Podcasts about Cancer rehabilitation

Carla P. Watson, MD, FAAPMR, Inclusion & Engagement Committee Chair, is joined by one of AAPM&R's Innovators & Influencers Honorees, Jessica Tse Cheng, MD, FAAPMR to discuss her career path and contributions to cancer rehabilitation medicine.

On Part 2 of this two part episode of the Health Care Education Transformation podcast, host Dr. F Scott Feil brings together a panel of experts in cancer rehabilitation to discuss the importance of oncology rehab and share their insights and experiences. The panel includes Scott Capozza, Dr. Elise Cantu, Dr. Adam Matichak, and Dr. Alex Hill. They discuss the misconceptions surrounding cancer rehab, the need for more education in this field, and the impact of physical therapy on cancer survivors. The panel also emphasizes the importance of advocating for cancer patients and providing comprehensive care, including addressing pelvic health concerns and sexual dysfunction. Overall, this episode highlights the crucial role of physical therapy in improving the quality of life for cancer patients and survivors.Key Takeaways:- Cancer rehab is not a niche area but a crucial aspect of healthcare that will affect most healthcare professionals at some point in their careers.- Physical therapists can play a significant role in improving the overall outcomes and survival rates of cancer patients.- It is essential for healthcare providers to be proactive in referring cancer patients to physical therapy and collaborating with oncology specialists.- Cancer survivors should not feel guilty about seeking help for long-lasting impairments and should be encouraged to live their lives to the fullest.- Advocacy for oneself and addressing sexual health concerns are vital for cancer patients, and healthcare providers should listen and take patients' concerns seriously.Reach out to Scott Capozza at:twitter.com/scottcapozzahttps://www.instagram.com/scottcapozza/Reach out to Dr. Elise Cantu at:https://twitter.com/theoncopt/https://theoncopt.com/Reach out to Dr. Adam Matichak at:https://www.instagram.com/adam_dpt/https://twitter.com/AdamMatichakReach out to Dr. Alex Hill at:https://www.oncopelvicpt.com/https://twitter.com/oncopelvicpt

On Part 1 of this two part episode of the Health Care Education Transformation podcast, host Dr. F Scott Feil brings together a panel of experts in cancer rehabilitation to discuss the importance of oncology rehab and share their insights and experiences. The panel includes Scott Capozza, Dr. Elise Cantu, Dr. Adam Matichak, and Dr. Alex Hill. They discuss the misconceptions surrounding cancer rehab, the need for more education in this field, and the impact of physical therapy on cancer survivors. The panel also emphasizes the importance of advocating for cancer patients and providing comprehensive care, including addressing pelvic health concerns and sexual dysfunction. Overall, this episode highlights the crucial role of physical therapy in improving the quality of life for cancer patients and survivors.Key Takeaways:- Cancer rehab is not a niche area but a crucial aspect of healthcare that will affect most healthcare professionals at some point in their careers.- Physical therapists can play a significant role in improving the overall outcomes and survival rates of cancer patients.- It is essential for healthcare providers to be proactive in referring cancer patients to physical therapy and collaborating with oncology specialists.- Cancer survivors should not feel guilty about seeking help for long-lasting impairments and should be encouraged to live their lives to the fullest.- Advocacy for oneself and addressing sexual health concerns are vital for cancer patients, and healthcare providers should listen and take patients' concerns seriously.Reach out to Scott Capozza at:twitter.com/scottcapozzahttps://www.instagram.com/scottcapozza/Reach out to Dr. Elise Cantu at:https://twitter.com/theoncopt/https://theoncopt.com/Reach out to Dr. Adam Matichak at:https://www.instagram.com/adam_dpt/https://twitter.com/AdamMatichakReach out to Dr. Alex Hill at:https://www.oncopelvicpt.com/https://twitter.com/oncopelvicptIf you are taking the NPTE or are teaching those about to take the NPTE, visit the NPTE FInal Frontier at www.NPTEFF.com and use code "HET" for 10% off all purchases at the website...and BREAKING NEWS!!!! They now have an OCS review option as well... You're welcome! You can also reach out to them on Instagram @npteff If you're a PT and you have student loan debt, you gotta talk to these guys. What makes them unique is that they view financial planning as like running hurdles on a track. And for PTs, the first hurdle many of us run into is student loan debt. Varela Financial will help you get over that hurdle. They not only take the time to explain to you which plans you individually qualify for and how those plans work, but they ALSO take the time to show you what YOUR individual case looks like mapped out within each option. So if you're looking for help on your student loan debt, or any area of your personal finances, we highly recommend working with them. You can check out Varela Financial out at varelafinancial.com. Feel free to reach out to us at: http://healthcareeducationtransformationpodcast.com/ https://www.facebook.com/HETPodcast https://twitter.com/HETpodcast Instagram: @hetpodcast @dawnbrown_pt @pteducator @dawnmagnusson31 @farleyschweighart @mail.in.stew.art @ujima_institute For more information on how we can optimize and standardize healthcare education and delivery, subscribe to the Healthcare Education Transformation Podcast on Apple Podcasts or wherever you listen to podcasts.

