab.
01:50 --> 01:52And a friend of mine who is a
01:52 --> 01:54physical therapist down in Florida
01:54 --> 01:56at the time where I was working
01:56 --> 01:58kept sharing stories of of recovery
01:58 --> 02:00and improvement and patient NOTE Confidence: 0.784003606
02:00 --> 02:01satisfaction with her
02:01 --> 02:03lymphedema therapy and I had never
02:03 --> 02:05heard of lymphedema therapy which
02:05 --> 02:07is unfortunately a common situation,
02:07 --> 02:09it's becoming more common and
02:09 --> 02:11more understood not only by the
02:11 --> 02:13patient population but also by
02:13 --> 02:15providers themselves that people who
02:15 --> 02:16are dealing with chronic swelling
02:16 --> 02:19in their legs or their arms or
02:19 --> 02:21their trunk from various
02:21 --> 02:23conditions, head and neck,
02:23 --> 02:25things like that,
02:25 --> 02:28that those folks can get actual
02:28 --> 02:30long-term and profound relief
02:30 --> 02:33from the swelling that is affecting
02:33 --> 02:35motion and pain and function.
02:35 --> 02:39And so I got my certification 11 years ago.
02:39 --> 02:41And went through the program
02:41 --> 02:43to get that certification,
02:43 --> 02:45which is a fairly lengthy and extensive one,
02:45 --> 02:47which unfortunately is probably
02:47 --> 02:49one of the reasons why many
02:49 --> 02:50therapists don't pursue it.
02:50 --> 02:53But there is such a desperate need
02:53 --> 02:55in the oncological population as
02:55 --> 02:57well as the non oncology patient
02:57 --> 03:00population to address those issues.
03:00 --> 03:02I had the good fortune of working
03:02 --> 03:04with Yale a few years ago,
03:04 --> 03:06about five years ago and was
03:06 --> 03:08exposed to the Smilow Cancer Hospital
03:08 --> 03:10and now I have an absolute passion
03:10 --> 03:12as I know Scott does to work with
03:12 --> 03:13this patient population because
03:13 --> 03:15it's such an underserved need.
03:16 --> 03:18So Scott, tell us a bit more
03:18 --> 03:20it sounds like when Suzanne
03:20 --> 03:23was kind of talking about the
03:23 --> 03:25myriad of patients who benefit from
03:25 --> 03:28lymphedema therapy and whether it's
03:28 --> 03:29oftentimes we think
03:29 --> 03:31about breast cancer patients and
03:31 --> 03:33getting swelling in the arms,
03:33 --> 03:35but it sounds like the patient
03:35 --> 03:38population who benefit from both physical
03:38 --> 03:40therapy and occupational therapy
03:40 --> 03:43is really quite broad and quite diverse.
03:43 --> 03:45Can you maybe talk a little bit
03:45 --> 03:47about the patient population and
03:47 --> 03:49the different kinds of cancers,
03:49 --> 03:51the different kinds of
03:51 --> 03:52therapies that are available?
03:53 --> 03:56Sure. That's a great question
03:56 --> 03:58because there's so much that we can
03:58 --> 04:00do in rehab to work with patients
04:00 --> 04:02really throughout the different
04:02 --> 04:04stages of their cancer care.
04:04 --> 04:06Probably the 1st place that we
04:06 --> 04:08could start is something that we
04:08 --> 04:10call in rehab, we call prehab.
04:10 --> 04:14So the idea of seeing these
04:14 --> 04:16patients prior to surgery,
04:16 --> 04:18so whether it's somebody who's
04:18 --> 04:20newly diagnosed with breast cancer or
04:20 --> 04:22it's somebody who's newly diagnosed
04:22 --> 04:24with pancreatic cancer or a
04:24 --> 04:27GI cancer, we want to see these
04:27 --> 04:28patients before they actually
04:28 --> 04:31have surgery so that we can get
04:31 --> 04:33baseline data so that we know where
04:33 --> 04:35that patient is starting from,
04:35 --> 04:37so that after surgery we know
04:37 --> 04:40what we need to take that
04:40 --> 04:42patient to try to return them to
04:42 --> 04:44their prior level of function.
04:44 --> 04:46It also can give us a little bit
04:46 --> 04:49of a runway so to speak that if we
04:49 --> 04:51see this patient early on and we
04:51 --> 04:53have you know 3-5 weeks before
04:53 --> 04:56surgery is scheduled that we could
04:56 --> 04:58work on conditioning and to be
04:58 --> 05:00able to try to help that patient
05:00 --> 05:03not just physically get ready for
05:03 --> 05:05surgery but also mentally right.
