Rehab: Oncology

Oncology Concepts 

  •  Cancer Definition: Group of diseases with abnormal cell growth caused by gene changes affecting cell function.

  • Cancer Effects: Cancer cells rapidly reproduce, deprive healthy cells of nutrients, and invade nearby tissues.

    • 2nd leading cause of death in the U.S.

    • Affects ~1.6 million people/year.

    • Survival rates are improving.

    • High personal & financial impact.

  • Metastasis: Cancer spreads via blood or lymphatic vessels.
    Common Cancer Treatments & OT Implications

Treatment

Purpose

Complications

Radiation Therapy

Kills cancer cells, shrinks tumors

Fatigue, skin burns, weakness

Chemotherapy

Drugs that kill cancer cells

Nausea, fatigue, hair loss, Peripheral Neuropathy, cognitive changes

Immunotherapy

Boosts immune system

Flu-like symptoms, fatigue

Hormone Therapy

Slows or stops hormone-dependent cancer growth

Mood swings, fatigue, hot flashes

Stem Cell Transplant

Restores blood-forming cells after chemo/radiation

Infection risk, GVH disease

Surgery

Removes tumors/cancer cells

Pain, mobility limitations, infection risk

Precautions / Contraindications:

  • Monitor vitals, labs, WBC, platelets.

  • Neutropenic precautions: low WBC = high infection risk (mask, gloves, gown).

  • GVH (Graft vs Host Disease): fever, rash, nausea, vomiting, jaundice.

  • Always verify ROM and WB restrictions with the medical team.

Secondary Conditions & Functional Implications

Cancer-Related Fatigue (CRF)

  • 70–90% experience CRF during treatment.

  • 30%+ experience moderate–severe CRF within 1 year of diagnosis.

  • Limits activity tolerance, participation, and ADL performance.

Cancer-Related Cognitive Dysfunction

  • Affects 75% during treatment; 20–30% continue post-treatment.

  • Impacts attention, memory, concentration, reaction time.

  • Leads to reduced productivity, social engagement, and daily function.

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

  • 38% of multi-agent patients develop it.

  • Causes burning, tingling, numbness, balance issues, falls.

  • Impairs ADLs and psychosocial functioning.

Cancer-Related Pain

  • 33–50% experience pain; often intractable.

  • Pain severity linked to poor ADL/IADL performance.

Lymphedema

  • Impaired lymph fluid flow (3–5 million affected in U.S.).

  • Often caused by cancer treatment.

  • Managed with Complete Decongestive Therapy (CDT) & Manual Lymph Drainage (MLD): bandaging, compression garments, skin care, exercises.

  • Requires specialized OT certification; done in OP, inpatient, or home health settings.

Psychological Impact

  • 1 in 4 experience clinical depression.

  • Anxiety, fear, and emotional burden affect work, leisure, sleep, social, sexual activity.

 Range of Deficits from Cancer / Treatment

  • Physical: heart rate/rhythm, dizziness, BP, vision, metabolism, appetite, fatigue

  • Cognitive: memory, concentration, processing speed, attention

  • Sensory: peripheral neuropathy

  • Pain: cancer-related or post-treatment

  • Psychosocial: depression, anxiety, decreased motivation

 Occupational Therapy Role in Oncology

Goal: Enable patients to achieve maximum physical, psychological, and social function in daily living—regardless of life expectancy.

  • 60–90% of cancer survivors have rehab needs.

OT Focus Areas

  • ADLs/IADLs, energy conservation, pain management

  • Safe mobility, adaptive equipment, fatigue & cognitive management

  • Emotional support, education, and lifestyle redesign

The PRISM Model (OT Framework for Oncology Care)

Purpose: Comprehensive, integrative, education-based rehabilitation model for cancer care.

Prevention

  • Prevent/slow functional decline

  • Promote engagement in life roles

  • Pre-habilitation: prepare newly diagnosed patients for treatment; reduce side effects and long-term problems

Education

  • Teach about disease, treatment effects, and self-management

  • Empower patients and families

Intervention

  • Evaluation & Plan of Care: based on setting and client context

  • Exercise & Wellness Programs: customized to medical status

  • Patient/Family Education

  • Safe Mobility: monitor vitals and symptoms

  • Functional Training: ADLs, cognition, pain, behavior

  • Lymphedema management & PAMs for pain

  • Discharge Planning: home safety, equipment, wheelchair eval

Sustained Wellness

  • Support health before, during, and beyond treatment

  • Referrals: Cancer Resource Centers, ACS, support groups, outpatient/home therapy

  • Programs: Cancer survivorship, integrative medicine, community wellness, exercise programs

  • Assess readiness for discharge or continued rehab (home vs SNF/inpatient)

Common Cancers Seen in OT

(General list — OTs encounter patients across most cancer types depending on treatment effects and functional needs)

  • Breast, Lung, Brain, Prostate, Colorectal, Head and neck, Blood cancers (leukemia, lymphoma)

Assessment

Purpose

Katz ADL Scale

Basic ADL independence

KELS

Living skills, cognition

A-One

Neurobehavioral function (facility-specific, costly)

Brief Fatigue Inventory

Fatigue impact snapshot

Cognitive Tests: EFPT, Kettle Test, Multiple Errands Test, MOCA

Executive function, problem-solving, memory

Pain Assessments

Chronic and acute pain levels

Functional Assessment of Cancer Therapy (FACT)

Emotional and behavioral health

Basic Functional Assessments

Mobility, balance, strength, endurance, cognition


Key Takeaways

  • Cancer affects multiple systems — physical, cognitive, psychological.

  • OT focuses on function, participation, education, and wellness throughout all stages.

  • Energy conservation, adaptive techniques, and psychosocial support are central.

  • PRISM model guides comprehensive, patient-centered oncology rehabilitation.