Occupational Therapy's Role in Cancer Rehabilitation

Wellness Rising from Wellness House of Annapolis welcomes Occupational Therapist Kamala Stevenson from NovaCare and ReVital Cancer Rehabilitation. She helps patients regain essential functions and achieve physical goals during a cancer treatment journey.

Wellness Rising from Wellness House of Annapolis welcomes Physical Therapist Erica Steuernagel, Program Director at ReVital Cancer Rehabilitation, who says a planned rehab and exercise regimen allows a cancer patient to both achieve their personal activity goals, and also have a greater chance of successful treatment.

ReVital Cancer Rehabilitation's focused and integrated programs give cancer patients a way to choose physical therapy and exercise that fits their activities and goals. Physical Therapist & Program Director Patty Horning is our guest.

Whether cancer patients are newly diagnosed, currently receiving treatment or having completed treatment, the role of a physiatrist is to optimize their function and quality of life. While physiatry has grown in its incorporation in cancer care nationwide, RUSH is one of a small number of hospitals offering dedicated physical medicine and rehabilitation care for its cancer patients. Obada Obaisi, MD, is an assistant professor in the RUSH Department of Physical Medicine and Rehabilitation and is the director of cancer rehabilitation at RUSH University Medical Center. “My role [as a physiatrist] is to maintain or restore function, minimize symptom burden, maximize independence and ultimately improve quality of life for cancer survivors. Cancer rehabilitation involves a large, multidisciplinary team that includes myself, physical therapists, occupational therapists, speech language pathologists, dieticians and psychologists. I often tell patients I'm their quarterback for their function, so I can help identify which of these services the patient may need and coordinate with them based on their impairments.” CME Link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/488832/

Dr. Nasim A. Chowdhury discusses what patients should know about cancer rehabilitation. He highlights the importance of an individualized, multidisciplinary care approach to help treat patients recovering and rehabilitation from cancer and its treatment. As the Medical Director of Cancer Rehabilitation at Weill Cornell Medical Center, he has a particular focus on cancer patients that are affected with musculoskeletal issues including those with spinal cord and brain injury, sports injuries, arthritis, stroke, and spasticity. To schedule with Nasim A. Chowdhury, M.D

Cancer rehabilitation is available before, during and after cancer treatment. It helps people with cancer maintain and restore physical and emotional well-being, cope with the side effects of cancer, and recover more quickly and more fully from cancer treatment.Cancer rehabilitation involves many types of specialists working together to develop a personal rehabilitation plan that considers a person's preferences, strengths and goals."Cancer rehabilitation aims to help patients maintain function, restore function, and, more broadly, maintain personhood," says Dr. Andrea Cheville, a Mayo Clinic specialist in physical medicine and rehabilitation. "We obviously don't want the process of curing cancer to leave patients with lasting issues that are going to compromise the quality of their life." Cancer rehabilitation can include help from a wide variety of specialists, including physical medicine and rehabilitation, physical and occupational therapy, speech and language pathologists, and psychologists. "All these specialists work in close partnership to develop an individualized program for each unique individual that meets their needs, goals and preferences," explains Dr. Cheville.Dr. Cheville encourages people with cancer to include their family and caregivers in the cancer rehabilitation process. It is important for caregivers to understand the patient's goals and can support the work needed to reach them."The ideal for a cancer rehab team is the full engagement of the caregiver or partner," says Dr. Cheville. " It truly is a partnership and a team effort."On the Mayo Clinic Q&A podcast, Dr. Cheville discusses what's involved in cancer rehabilitation and how it can help people with cancer cope with the challenges that come with cancer diagnosis, treatment and recovery.