05:05 --> 05:07I think we can all agree that the
05:07 --> 05:09cancer diagnosis is a
05:09 --> 05:11scary thing and it's a time
05:11 --> 05:12when patients maybe don't feel
05:12 --> 05:14like they have any control.
05:14 --> 05:17But we as rehab professionals,
05:17 --> 05:20we can help give some sense of control back,
05:20 --> 05:22especially in those early
05:22 --> 05:25phases to say we can teach you how
05:25 --> 05:27to move your body going into surgery.
05:27 --> 05:29Then there's the phase during
05:29 --> 05:30active treatment,
05:30 --> 05:33so during chemotherapy and during
05:33 --> 05:35radiation therapy where you're
05:35 --> 05:37trying to mitigate some of the
05:37 --> 05:39side effects of of treatment,
05:39 --> 05:41whether that's deconditioning
05:41 --> 05:43or that's peripheral neuropathy
05:43 --> 05:46that's caused by chemotherapy.
05:46 --> 05:48Range of motion concerns that might
05:48 --> 05:50arise from any of the different
05:50 --> 05:52diagnosis that we see again in patients
05:52 --> 05:55with breast cancer or a patient who's
05:55 --> 05:57diagnosed with a head and neck cancer.
05:57 --> 06:00We can see these patients while
06:00 --> 06:02they're in active treatment
06:02 --> 06:04and then we can continue to see
06:04 --> 06:06these patients when they're done
06:06 --> 06:08with active treatment in
06:08 --> 06:10the supportive phase,
06:10 --> 06:13the survivorship phase so to speak.
06:13 --> 06:15We think of our
06:15 --> 06:16patients with breast cancer who
06:16 --> 06:18might be on hormone therapy.
06:18 --> 06:20We know those hormone therapies have
06:20 --> 06:23their own set of of side effects as
06:23 --> 06:26far as joint pains or increased bone loss.
06:26 --> 06:28So we can address all of that
06:28 --> 06:31to design a structured,
06:31 --> 06:33individualized exercise plan and
06:33 --> 06:36really help serve as a bridge to
06:36 --> 06:38help transition those patients
06:38 --> 06:40back into the community,
06:40 --> 06:41whatever that might be,
06:41 --> 06:43if that's returning to the
06:43 --> 06:44gym or doing you know,
06:44 --> 06:47yoga videos or that sort of thing.
06:47 --> 06:50And there's also a place for rehab
06:50 --> 06:52in the the other phase of treatment
06:52 --> 06:55which is more the the palliative
06:55 --> 06:57and Hospice setting as well.
06:57 --> 06:59Whether that's making sure that the patient
07:01 --> 07:03is comfortable and
07:03 --> 07:05helps reduce pain at that stage of
07:05 --> 07:09of life to be able to do patient and
07:09 --> 07:11caregiver education as far as proper
07:11 --> 07:13body mechanics and making sure that
07:13 --> 07:15the home is set up properly so that
07:15 --> 07:17the patient and the caregivers are safe.
07:17 --> 07:20There's never a bad time
07:20 --> 07:23to initiate rehab for a patient
07:23 --> 07:25who's been diagnosed with cancer.
07:26 --> 07:29And Suzanne, maybe you can chime in
07:29 --> 07:32and and tell us a little bit more about
07:32 --> 07:35the different modalities that are at play.
07:35 --> 07:37I mean, it sounds like physical
07:37 --> 07:41therapy is not just one thing.
07:41 --> 07:43It sounds to me like it's not
07:43 --> 07:45just exercise or strengthening.
07:45 --> 07:47It's also, you know, getting into
07:47 --> 07:50sleeves or garments for lymphedema,
07:50 --> 07:53maybe massage, learning about
07:53 --> 07:56different techniques or exercises
07:56 --> 07:58that might be helpful.
07:58 --> 07:59Can you tell us more?
08:00 --> 08:02Absolutely. And I couldn't
08:02 --> 08:04agree more with with Scott's
08:04 --> 08:06information and perspective
08:06 --> 08:10there are so many ways that people,
08:10 --> 08:12patients, caregivers, family,
08:12 --> 08:15friends the support networks for
08:15 --> 08:17these patients along their journey
08:17 --> 08:19pre and post treatment and then
08:19 --> 08:21long term survivorship that we
08:21 --> 08:24can help with certainly the things
08:24 --> 08:26that we do as therapists manual
08:26 --> 08:29therapy utilization of cupping,
08:29 --> 08:31dynamic cupping to help improve scar
08:31 --> 08:33mobilization when the range of motion
08:33 --> 08:35for instance after breast cancer
08:35 --> 08:37really inhibits that lifting and
08:37 --> 08:39raising of the arm even for putting
08:39 --> 08:41on a coat or getting dressed or
08:41 --> 08:44bathing something as simple as that.
