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Clinical Programs in the Department of Supportive Care - Cancer Rehab and Survivorship
- 1. INTRODUCTION TO CANCER REHABILITATION AND SURVIVORSHIP Summer Research Student Program Stephanie Phan, Clinical Lead Cancer Rehabilitation and Survivorship Program
- 2. Objectives • Explore the meaning of cancer survivorship and related terms • Identify common cancer survivorship concerns for patients and families • Introduce ELLICSR and Cancer Rehab & Survivorship • Comprehensive Assessment and 8-week Group Cancer Rehab Program • Review other services and resources
- 3. Cancer Survivorship and Related Terms Who is a cancer survivor? • Anyone who has ever received a cancer diagnosis. Cancer survivorship starts at diagnosis. • Anyone who completed definitive cancer treatment (surgery, radiation, systemic therapy) with the exception of targeted therapies and hormonal therapy. Cancer survivorship starts at treatment completion. • Anyone who has ever been touched by cancer including patients, family members, friends, and caregivers. Cancer survivorship starts at diagnosis.
- 4. Cancer Survivorship and Related Terms • No single definition • Health care professionals: living with, through and beyond cancer • Individuals with cancer: disease free after treatment completion • Stigma
- 5. Cancer Survivorship and Related Terms Persistent Effects versus Late Effects Long-lasting (persistent) effects refer to any side effects or complications of treatment for cancer that continue beyond the end of treatment Late effects of cancer treatment appear months or years after treatment has ended
- 6. Cancer Survivorship Issues Common late and persisting effects • Neurocognitive changes • Cancer related fatigue • Lymphedema • Peripheral neuropathy • Depending on the system affected: endocrine, CV, GI, GU, hematological/immune, MSK, neurologic, pulmonary
- 7. Cancer Survivorship Issues • Fear of cancer recurrence • Return to work/school • Body image/sexual health • Relationships • Psychological distress
- 8. Cancer Survivorship Self-management Cancer Survivorship Clinics are based on the self-management model Self-management requires ability to manage • Disease (medical management) • Emotional consequences (emotional management) • Changes of daily life (role management) Patients need: • Knowledge (i.e. disease, resources) • Attitudes (i.e. motivation, confidence) • Skills (i.e. self-care skills, self-management skills) All patients self-manage to some extent.
- 9. ELLICSR, Health, Wellness and Survivorship Centre Mission: To maximize the quality of life, health & wellness of all who are impacted by cancer Goals (HEAT): Harness the power of survivor communities Enable survivors to become empowered experts in the management of their health & wellbeing Accelerate research & innovation in survivorship programs & services Transform care by integrating evidence- based self-management support
- 10. Survivorship Centre located on 2nd floor of Princess Margaret • Fatigue Clinic • Lymphedema Clinic • Function and Mobility Clinic • Neurocognitive Clinic • Physiatry Consult • Return to Work Consult • Sexual Health Consult
- 11. Cancer Rehabilitation and Survivorship Program Redesign • Every patient gets a Comprehensive Assessment by an inter-disciplinary team within a reasonable timeframe • Informed, collaborative decision is made at the end of the visit re: care plan • Opportunity to refer patients to a group-based cancer rehabilitation program that may eliminate need for multiple individual follow-ups • Part of standard of care for every cancer patient
- 12. Cancer Rehabilitation • Pain • Fatigue • Deconditioning • Reduced physical strength • Reduced range of motion of joints • Decreased cardiovascular capacity • Lymphedema • Bone Loss • Mood disorders including depression and anxiety • Decreased work productivity • Decreased social functioning • Heart disease (future) • Diabetes (future) • Second malignancies and recurrence of primary malignancy Adverse effects of cancer treatment that may be reduced with Rehab Intervention “Cancer rehabilitation, involves helping a person with cancer to help himself or herself to obtain maximum physical, social, psychological, and vocational functioning within the limits imposed by disease and its treatment” (Crome)
- 13. Medical Physical Functional Psychosocial/ Cognitive • Physiatrist • RN • OT • PT • RD • RMT • RN • RKin • OT • PT • SW • Neuropsychologist • OT • Psychologist • SW Impairment-Focused Cancer Rehabilitation Therapeutic exercise Lymphedema MSK (ROM, strength) Neurological deficit Balance impairment Nutrition needs Fatigue Difficulties with ADLs Return to work/school Sexual health Brain Fog Living Well with Ca Psychosocial counseling/triage Pain Neurological problem Complex medical Hx