"You're young & healthy." This was a quote that I heard time & time again with my young patients. If they're so young & healthy, then why do they have cancer? As frustrating as that may be for us to hear, imagine hearing that as a patient. For Shauna O'Brien of the Too Young For This Shit Podcast, this is her reality.  Shauna was diagnosed with breast cancer at 32 & underwent surgery, chemotherapy, & radiation therapy in a whirlwind year.  At the end of that year, in her words, "you get thrown to the wolves." In our interview, we talk about the fact that it's important to hear the patient's side of things - their point of view & the different aspects of life that cancer affects: physically, emotionally, mentally, relationships, socially, etc., and the positive effects of physical therapy. Support TheOncoPT Podcast on Patreon.

This week, we are joined by Dr. Susan Maltser, DO. She has written one of my favorite articles, A Focused Review of Safety Considerations in Cancer Rehabilitation, which you'll definitely want to save & reference frequently.  This article is the Bible of Basics when it comes to being safe with people who have or who have had cancer. We are focusing on what safety considerations and red flags we should be aware of as oncology physical therapists. The way we treat our patients is based on dogmas and fear, and this can actually hinder the patient's ability to heal.

The Women's Cancer Center at Deaconess is always innovating. Dusty Fiester discusses prehabilitation, or prehab, and how it can help prevent lymphedema in cancer rehabilitation.

Dr. Mary Hidde discusses the role of high intensity interval training for reducing cancer-related fatigue with an emphasis on moving evidence into clinical practice.

Cancer survivors are often overwhelmed when their support teams disappear after they ring the bell. Yet the long-term side effects, fears, and lifestyle care still need to be addressed. On today's show, I had the honor of bringing a registered dietician, Dr. Stacy Roberts, to the show to share with us what she has learned from working with the cancer community & what we need to know moving forward with long-term survivorship.

When you're told you have lung cancer, the shock and uncertainty you feel is unimaginable, but there's help at hand, and that's the topic of our latest podcast. Our workplace illness expert Nicola Handley is joined by her client David, who explains how specialist support has helped him transform his quality of life. Also featured are independent case manager Lisa Barnes, and physiotherapist Lynn de Dombal of Rehab Beyond Cancer, who discuss why professional help is so crucial.

Welcome to Medical Rehab Matters. In the weeks since this podcast began, we've learned a lot inpatient medical rehabilitation and about podcast production, including that it's not always possible to include everything we record. In this episode, we're going to present some of the things we couldn't earlier – from our episodes on stroke, cancer, and amputation. We hope you enjoy this episode and it inspires you to go back and listen to the full episodes on these topics. Guests: Dr. Vish Raj, a cancer rehab specialist at Carolinas Rehab, and Sarah Mullan, an occupational therapist and Manager of Cancer Rehabilitation at the Levine Cancer Institute. Dr. Michael Stubblefield, Director of Cancer Rehab at Kessler. Roseann Sdoia, who lost her leg in the Boston Marathon Bombing in 2013,  David Crandell, MD, Medical Director of the Amputee Program at Spaulding in Boston. Scott Riddle, Vice President of Orthotics, Prosthetics and Bionics at Mary Free Bed. Dr. Jaclyn Barcikowski from Moss Rehab, Dr. Argye Hillis, Director of the Center of Excellence in Stroke Detection and Diagnosis, at the Sheikh Khalifa Stroke Institute, Brian Reid, a patient who suffered a stroke in May 2020, and his wife Veronica. Cohosts Dr. Robert Krug, immediate past chairman of the AMRPA Board and Vice President of Medical Affairs for Mary Free Bed Rehabilitation Hospital Advisory Group and Patricia Sullivan, AMRPA director of communications.

In this episode of Medical Rehab Matters, we talk about cancer and inpatient medical rehabilitation. The American Cancer Society estimates that there will be 1.9 million new cancer cases in the U.S. this year. Many of them will benefit from inpatient medical rehab at different points during and after their cancer treatment. Our guests are Vishwa Raj, MD, a cancer rehab specialist at Carolinas Rehab, Sarah Mullan, MS, OT, an occupational therapist and Manager of Cancer Rehabilitation at the Levine Cancer Institute, and Michael Stubblefield, MD, Director of Cancer Rehab at Kessler.  Cohosts: Patricia Sullivan, director of communications for the American Medical Rehabilitation Providers Association and Robert Krug, MD, immediate past chairman of the AMRPA Board and Vice President of Medical Affairs for the Mary Free Bed Rehabilitation Hospital Advisory Group.