08:44 --> 08:46We we do exercise certainly
08:46 --> 08:48we do education of course these
08:48 --> 08:50are all really important things
08:50 --> 08:52and they follow the path of
08:52 --> 08:54rehabilitation that we have followed
08:54 --> 08:56for other patient populations.
08:56 --> 08:58But there are other things as you just
08:58 --> 09:00mentioned briefly as far as even the
09:00 --> 09:02lymphedema side,
09:02 --> 09:04folks need to know
09:04 --> 09:06how do they manage
09:06 --> 09:08these symptoms that they are
09:08 --> 09:09sometimes left with sometimes long
09:09 --> 09:11term how do they manage the changes
09:11 --> 09:13that occur with those symptoms
09:13 --> 09:15and we can show them whether
09:15 --> 09:16it's compression bandaging,
09:16 --> 09:19a compression garment fitting,
09:19 --> 09:20compression pump uses.
09:20 --> 09:23This is just on the lymphedema side of
09:23 --> 09:25the subspecialty that we can offer
09:25 --> 09:27and it could be education and
09:27 --> 09:28learning the techniques for
09:28 --> 09:31kinesio tape use for not only scar
09:31 --> 09:32mobilization for wherever their
09:32 --> 09:35scars are but moving a dam
09:35 --> 09:37again if the lymphedema is a problem.
09:37 --> 09:39And those are just a very small
09:39 --> 09:43slice of the things that we do for
09:43 --> 09:46modalities besides the general exercise,
09:46 --> 09:48manual therapy, strengthening,
09:48 --> 09:50etcetera, activity tolerance.
09:50 --> 09:52I had an experience that I could
09:52 --> 09:54share briefly if we had the time.
09:54 --> 09:55When I was working with a client
09:55 --> 09:57and she was coming in after having
09:57 --> 10:00an inoperable brain tumor that
10:00 --> 10:01was benign, thankfully,
10:01 --> 10:03but she had two surgeries over
10:03 --> 10:05the course of 15 years that left
10:05 --> 10:07her as a single mom and a young
10:07 --> 10:10working person with great
10:10 --> 10:11attention difficulties,
10:11 --> 10:12multitasking difficulties.
10:12 --> 10:14So her primary focus,
10:14 --> 10:17even though she did have range of
10:17 --> 10:18motion and weakness on one side,
10:18 --> 10:20her primary interest and goal
10:20 --> 10:22when she first came to see me
10:22 --> 10:24was I need to get a job again.
10:24 --> 10:26I need to get back to work to
10:26 --> 10:27support myself and my daughter.
10:27 --> 10:29And so we spent from an
10:29 --> 10:30occupational therapy's perspective,
10:30 --> 10:33we spent most of her sessions basically
10:33 --> 10:35focused on functional cognitive rehab,
10:35 --> 10:37things that weren't more speech
10:37 --> 10:38language specific.
10:38 --> 10:41But more how do I redo my resume and
10:41 --> 10:43figure out how I'm going to get a
10:43 --> 10:44job and what are the skills that I
10:44 --> 10:47actually have and how can I manage
10:47 --> 10:49multitasking or all this input
10:49 --> 10:52from a sensory or verbal or visual
10:52 --> 10:54standpoint so I can focus on my job.
10:54 --> 10:56So those kinds of things also
10:56 --> 10:57are really critical.
10:57 --> 11:00Wow. I mean, it sounds like physical
11:00 --> 11:03therapy has a lot more than just
11:03 --> 11:05perhaps what the general public
11:05 --> 11:07might think about in terms of
11:07 --> 11:11exercise and so on. Scott,
11:11 --> 11:12when you mentioned the different phases,
11:12 --> 11:15so getting people into
11:15 --> 11:16physical therapy right,
11:16 --> 11:19even before therapy begins in that
11:19 --> 11:23kind of prehab all the way through
11:23 --> 11:25to survivorship and getting
11:25 --> 11:27caregivers involved as well.
11:27 --> 11:31How do people access services?
11:31 --> 11:35I mean if they're living in an area
11:35 --> 11:38that might not be a major center.
