By Rachel Walton OTR/L

1. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
OT Case Study
Rachel Walton OTR/L
April 6, 2016

2.  The role of occupational therapy in oncology is “to
facilitate and enable an individual patient to achieve
maximum functional performance, both physically and
psychologically, in everyday living skills regardless of his or
her life expectancy” (p. 75).
2
OT Roles in Cancer Rehabilitation
• ADL/IADL training
• Cancer-Related Fatigue
• Caner-Related Cognitive
Dysfunction
• Chemo-Induced Peripheral
Neuropathy
• Cancer-Related Pain

3.  National Comprehensive Cancer Network (NCCN):
 “Cancer-related fatigue is a distressing, persistent
subjective sense of tiredness or exhaustion related to
cancer or cancer treatment that is not proportional
to recent activity and interferes with usual
functioning.”
3
Cancer-Related Fatigue
Cancer-Related Cognitive Dysfunction
 Cancer-related cognitive dysfunction or CRCD,
describes memory or thinking problems that occur as a
side effect from chemotherapy treatments. It can
affect a person’s ability to carry out daily tasks

4.  70 year old female
 Medical History
 Diagnosed with breast cancer in 2006
 Underwent right mastectomy and right axillary
sentinel lymph node biopsy
 Received post-op systemic chemotherapy
 Patient developed lymphedema in her right arm in
2012
 History of mild cerebral palsy affecting her right arm
and seizure disorder
 Social History:
 Living in an assisted living apartment
 Involved in church
 Supportive family in a different state
4
Case Study: Jillian

5. 5
 Increased Fatigue with daily activities
 Mental Fatigue with social
interactions
 Difficulty remembering to perform
important tasks and attend
appointments/events
 Difficulty multi-tasking and staying
focused on a task
 Increased anxiety and stress
Global Complaints

6.  Activities of Daily Living (ADL) and Instrumental Activities of Daily
Living (IADL)
 Difficulty with upper body dressing and morning routine due
to increased fatigue and limited use of RUE
 Increased fatigue after cleaning apartment
 Increased fatigue with cooking due to only using LUE
 Forgetting to pay bills on time
 Difficulty with carrying out grocery shopping
 Leisure
 Forgetting to attend volunteering events at church and
increased fatigue with attending Sunday morning church
service
 Increased mental fatigue with social gatherings at assisted
living apartment
6
Impact of Jillian's Functional Ability

7.  Canadian Occupational Performance Model (COPM): looks at
self-reported occupational performance problems
7
OT Assessments
Performance
Problems
Satisfaction Performance
Morning Routine 5 5
Cleaning house 2 3
Grocery Shopping 5 4
Money
Management
4 6
Performance: 1= not able to do at all ----------------- 10 = able to it extremely well
Satisfaction: 1= not satisfied at all ----------------- 10 = extremely satisfied

8.  Multidimensional Assessment of Fatigue Scale: 40.1 (50 =
severe fatigue)
 Highest self-rated fatigue scores were with household chores,
bathing/dressing, shopping/errands
 FACT-COG (2008): assesses perceived cognitive dysfunction
quality of life measure
 Perceived Cognitive Impairments
 Perceived Cognitive Abilities
 Comments from Others
 Impact on Quality of Life
8
OT Assessments

9. 9
OT Intervention
Patient will verbalize at least 5 different fatigue management
and energy conservation strategies utilized with morning
routine.
• One handed dressing
techniques for UB/LB dressing
• Adaptive equipment
education
• Adapt patient’s home and
bathroom environment in
order to ensure optimal
performance with morning
routine.
• Organization
• Energy conservation
strategies

10. 10
OT Intervention
Patient will be able to complete weekly routine chores,
without experiencing an increase in symptoms, utilizing
compensatory strategies.
• Activity modification
• Developed a weekly
schedule
• Schedule in rest breaks
• Energy conservation
strategies

11. 11
Activity Modification Examples

12. 12
• Education on external memory
aides (calendar's, making a list,
task reminders on smart phone,
written instructions on
refrigerator, memory book)
• Organize a routine schedule for
paying bills each month
• Develop a checklist of bills that
need to be paid and review it
last week of the month
Patient will be educated on and demonstrate independent use of 2-3
compensatory strategies to improve functional memory skills in order
to increase independence with money-management tasks.
OT Intervention

13. 13
Develop an action plan
• Break down task and decide what makes the
task difficult
• Develop strategies/alternative ways of
performing task
• Trail new strategies
• Modify as needed based on patient success
Patient will independently utilize cognitive strategies to initiate, plan, and
organize functional tasks in therapy to promote independence with
grocery shopping.
OT Intervention

14. 14
Develop An Action Plan
• Break down task and decide what makes the task difficult
• Scheduling transportation
• collecting all needed items
• making sure your within budget
• getting back to bus on time
• Develop strategies/alternative ways of performing task
• Write bus schedule in calendar/memory book/post on refrigerator
• Choose the same time to catch bus each week
• Make a grocery list, start at one end of store and work your way
down
• Decide budget before leaving, plan meals for the week
• Set phone alarm 15 minutes before bus arrives, as well as when bus
arrives
• Trail new strategies
• Modify as needed based on patient success
Problem solving steps repeated for maintaining budget.

15. 15
OT Problem Solving Worksheet Example

16. 16
Conclusion
Global Fatigue Score went from 40 to 27.
Patient demonstrated a 8 point increase on FACT-Cog – demonstrating
minimal detectable change
Patient reported feelings of being more equipped to take on the challenges
of fatigue and cognitive dysfunction.
COPM Initial Assessment Re-Assessment
Performance
Problems
Satisfaction Performance Satisfaction Performance
Morning Routine 5 5 7 7
Cleaning house 2 3 5 5
Grocery Shopping 5 4 7 6
Money
Management
4 6 7 7

17. 17
Questions

18. Thank You
18
For more information on OT’s role in
cancer rehabilitation please contact:
Rachel Walton OTR/L
Stephanie Spielman Oncology
Rehabilitation
rachel.walton@osumc.edu