Bustin' Out of Breast CancerNew Episodes release Wednesdays at 7:00 am ESTEP 137-Straight Talk with Physiotherapist, Beth Hoag, PT, CPTBeth Hoag is a Physiotherapist who specializes in Cancer Rehabilitation, Lymphedema Therapy, and Pelvic Health. Beth became passionate about specializing in Cancer Rehabilitation and Lymphedema Therapy after she watched her mom and 2 aunts battle breast cancer. She then added on Pelvic Health as she realized how important pelvic health is especially after going through treatment and the side effects that come along with it.We talk about so many "hot topics" including:● How bridging the gap between the medical and fitness industries are so important● How working with your Physiotherapist and Personal Trainer can complement each other● How she truly loves to empower women with knowledge to help them through their breast cancer journey● The importance of Pelvic HealthHOW TO REACH Beth Hoag, Physiotherapist, PT, CPTWEBSITE: bethhoagphysio.caIG: https://www.instagram.com/bethhoagphysio/ FB: https://www.facebook.com/bethhoagphysioYOU TUBE: https://www.youtube.com/channel/UCI4LRJB7qW8dUqBJBgVvi8w?view_as=subscriberHey, let's stay in touch:Be the first to get the latest podcast, blogs, news, and specials by signing up for my newsletter:● Head over to my website www.shannonburrows.com  Join our Breast Cancer Health & Wellness Private Facebook Group● Are you a survivor, thriver, or caregiver? Come join our PRIVATE Free Facebook Group Where do you like to hang out on social media? Come find me and let's get to know each other.● Follow me on Instagram (and then send me a DM and say Hi:)● Follow me on Facebook (and then send me a DM to say Hi:)

Dr. Mackenzi Pergolotti answers questions posed by Podcast Editor Dr. Stephen Morris about her work examining the effect of community-based rehabilitation on patient-reported outcomes and physical functioning. This work highlights the importance of cancer rehabilitation for those treated for cancer, and how rehabilitation improves function and overall health-related quality of life. The authors suggest that collaboration between outpatient facilities and academic cancer centers can provide opportunities to address gaps in the evidence base as well as address unmet cancer rehabilitation needs.

Fighting cancer takes a huge toll on your body. Up to 90 percent of individuals with cancer experience painful, function-limiting consequences brought on by chemotherapy, radiation and/or surgery. Cancer rehabilitation can help you prepare for treatment and maintain strength throughout your journey so you can get back to the things you care about most. In this episode, Jessika Lackie, MOT, OTR/L, CLT, Director of the  ReVital Cancer Rehabilitation program at NovaCare Rehabilitation in Minnesota, discusses the various types of cancer rehabilitation available to patients and how these therapies can help their treatment and recovery. With more than 100 cancer care providers, Minnesota Oncology offers access to the latest evidence-based treatment paths, 12 close-to-home locations in the Twin Cities Metro area, and comprehensive services to support the whole person. In each podcast, experts from Minnesota Oncology and their community of care discuss the latest topics in oncology treatments, research, support, caregiving, and more. Treating cancer takes a community. Welcome to ours. Visit: https://mnoncology.com

Special Election Edition with  Brent Braveman, OTR, PhD, FAOTA Director, Department of Rehabilitation Services, MD Anderson Cancer Center AOTA candidate for Vice President  Dr. Brent Braveman has practiced as an occupational therapy clinician, educator, researcher and manager since entering the profession in 1984. He currently is the Director of the Department of Rehabilitation Services at the University of Texas MD Anderson Cancer Center in Houston Texas. Dr. Braveman is an author on 25 peer reviewed journal articles, 20 book chapters and is author of three occupational therapy text books. He has presented at national and international conferences on cancer rehabilitation, work disability, strategic planning and leadership.   He has a long history of volunteer service in state and national professional association activities including serving two terms on the AOTA Board of Directors as Speaker of the Representative Assembly and as Secretary. He is currently serving as Board Director for Region IV on the American Occupational Therapy Association Political Action Committee (AOTPAC) Board of Directors. He served as a representative to the National Institutes of Health Working Group on Cancer Rehabilitation, as a Standing Committee Member on the National Quality Forum’s NQF) Cancer Project and on the NQF’s project on co-designing patient centered care.   Dr. Braveman is a Fellow of the American Occupational Therapy Association and a recipient of the AOTA Recognition of Achievement Award for “Exemplary Contributions in Management and Program Development.” Facebook brent.braveman Twitter @brentbraveman http://www.brentbraveman.com/ (www.brentbraveman.com) ______________ Brent was interviewed by Robin Akselrud, Assistant Professor at LIU Brooklyn, author of the My OT Journey Planner myotjourney.com  IG: myotjourneypodcast FB: My OT Journey   And Michael Roff, 3rd year OT student at Stonybrook University 

Guest: Grant Fedoruk, Owner and physiotherapist with Leading Edge Physiotherapists.  See omnystudio.com/listener for privacy information.