11:38 --> 11:41Is this something that people should ask for?
11:41 --> 11:43Are there other resources that
11:43 --> 11:46are available or do you have to go
11:46 --> 11:48to a large academic center
11:48 --> 11:50to avail yourself of these?
11:50 --> 11:52Yeah, that's a great question.
11:52 --> 11:55So if it is something
11:55 --> 11:58that patients can advocate for,
11:58 --> 11:59you know, they can bring that up
11:59 --> 12:02to their to say, hey,
12:02 --> 12:04you know I'm worried about developing
12:04 --> 12:07lymphedema or I'm worried about
12:07 --> 12:08being tired from chemotherapy.
12:09 --> 12:12I have to work a full time job.
12:12 --> 12:14I have children that I have to provide for.
12:14 --> 12:17So patients can definitely
12:17 --> 12:20advocate for that where they are.
12:20 --> 12:23As far as being able to seek out
12:23 --> 12:25qualified physical therapist
12:25 --> 12:28and an occupational therapist,
12:28 --> 12:31I know at least for physical therapist
12:31 --> 12:33through the American Physical
12:33 --> 12:34Therapy Association,
12:34 --> 12:35there is a website
12:37 --> 12:39called choosept.com and so if you don't
12:39 --> 12:43live near a major academic institution,
12:43 --> 12:46you can go to that website again it's
12:46 --> 12:49choosept.com and you can put your
12:49 --> 12:53state and you can put what discipline
12:53 --> 12:56you're looking for and that would
12:56 --> 12:58include oncology physical therapy
12:58 --> 13:01and so that will connect you with
13:01 --> 13:04a physical therapist who's in your area who
13:04 --> 13:07has either extensive training
13:07 --> 13:09in oncology physical therapy or
13:09 --> 13:11is board certified in oncologic
13:11 --> 13:14physical therapy like I am.
13:14 --> 13:16So there are resources that are
13:16 --> 13:18out there that patients can use.
13:18 --> 13:20Fantastic. Well, we're going to take
13:20 --> 13:22a short break for a medical minute
13:22 --> 13:25and then when we come back we'll learn
13:25 --> 13:26more about oncology rehabilitation
13:26 --> 13:29with Scott Capozza and Suzanne Burbank.
13:29 --> 13:31Funding for Yale Cancer Answers
13:31 --> 13:34is provided by Smilow Cancer Hospital where
13:34 --> 13:36their survivorship clinic is available
13:36 --> 13:38to educate survivors on the prevention,
13:38 --> 13:41detection, and treatment of complications
13:41 --> 13:42resulting from cancer treatment.
13:42 --> 13:47Smilowcancerhospital.org.
13:47 --> 13:48Breast cancer is one of the
13:48 --> 13:50most common cancers in women.
13:50 --> 13:51In Connecticut alone,
13:51 --> 13:53approximately 3500 women will be
13:53 --> 13:56diagnosed with breast cancer this year,
13:56 --> 13:58but there is hope thanks
13:58 --> 13:59to earlier detection,
13:59 --> 13:59noninvasive treatments,
13:59 --> 14:02and the development of novel therapies
14:02 --> 14:03to fight breast cancer.
14:03 --> 14:05Women should schedule a baseline
14:05 --> 14:07mammogram beginning at age 40 or
14:07 --> 14:09earlier if they have risk factors
14:09 --> 14:11associated with the disease.
14:11 --> 14:13With screening, early detection,
14:13 --> 14:15and a healthy lifestyle,
14:15 --> 14:17breast cancer can be defeated.
14:17 --> 14:19Clinical trials are currently
14:19 --> 14:21underway at federally designated
14:21 --> 14:22Comprehensive cancer centers such
14:22 --> 14:25as Yale Cancer Center and Smilow
14:25 --> 14:27Cancer Hospital to make innovative
14:27 --> 14:29new treatments available to patients.
14:29 --> 14:30Digital breast tomosynthesis,
14:30 --> 14:32or 3D mammography,
14:32 --> 14:34is also transforming breast
14:34 --> 14:37cancer screening by significantly
14:37 --> 14:38reducing unnecessary procedures
14:38 --> 14:40while picking up more cancers.
14:40 --> 14:43More information is available
14:43 --> 14:44at yalecancercenter.org.
14:44 --> 14:46You're listening to Connecticut public radio.
14:47 --> 14:49Welcome back to Yale Cancer Answers.
14:49 --> 14:51This is doctor Anees Chagpar and
14:51 --> 14:53I'm joined tonight by my guests,
14:53 --> 14:56Scott Capozza and Suzanne Burbank.
