1. File #6 Presentation Conclusion Oncology Rehabilitation: Web-based Learning for Physical Therapists Who Provide Rehabilitation to Patients with Breast Cancer

2. 2 Presentation Conclusion Case Studies Case Studies Survival Survival Education Education Join your peers and reach for progress Join your peers and reach for progress

3. 3 Case Studies The following are a few case studies that I have been involved with, over the years.

4. Case # 1 Telephone call from patient; recent bilateral TRAM procedure; physician advised her to find a therapist; unsuccessful finding anyone with experience in treating a TRAM patient; networking, I was able to find her a physical therapist in her hometown of St. Louis, who was experienced in breast cancer care; received fax from patient, notifying me of her satisfaction and success in P.T.

5. 5 Case #2 35 y/o model advised by her physician (surgeon) that after her breast surgery she would be unable to return to her career and must limit exercises; telephone call from her physical therapist, who had read my publications; discussed my thoughts on a quality of life program for this patient; advised therapist, if desired, I would communicate with physician about the benefits of therapy post- op; discussed program with physician, who hesitantly agreed with program; with rehabilitation, Result: patient able to resume full activities, including modeling. 35 y/o model advised by her physician (surgeon) that after her breast surgery she would be unable to return to her career and must limit exercises; telephone call from her physical therapist, who had read my publications; discussed my thoughts on a quality of life program for this patient; advised therapist, if desired, I would communicate with physician about the benefits of therapy post- op; discussed program with physician, who hesitantly agreed with program; with rehabilitation, Result: patient able to resume full activities, including modeling.

6. 6 Case # 3 38 y/o female scheduled for breast reduction, advised by her physician that a mammogram was not needed; independently patient decided to undergo diagnostic test; diagnosed with a intraductal carcinoma; patient completed left modified mastectomy with a TRAM reconstruction and a reduction of the right breast; followed individualized plan of treatment with positive response. 38 y/o female scheduled for breast reduction, advised by her physician that a mammogram was not needed; independently patient decided to undergo diagnostic test; diagnosed with a intraductal carcinoma; patient completed left modified mastectomy with a TRAM reconstruction and a reduction of the right breast; followed individualized plan of treatment with positive response.

7. 7 Case #4 33 y/o female noted a lump in her breast; advised by physician that she was too young to be worried; because patient was worried she independently went for a second opinion and mammogram; patient diagnosed with breast cancer; right modified radical mastectomy followed by a TRAM procedure (8 hrs.), hospitalized 6 days, only therapy received was for gait training due to weakness following bed rest. Program of out-patient rehabilitation progressed patient (out-pt. and home program) to independence within two months. 33 y/o female noted a lump in her breast; advised by physician that she was too young to be worried; because patient was worried she independently went for a second opinion and mammogram; patient diagnosed with breast cancer; right modified radical mastectomy followed by a TRAM procedure (8 hrs.), hospitalized 6 days, only therapy received was for gait training due to weakness following bed rest. Program of out-patient rehabilitation progressed patient (out-pt. and home program) to independence within two months.

8. 8 Survival

9. 9 Survival Over 8 million Americans alive with a history of cancer. 2.3 million with a history of breast cancer 5 million diagnosed five or more years ago. Five year survival rate generally considered cured, meaning no evidence of disease and regular life expectancy. Report from American Cancer Society, Surveillance Research. (www.cancer.org, 2005)www.cancer.org

10. 10 Breast Cancer 5 Year Survival Rates by Stages: by Stages: Stage 0 98-100% Stage I 85-97% Stage II 70-90% Stage III 40-70% Stage IV 5-20% (Dollinger, 2002)

11. 11 Education

12. 12 Hours vary, but generally minimal, due to the great amount of material that has to be covered for overall educational requirements. Breast Cancer education is limited at many educational facilities. Breast Cancer education is limited at many educational facilities.

13. 13 Telephone Survey Cancer education presented in physical therapy curricula (Study completed by Coleman, 2005)

14. 14 “I found that, working with breast cancer patients is very educational and challenging, but this specialty can be most exciting and rewarding” M.S. Coleman

15. 15 Potential Now that you have reviewed the basic oncology portion, as well as the breast cancer interventions associated with physical therapy, you should be motivated by the research and various therapy regimes which have been reviewed. Incorporating everything together, I hope you are ready to provide quality care to the patient diagnosed with breast cancer. Now that you have reviewed the basic oncology portion, as well as the breast cancer interventions associated with physical therapy, you should be motivated by the research and various therapy regimes which have been reviewed. Incorporating everything together, I hope you are ready to provide quality care to the patient diagnosed with breast cancer. The American Cancer Society reports that exercise programs for breast cancer patients, “Are popping up all over the U.S.”. Let the new programs be run by physical therapists, like yourself. The American Cancer Society reports that exercise programs for breast cancer patients, “Are popping up all over the U.S.”. Let the new programs be run by physical therapists, like yourself.

16. 16 Conclusion of presentation

17. 17 Conclusion: Objectives Covered Presented the reality of cancer. Statistics of growth and progression of this disease. Medical team approach, including physical therapy. Why patients diagnosed with cancer need rehabilitation. Wellness / Cancer should be synonymous. The Physical Therapist’s Role. The need to promote Quality care through continual education.

18. 18 Your peers can assist you

19. 19 Join the Oncology Section Network made up of active physical therapist throughout the USA, working in cancer rehab. Educate the patient, health care provider and the public of the benefits of cancer rehabilitation. Share Knowledge with other professionals. Participate in research studies. Contribute knowledge through research and case studies to quarterly publications. Special Interest Group available: HIV/AIDS Become a member of a section, of the APTA, that could use your help in developing quality care for the patient diagnosed with cancer. Spread the word about early detection and care.

20. 20 Answers to the pre/post test

21. 21 Answers to pre/post test 1.Cancer is a large group of diseases characterized by uncontrolled growth and spread of abnormal cells and if not controlled can lead to death. 2.C – Change in bowel or bladder habits A – A sore that does not heal U – Unusual bleeding or discharge T – Thickening or lump in breast or elsewhere I – Indigestion or difficulty swallowing O – Obvious change in wart or mole N – Nagging cough or hoarseness 3.Family history; Long menstrual cycles; age at first pregnancy; education & socioeconomic class; stress; obesity; live in Northern U.S.; history of colon or other female cancers. 4.Tumor size; Node involvement; Metastasis 5.Physical Therapist plus entire medical team 6.Oncology Section of the A.P.T.A. 7.Promote Quality of Life 8.D. All facilities listed 9.Increase muscle protein; joint mobility and strength; decrease edema, pain, anxiety, and depression. Enhance Immune system and decrease infections.

22. 22 Continue test answers 10. Diagnostic: Biopsy / Obtain tissue for diagnosis Curative: Remove cancer with attempt to cure Palliative: Improve Quality of Life Prophylastic: Prevent future disease 11.Radiation 12.Questionable; Know the contraindications of modalities before taking a chance when treating Lymphedema. 13. Inguinal; Axilla; Popliteal 14. Unusual fatigue; dizziness; unusual weakness; nausea; platelets; white blood cell counts. 15. Demonstrate the progress that has been reported with research and prolonged quality of life, for the patient receiving breast cancer rehabilitation.

23. Michael S. Coleman, P.T. COLEMAN CONSULTING user521159@aol.com user521159@aol.com