Well Said has invited Dr. Susan Maltser, Vice-Chair and an Associate Professor of Physical Medicine and Rehabilitation at the Zucker School of Medicine at Hofstra/Northwell, Chair and Medical Director of the Physical Medicine and Rehabilitation at Glen Cove Hospital, and the Director of Cancer Rehabilitation at Northwell Health to talk about new information on these long-term symptoms as well as the rehabilitation programs used to help patients recover from COVID-19.

Rehabilitation after cancers is being highlighted in a campaign led by New Zealand organisation, PINC & STEEL which specialise in helping survivors.  CEO Lou James talks to Jesse about cancer rehabilitation.

Dr. Alyssa Cole is a physical medicine and rehabilitation physician in Philadelphia, PA. She will be the first Cancer Rehabilitation fellow physician in Philadelphia and is looking forward to trailblazing this field for the future generation of doctors. She is passionate about combining the arts and sciences, from earning dual degrees with a BA in Classics and a BS in Biology to competing in the Miss America scholarship program while championing her platform of adding Arts to STEM (Science, Technology, Engineering, Arts, and Mathematics) disciplines. She is also studying to get her MBA and loves sharing helpful tips from health to fashion, food, and lifestyle on her social media platforms (@doctor.cole) and her blog Daily Dose of Vita. Dr. Alyssa's IG: @doctor.coleDaily Dose of Vita website: dailydoseofvita.blogspot.com For more on Lo Wentworth, head over to her Instagram @lowentworth and www.lowentworth.com

Brief Discussion On Why Rehabilitation Programs Are Necessary And What To Expect From Physiotherapists.. Intermixed With Few Questions On Breast Cancer Physiotherapy.

Welcome to another episode of the Ignite Your Mind podcast And this week! I have another special guest and good friend of mine that is Johnny Stokes! Johnny as a kid was confident, hyperactive and loved his football! We dig deep into the challenges he faced finding in his purpose in life and what he really wanted to do as a career. With surrounding himself with the right people he went on a mad mission to make this a reality, even starting at posting leaflets through doors and working for minimum wage whilst in training to become a Wellbeing Coach and to help individuals in cancer rehabilitation. If you're thinking about starting a business and want to know the gritty details of what you HAVE to put in then this is real talk, real life, raw conversation. I hope you enjoy it. Get in touch with Johnny: Email: johnnystokespt@gmail.com Facebook: https://www.facebook.com/JWSFitnessAndWellbeing Instagram: https://www.instagram.com/jws_fitness_wellbeing

More women than ever are surviving breast cancer. With advances in early detection and treatment, we see patients living long, full lives after breast cancer. These patients often are eager to get back to their normal activities, but side effects from treatment sometimes hold them back. Chemotherapy, radiation therapy, and surgery are effective treatments for breast cancer, but nerve damage, swelling, and soreness can sometimes occur.   There’s this notion that recovering from cancer is just going to be bad. But it doesn’t have to be.   On this week's podcast episode Marni will be speaking with Denise Stewart, Director of Breast and Shoulder Rehab. Denise is an Occupational Therapist trained in Australia at University of Queensland. Her career started at a major public hospital, providing rehabilitation to people with very serious and chronic illness and injuries. With the introduction of workplace rehabilitation in the 80's, Denise moved into the private health sector and helped injured workers return to work. This experience created a passion for workplace injury prevention and the importance of good return to work programs. This same concern for a person's recovery and the importance of returning to work was applied to her work with women after breast cancer. For 25 years, Denise has been a leader in developing improved rehabilitation services for this special client group. Empowering people to take control of their health and well-being has been the driving force for her latest work in developing educational resources for clients. Knowledge is shared about common physical issues experienced by women after breast cancer. Listen with us, as Denise uncovers the truths and misconceptions about breast cancer rehabilitation. Learn more about Denise Stewart and Breast & Shoulder Rehab here: Website: https://www.breastandshoulder-rehab.com/ Facebook: https://www.facebook.com/recoverwell.afterbreastcancer/ LinkedIn: https://www.linkedin.com/in/denise-stewart1 Youtube: https://www.youtube.com/channel/UCUFQepj0eaQyuTwyyO55xqg Be sure to subscribe to the podcast! And follow us on Instagram @dermhealth.co or visit us online at https://www.dermhealth.co/ --- Send in a voice message: https://anchor.fm/dermhealthco/message