14:56 --> 14:59We're talking about oncology rehabilitation
14:59 --> 15:02and right before the break,
15:02 --> 15:05Scott and Suzanne were both telling us
15:05 --> 15:07about the really dramatic impact that
15:07 --> 15:11getting rehabilitation services can have.
15:11 --> 15:13Everything from strengthening exercises,
15:13 --> 15:15which is what we normally think
15:15 --> 15:17about for physical therapy,
15:17 --> 15:19all the way to
15:19 --> 15:22how do you buff up your CV and get back into
15:22 --> 15:25the job market after a cancer diagnosis.
15:25 --> 15:27And Suzanne, when Scott
15:27 --> 15:31said you can advocate for yourself,
15:31 --> 15:33you can seek out these services,
15:33 --> 15:35one of the questions that people might
15:35 --> 15:38have is, is this covered by insurance?
15:38 --> 15:40I mean, is this something that
15:40 --> 15:43I can truly avail myself of?
15:43 --> 15:46Absolutely. That's a great question and
15:46 --> 15:48I do get that question actually
15:48 --> 15:49from doctors as well.
15:49 --> 15:52What sort of codes
15:52 --> 15:55do I send a person to you folks for cancer rehab.
15:57 --> 15:58As therapists,
15:58 --> 16:00we have historically worked on
16:00 --> 16:04things such as pain and endurance
16:04 --> 16:07and balance and cognitive decline or
16:07 --> 16:09cognitive issues and all of these
16:09 --> 16:11different things that really do apply
16:11 --> 16:13specifically also to the cancer
16:13 --> 16:15population to these oncological patients.
16:15 --> 16:18So I tell people which has been the
16:18 --> 16:20case of course since oncology
16:20 --> 16:24rehab has come to the forefront as a
16:24 --> 16:26new and developing specialty that yes,
16:26 --> 16:27insurance will cover
16:27 --> 16:29this services that we provide
16:29 --> 16:31because the services are the same
16:31 --> 16:33that we provide for all of the
16:33 --> 16:35different populations we see.
16:35 --> 16:35For instance,
16:35 --> 16:39if a cardiac patient has a cardiac event,
16:39 --> 16:41a heart attack or sometimes a stroke,
16:41 --> 16:43it's become common knowledge for
16:43 --> 16:45both the population, the patients,
16:45 --> 16:47families and doctors that that patient
16:47 --> 16:49probably would benefit from cardiac rehab.
16:49 --> 16:50That's a specialty.
16:50 --> 16:53But the codes that the doctors will
16:53 --> 16:55refer those patients for would be
16:55 --> 16:58things like activity and tolerance or pain.
16:58 --> 17:00For things like that balance and
17:00 --> 17:03so the case is the same for the
17:03 --> 17:05oncological rehab group as well for
17:05 --> 17:07patients that require our services
17:07 --> 17:10and insurance does cover it,
17:10 --> 17:11it's just a different population
17:11 --> 17:12coming to us.
17:12 --> 17:14But for similar deficits
17:14 --> 17:16if you will or functional issues,
17:17 --> 17:20and Scott you had mentioned
17:20 --> 17:24before the break the idea of both
17:24 --> 17:26inpatient and outpatient kind of
17:26 --> 17:28services and I wonder,
17:28 --> 17:31for many oncology patients who might
17:31 --> 17:34you know have their surgery and
17:34 --> 17:38then be sent home and they may live
17:38 --> 17:41quite a ways away from any
17:41 --> 17:46major center or any center at all.
17:46 --> 17:48These days, especially post COVID,
17:48 --> 17:51we've kind of gotten into the
17:51 --> 17:52virtual mindset.
17:52 --> 17:55So can you talk a little bit about whether
17:55 --> 17:58these services are available virtually and
17:58 --> 18:01whether you equip patients with
18:01 --> 18:04activities or exercises or things
18:04 --> 18:07that they can do on their own in
18:07 --> 18:10their home that might help them as
18:10 --> 18:13well without actually having to be in
18:13 --> 18:15the hospital to get these services.
18:15 --> 18:18Yeah that's a great point.
18:18 --> 18:21We want to be able to
18:21 --> 18:23empower our patients through education.
18:23 --> 18:26So yes there's a lot that we
18:26 --> 18:29can do as far as making sure that
18:29 --> 18:32we educate our patients on
18:32 --> 18:34exercises and movement strategies
18:34 --> 18:37that they can safely do at home.