- 14. Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Exercise (1hr) Fatigue (1hr) Mood (1hr) Relaxation (1hr) Diet (1hr) Mindful Eating (1hr) Brain Health (1 hr) Graduation (2hrs) Intro & Goals (1hr) 8-week Group Cancer Rehabilitation Program
- 15. Other Services and Resources • Lymphedema Awareness • Healthy Steps • Getting Back on Track • What You Can Do About Brain Fog • Relaxation Therapy Sessions • Sex and Intimacy • Survivor’s Kitchen • Nutrition Classes • Living Well With Cancer Classes/Group format Check Patient and Family Calendar http://www.uhn.ca/PatientsFamilies/Health_Information/Pages/default.aspx
- 16. Other Services and Resources Community Programs and Partners • Community Connections (ELLICSR) • Wellspring • Gilda’s Club • Willow • Rethink • Taking Charge (Mount Sinai Hospital & ELLICSR) • Canadian Cancer Society Driving Services • After Cancer Treatment Transition Clinic (ACTT) • Toronto Rehabilitation Institute • Young Adult Cancer Canada (YACC)
- 17. Contact Information Cancer Survivorship Clinics Madelyn Fler: 16-2363 ……………………………………… ELLICSR: 18-8621
- 18. Resources • ELLICSR website http://ellicsr.ca/ • ELLICSR Kitchen website http://www.theprincessmargaret.ca/en/PatientsFamilies/SupportServices/Kitchen/Pages/ab out-us.aspx • Patient and Family Calendar http://www.uhn.ca/PatientsFamilies/Health_Information/Pages/default.aspx
- 19. 19 Acknowledgement • The Princess Margaret Cancer Foundation
Editor's Notes
- We’ll warm up with a little quiz. By showing hands, please indicate your understanding of cancer survivorship.
- There is no single definition of cancer survivor or cancer survivorship. Health care professionals tend to refer to cancer survivorship as living with (diagnosis and treatment), through (after treatment completion) and beyond cancer (more than 1 year after treatment completion). In this case survivorship starts at diagnosis. NCI includes in the definition of cancer survivors people who have ever been touched by cancer including family members, friends and caregivers. In different documents, you may find various definitions. Individuals with cancer tend to understand cancer survivorship as being free of disease after completing the treatment. So, in this case survivorship starts at treatment completion. Not all people touched by cancer like being called cancer survivors, but we don’t have a better term. As long as there is stigma associated with cancer, there will be negative connotations to whatever term we use to refer to cancer survivors. Living with or acute: diagnosed in treatment Living through or extended: immediately after treatment is completed Permanent or beyond cancer: living beyond cancer, more than 1 year since
- Other terms that are often used in cancer survivorship are late and persisting effects. Examples of side effects: nausea& vomiting Examples of long-lasting effects: memory and attention deficits, lymphedema Examples of late effects: lymphedema
- Discuss expectations as a cause of distress under psychological distress, the importance of providing patients with a frame of reference in terms of what to expect (treatment, late and persistent effects, transition, etc.)
- ELLICSR Cancer Survivorship Clinics are based on the self-management model. Our aim is to empower cancer survivors to manage not only their physical symptoms, but also the emotions attached to living with persisting effects while being able to fulfill other roles in their lives (parenting, caregivers, work related roles, etc.). To do so, patients need certain knowledge, motivation and confidence as well as self-care and self-management skills)
- The next section focuses on programs, services and resources available at PM and in the community to support cancer survivors. ELLICSR (Electronic Living Laboratory for Interdisciplinary Cancer Survivorship Research), Health, Wellness and Survivorship Program is a centre for cancer survivors located across the street at TGH in the basement (directions provided in the folder). There is a kitchen where a dietician and a chef run healthy cooking classes, a gym for exercise, a library, consult rooms and meeting rooms. Briefly refer to the mission, vision and strategic priorities as stated on the slide. The Patient Education and Survivorship Programs are supported by The Princess Margaret Cancer Foundation. The meaning of survivors here is anyone who is touched by cancer, including patients, families, friends, and caregivers.
- While some of the services available through ELLICSR are located at TGH, most of the Survivorship Clinics run at PMH.
- Individual Exercise Prescription (includes education on exercise safety and pain management)
- Use the Calendar to point out various classes, the description of classes and how to register. Explain how to access the Calendar. In addition to classes, music therapy and relaxation sessions are available through POPC, Spirituality Clinic through Spiritual Care