Do You Know How to Treat and Assess Complex Cancer Cases?
By: Nataliya Zlotnikov, HBSc, MSc
By: Nataliya Zlotnikov, HBSc, MSc
Today’s blog is based on Jodi Steele’s – physiotherapist and founder of Cancer Rehab Inc., Canada’s first not-for-profit cancer rehabilitation centre – online healthcare course on Embodia, Complex Case Studies in Oncology.
The course is based on a live, interactive webinar and examines two real-life complex cancer case studies that you may see in the home or at your clinic. We will discuss one of the two case studies below.
But before we present the case study, a test! NO, DON'T GO!
Do you remember the HRmax equation?
Take a look at this snippet from the course in which Jodi Steele discusses the new HRmax and the reasoning behind it.
The New Max Heart Rate
If you'd like to travel deeper down this rabbit hole take a look at the paper below:
Course Learning Objectives
- Examine two real-life complex case studies that you may see in the home or at your clinic
- Discuss proper assessments and outcome measures
- Distinguish the underlying principles of the various treatment modalities/activities to enhance functionality for the clients diagnosed with cancer
- Outline treatment plans that encompass the whole person
- Talk about exercise research and the importance of exercise programming for all clients with a diagnosis of cancer
Case Study 1: Norma
In today's blog, we will touch on the first of the two case studies.
We'd like to introduce you to Norma.
- Norma is an 85-year-old woman who was a housewife.
- She has never had an active lifestyle but has always been underweight.
- She was diagnosed with osteoporosis and osteoarthritis in her 60’s.
- Her current resting heart rate is 80 bpm and her blood pressure is 126/84 mmHg.
- She weighs 51 kg and is 162 cm tall.
Norma's Functional Limitations
- Getting out of bed must roll right and use a handrail.
- She has a PSW daily for bathing and other household duties.
- Norma was diagnosed with malignant melanoma on her scalp.
- After biopsy and MRI she underwent a 5-hour surgery for excision.
- The surgery involved removing the primary tumour and the surgeons looked to take a large margin.
- A circular piece, 8 cm in diameter (quite extensive), was removed from the scalp.
- A muscle flap was taken from the left latissimus dorsi.
- The skin and muscle flap was placed onto the scalp after the tumour was removed and then we had quite an extensive wound.
- Quite a bit of pain and stiffness in the neck.
- Some swelling.
- Dizziness and fatigue.
Assessment & Treatment
Now let's discuss the assessment and treatment.
Although we want to treat the whole person, it can be quite beneficial to separate all that we have to work on into sections.
We can't just place a blanket and say we're going to do some range of motion or something like that.
We need to think of what are all the things we need to be concerned about and how are we going to treat them individually or if we’re lucky, using different physiotherapy techniques and exercise.
We need to think about Norma's function, pain and discomfort, ROM and neck mobility.
Questions to Ask Yourself for Norma's Assessment and Treatment
Take a second as you work through the questions below, then check in with the course to see what the webinar attendees and Jodi Steele said during the live version of this course.
- So what kinds of things would you want to assess particularly when it comes to the neck region?
- Think about pain and discomfort: what kinds of things would you like to use to try to get a real handle on her pain?
- What would you do for function?
- How would you go about her treatment?
- What kind/s/ of manual therapy if any would you like to provide for Norma?
Let's switch gears and talk about the importance of exercise in cancer:
There is now really good research supporting moderate-intensity exercise for:
- Decreasing the re-occurrence of cancer
- Helping to decrease secondary diagnosis
Helping persons with:
- Cancer-related fatigue
- Symptoms from chemotherapy radiation
Jodi Loves Target Heart Rate
Remember our new equation from the intro of this blog? Well, it now becomes relevant.
Jodi likes to keep her patients at 50-75% of HR max.
Exercise on Chemotherapy or Radiation
Watch this snippet from the course in which Jodi answers the question "When a patient is still doing chemotherapy or radiation, what are the limitations or even advantages of exercises, are there guidelines to prescribe?"
Love Oncological Case studies?
If you can't get enough of oncological case studies, take a look at another one of our case-study-based oncology blogs, Physical Therapists Make Life Worth Living: Physiotherapy in Oncology, based on an informal dialogue with oncology expert, Marize Ibrahim.
Personally, I truly enjoy the humility and humour that Jodi Steele brings to her courses and the knowledge of course.
You can find more of Jodi's online healthcare courses on Embodia here.
PT, BKin, BSc(PT)
Jodi earned her kinesiology degree in 1997 and a physiotherapy degree in 1999 from McMaster University. Upon graduation she co-developed an oncology rehabilitation program, Cancer Rehab-The Next Step. In 2005 her husband joined her and founded Cancer Rehab Inc., Canada’s first not-for-profit cancer rehabilitation centre.
In 2009, Jodi designed, developed and launched Wellspring’s Cancer Exercise Program, which continues to be delivered at sites throughout southern Ontario. For her innovative contributions to society, Jodi received the 2009 Arch Award from McMaster University.
Presently Jodi is a professor at Niagara College. She continues to educate peers through educational lectures focusing on cancer exercise and rehabilitation for health care professionals and lymphedema management in the home care setting.