18:40 --> 18:42And for physical therapists, you know,
18:42 --> 18:43as long as you live
18:43 --> 18:45in the state of Connecticut,
18:46 --> 18:48we can do a telehealth visit,
18:48 --> 18:49you can live in the four corners of
18:49 --> 18:51the state, but we could still connect
18:51 --> 18:53with you and we can go through,
18:53 --> 18:56you know, an exercise routine.
18:56 --> 18:57And also make sure that we
18:57 --> 18:58are trying to
18:58 --> 19:01help you set up that home
19:01 --> 19:03environment as best as possible.
19:06 --> 19:08And with all of our talents and lymphedema therapists,
19:08 --> 19:09they do something very similar
19:09 --> 19:11where yes they
19:11 --> 19:13like to be able to do the
19:13 --> 19:16hands on manual techniques.
19:16 --> 19:18They're also going to teach their
19:18 --> 19:20patients how to do their own
19:20 --> 19:22manual techniques to be able to
19:22 --> 19:23help manage their lymphedema.
19:23 --> 19:27So there's a big part of rehab that is education.
19:30 --> 19:32We want to make sure that we are
19:32 --> 19:33setting our patients up for success.
19:34 --> 19:37And Suzanne, the
19:37 --> 19:41question of setting up a home environment,
19:41 --> 19:45I mean I can imagine that there are patients
19:45 --> 19:49who after a cancer surgery or treatment
19:49 --> 19:53might have difficulty with basic things,
19:53 --> 19:55right, getting into their bathtub,
19:55 --> 19:58getting up the three flights
19:58 --> 20:01of stairs in their house and can you
20:01 --> 20:04talk a little bit about how
20:04 --> 20:06occupational therapy can actually
20:06 --> 20:09help to kind of make home environments
20:09 --> 20:12more livable after a cancer diagnosis?
20:13 --> 20:17Is that an out of pocket cost or does
20:17 --> 20:20insurance help to make homes more
20:20 --> 20:23livable after a cancer diagnosis?
20:24 --> 20:26That's an excellent question.
20:26 --> 20:30I do know from my experience,
20:30 --> 20:31not only as an outpatient therapist,
20:31 --> 20:33but also in home health,
20:33 --> 20:35that sadly at this point to my
20:35 --> 20:37knowledge and I could be wrong,
20:37 --> 20:38so please, if anyone can
20:38 --> 20:39correct me that would be great.
20:39 --> 20:41I would love to know, but
20:41 --> 20:43insurance is not an option for this.
20:43 --> 20:47To my point I believe that most home health changes,
20:48 --> 20:50the shower bars,
20:50 --> 20:53the non skid mats,
20:53 --> 20:54the accessibility
20:54 --> 20:57options that are available,
20:57 --> 20:59even something as simple as a
20:59 --> 21:01sock aid or a long handled
21:01 --> 21:03sponge or things that make
21:03 --> 21:05just the basic self-care tasks
21:05 --> 21:08easier and more tolerable until
21:08 --> 21:09function is restored or improved.
21:09 --> 21:12Most of the times to my knowledge
21:12 --> 21:15those are not covered by insurance.
21:15 --> 21:18However there are ways to do things
21:18 --> 21:20that you can modify a home with that
21:20 --> 21:22sometimes are not as structural.
21:22 --> 21:24I do believe that safety bars you
21:24 --> 21:26know that the hand rails and the
21:26 --> 21:28safety bars to go in certainly
21:28 --> 21:31home ramps
21:31 --> 21:33and whatnot that is a different
21:33 --> 21:36area that certainly outside of
21:36 --> 21:38what you could consider smaller
21:38 --> 21:40financial investment of changes.
21:40 --> 21:43I believe that some of those things of
21:43 --> 21:45course can be covered like it could
21:45 --> 21:47be for any patient that has a need.
21:47 --> 21:50But that would be very insurance specific
21:50 --> 21:52and probably require a bit more research.
21:52 --> 21:54So I will be honest and saying
21:54 --> 21:56I'm not sure how much of those
21:56 --> 21:58kinds of things can be changed or
21:58 --> 21:59provided for by insurance except
21:59 --> 22:03for the larger lift chairs
22:03 --> 22:05and ramp access.
22:05 --> 22:07Those kinds of things I have seen
22:07 --> 22:09provided for by especially
22:09 --> 22:11with patients who are affiliated
22:11 --> 22:12with the VA and things like that
22:12 --> 22:14as far as modifications in this day
22:14 --> 22:17and age where we have such virtual
22:17 --> 22:19accessibility through telehealth
22:19 --> 22:22meetings or sessions.
