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

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).

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OT Roles in Cancer Rehabilitation

• ADL/IADL training • Cancer-Related Fatigue • Caner-Related Cognitive

Dysfunction • Chemo-Induced Peripheral

Neuropathy • Cancer-Related Pain

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.”

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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

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

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Case Study: Jillian

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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

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

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Impact of Jillian's Functional Ability

Canadian Occupational Performance Model (COPM): looks at self-reported occupational performance problems

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OT Assessments

Performance Problems

Satisfaction Performance

Morning Routine 5 5

Cleaning house 2 3

Grocery Shopping 5 4

Money Management

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Performance: 1= not able to do at all ----------------- 10 = able to it extremely well Satisfaction: 1= not satisfied at all ----------------- 10 = extremely satisfied

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

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OT Assessments

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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

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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

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Activity Modification Examples

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• 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

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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

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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.

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OT Problem Solving Worksheet Example

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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

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Questions

Thank You

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