22:22 --> 22:24And someone literally could be on the phone,
22:24 --> 22:27on their laptop or on their
22:27 --> 22:28video camera walking around the home
22:28 --> 22:31and we could talk them through OK,
22:31 --> 22:32show me your bathroom.
22:32 --> 22:33Literally turn that camera around
22:33 --> 22:35and let me turn that phone around.
22:35 --> 22:37Let me see what you have.
22:37 --> 22:38Let's see what kind of equipment
22:38 --> 22:40you may or may not need.
22:40 --> 22:42Let's see the height of that tub or
22:42 --> 22:44that walk in shower and looking at
22:44 --> 22:45their accessibility that they
22:45 --> 22:47currently have can be definitely
22:47 --> 22:48done virtually.
22:48 --> 22:50As far as the lymphedema side,
22:50 --> 22:51I'm just going to slip that in again.
22:53 --> 22:56Scott is actually right to tell our
22:56 --> 22:59people and show them in person initially,
22:59 --> 23:00reduce their swelling and then
23:00 --> 23:03teach them how to do it long term so
23:03 --> 23:04they don't keep coming to therapy
23:04 --> 23:06for the rest of their lives is
23:06 --> 23:08actually an integral part of the
23:08 --> 23:09program for lymphedema side.
23:10 --> 23:14And Scott, the other question
23:14 --> 23:17I think people might be asking themselves
23:17 --> 23:20is #1 how much time does this take?
23:20 --> 23:23And #2, can I really do this?
23:23 --> 23:26I mean all of these exercises,
23:26 --> 23:27these strength training things,
23:27 --> 23:29all of the things that they're going
23:29 --> 23:31to teach me at physical therapy.
23:31 --> 23:33Can I do this?
23:33 --> 23:36Can I do I actually know how to do it?
23:36 --> 23:38Is it possible for me to do
23:38 --> 23:40and how long does it take and
23:40 --> 23:43finally, what are the tangible benefits?
23:44 --> 23:47Yeah, I think o
23:47 --> 23:50address the those questions
23:50 --> 23:52as far as the time frame and
23:52 --> 23:55the time commitment that is very
23:55 --> 23:59individualized that you you can have two
23:59 --> 24:02individuals with the same cancer diagnosis
24:02 --> 24:04but they're going to have different
24:04 --> 24:06treatments and
24:06 --> 24:08so they're going to have different
24:08 --> 24:10adverse effects from those treatments.
24:10 --> 24:12So to be able to meet with an
24:12 --> 24:15occupational therapist or physical therapist.
24:15 --> 24:17Or a speech therapist for our
24:17 --> 24:20patients with a head and neck cancer
24:21 --> 24:23that's our role as the rehab
24:23 --> 24:25professionals, to help figure out
24:25 --> 24:27what that time frame is going to be.
24:28 --> 24:30This is not cookie cutter,
24:30 --> 24:32this is not a set protocol.
24:32 --> 24:36It's very individualized to the person.
24:36 --> 24:39But then to your point also about
24:39 --> 24:41can the patient do this.
24:41 --> 24:42Yes, you can.
24:42 --> 24:43And that is our job,
24:43 --> 24:46to be able to help teach you to be
24:46 --> 24:49able to breakdown movement strategies,
24:49 --> 24:52to be able to to listen to you and hear
24:52 --> 24:56what's working and what's not working.
24:56 --> 24:59And we can make changes, you know,
24:59 --> 25:00to be able to change the different
25:00 --> 25:02exercises that you're working on,
25:02 --> 25:05to be able to change movement patterns.
25:05 --> 25:06And ultimately, again,
25:06 --> 25:08it's our responsibility,
25:08 --> 25:09it's our goal to be able to empower
25:09 --> 25:11you to be able to do these
25:11 --> 25:13stretches and these exercises and
25:14 --> 25:17these manual lymph drainage
25:17 --> 25:20techniques all on your own.
25:20 --> 25:21So that's what we're going to do.
25:21 --> 25:23We're going to listen to you.
25:23 --> 25:25I think one of the things that we
25:25 --> 25:28do very well is that we do create
25:28 --> 25:30this safe space for you to be
25:30 --> 25:32able to listen to you and then be
25:32 --> 25:33able to turn around and say,
25:33 --> 25:36OK, I hear what you're saying.
25:36 --> 25:38This is how we're going to take
25:38 --> 25:40these exercises and help apply
25:40 --> 25:42it to your life and make sure
25:42 --> 25:44that it's all relevant to you.
25:46 --> 25:47And Suzanne, you know,
25:47 --> 25:49one of the questions that people might ask,
25:49 --> 25:53particularly in the lymphedema world is
25:53 --> 25:56if I do these exercises,
25:56 --> 25:58I do the the massage,
25:58 --> 26:00I wear the compression garment,
26:00 --> 26:03if that's what's been prescribed, et cetera,
26:03 --> 26:05will it actually make a difference?
26:05 --> 26:07In other words,
26:07 --> 26:10will the swelling go down and stay down?
26:10 --> 26:12And what if it comes back?
26:12 --> 26:15How often does that happen and what
26:15 --> 26:18are the options at that point?
26:19 --> 26:21Actually that is such a common question
26:21 --> 26:23and I appreciate your asking that.
26:23 --> 26:25It's such a common sentiment from the
26:25 --> 26:27patients that I see for lymphedema
26:27 --> 26:29regardless of where it's located in
26:29 --> 26:31their body and and what was the reason
26:31 --> 26:34they they got it or developed it.
26:34 --> 26:36Absolutely the complete decongestive
26:36 --> 26:39therapy program which is the four
26:39 --> 26:41pronged approach to lymphedema
26:41 --> 26:43management for patients
26:43 --> 26:44has two phases.
26:44 --> 26:46One is the in clinic reduction phase
26:46 --> 26:48and our job as therapists
26:48 --> 26:50is to look
26:50 --> 26:53at the patient, as Scott said,
26:53 --> 26:55be very patient specific.
26:55 --> 26:56See what their needs are,
26:56 --> 26:59what their swelling volume is as
26:59 --> 27:01compared to the unaffected portion,
27:01 --> 27:03whether it's a leg or trunk,
27:03 --> 27:05and then look at their home,
27:05 --> 27:06their home support.
27:06 --> 27:08Are they alone?
27:08 --> 27:09Can they even reach their feet
27:09 --> 27:11if the swelling is in their legs
27:11 --> 27:13after having some sort of a
27:13 --> 27:17GYN or prostate cancer diagnosis and surgery.
27:17 --> 27:19So we look at the patient and we say,
27:19 --> 27:21OK, here is what we have and the
27:21 --> 27:23tools that we have as lymphedema
27:23 --> 27:25therapists are the manual lymphatic drainage,
27:25 --> 27:27which is a very unique and specialized
27:27 --> 27:29massage, very light,
27:29 --> 27:31almost seems counterintuitive.
27:31 --> 27:32And I can't tell you how many
27:32 --> 27:33times people will tell me,
27:33 --> 27:34are you kidding?
27:34 --> 27:36Is this actually going to make a difference?
27:36 --> 27:37And it does.
27:37 --> 27:39I've seen it time and time again.
27:39 --> 27:41I share with people the logic and
27:41 --> 27:43the rationale behind that.
27:43 --> 27:45We talk about the compression
27:45 --> 27:47aspect of thecomplete
27:47 --> 27:49decongestive therapy program.
27:49 --> 27:51We say we're going to use the massage
27:51 --> 27:52the manual lymphatic drainage.
27:52 --> 27:54We're going to use compression
27:54 --> 27:56bandages if possible to reduce the
27:56 --> 27:59size of your area that is of concern.
27:59 --> 28:01We will measure you and or send
28:01 --> 28:03you to vendors within or without
28:03 --> 28:06the Yale and YNH program and system
28:06 --> 28:09to measure you to get you in the
28:09 --> 28:10appropriate compressive garments.
28:10 --> 28:13And then we show them exercises
28:13 --> 28:15and we put all those four things
28:15 --> 28:17together and we say, OK,
28:17 --> 28:20now this is how you do this,
28:20 --> 28:22this is how you manage this long term,
28:22 --> 28:24it should reduce you.
28:24 --> 28:26That's the goal.
28:26 --> 28:28Then you are going to maintain
28:28 --> 28:29that reduction as you move forward.
28:30 --> 28:32Suzanne Burbank is an occupational and
28:32 --> 28:34lymphedema therapist and Scott Capozza
28:34 --> 28:37is a physical therapist for the Smilow
28:37 --> 28:39Cancer Hospital survivorship clinic.
28:39 --> 28:41If you have questions,
28:41 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:45and past editions of
28:45 --> 28:48the program are available in audio and
28:48 --> 28:49written form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Oncology Rehabilitation with guests Scott Capozza and Suzanne Burbank December 18, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095