#107 My lovely guest this week is Professor Kylie O'Brien, an expert in Chinese medicine, integrative medicine & medicinal cannabis.   I've been wanting to get the facts straight around CBD oil, THC oil and medicinal cannabis for quite some time, so I invited Kylie onto my show. We discuss the many benefits, the concerns and where the law stands right now and what the future holds around this fascinating topic. We keep the technical jargon to a minimum where possible, and this is a podcast for everyone if you want to know more about this incredible plant. Enjoy.   Some of the questions we covered on the show: What is cannabis? How does it differ from marijuana?  What sort of conditions do people seek to use cannabis for? Is there any scientific evidence that it works? How does cannabis work? What's the difference between CBD & THC? Is it safe?  Can we over-use CBD oil and THC oil? Are there any examples/case studies where people were using conventional medication and then moved to Med Cannabis? What are our laws around cannabis use? What are other countries doing with respect to cannabis? How do people get access to it in Australia? What have you been doing in educating doctors about medicinal cannabis? :)   About Kylie O'Brien: Kylie O'Brien has had a strong academic career in the fields of Chinese medicine, integrative medicine and now medicinal cannabis since career changing in 2000. She has worked for the Victorian Department of Human Services, and held senior leadership roles in the university and private education sector. She is an internationally recognised expert in Chinese medicine and integrative medicine, and has published extensively including a first book on integrative oncology (US: Springer, 2017) and a second one on mental health and medicinal cannabis due for publication in 2020. She is a member of the TGA Advisory Committee for Complementary Medicine, the TEQSA Expert Panel and the World Federation of Chinese Medicine Societies’ Speciality Committee on Cancer Rehabilitation. Learn more about Prof. Kylie O'Brien: Global Health Initiative Australia: www.ghiaustralia.org.au Doctors and healthcare practitioners who are interested in the medicinal cannabis course on 22/23 February 2020 in Brisbane featuring Dr Philip Blair MD (US), expert in medicinal cannabis, should go to the following link: https://www.acnem.org/events/face-face-training/medicinal-cannabis-masterclass-cannabidiol-thc-and-clinical-applications I stress this is for healthcare practitioners and not the general public. Referenced Podcast with Professor Ian Brighthop: Love & Guts Podcast: Medicinal Cannabis- benefits, safety and how to access   Learn more about Guy: www.guylawrence.com.au Let It In Academy: www.letitin.com.au

Thanks to early detection and treatment, more women are surviving breast cancer. Sometimes the treatments, chemotherapy, radiation, and surgery can cause side effects that make it hard for patients to get back to normal activities. Physical Therapist Emily Hulke and Occupational Therapist Lynn Cattanach are her to talk about the benefits of breast cancer rehabilitation.

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Nicole Stout on the show to discuss cancer rehabilitation and survivorship care.  Dr. Nicole L. Stout is a renowned health care researcher, consultant, educator, and advocate.  She is research assistant professor in the School of Medicine, Department of Hematology/Oncology at West Virginia University Cancer Institute. Dr. Stout is an internationally recognized expert and leader in the field of cancer rehabilitation and survivorship care.   In this episode, we discuss: -Functional morbidity in cancer survivors and the role of rehabilitation -Evidence for rehabilitation and exercise interventions to support individuals with cancer -Physical therapy clinical, research and education needs to develop survivorship care models -Why every clinician should be familiar with survivorship care -And so much more!   Resources: Nicole Stout Twitter Nicole Stout LinkedIn Academy of Oncologic Physical Therapy  2nd International Conference on Physical Therapy in Oncology (ICPTO) American Congress of Rehabilitation Medicine American Cancer Society Nicole Stout Research Gate    Email: nicole.stout@hsc.wvu.edu   For more information on Nicole: Nicole L. Stout DPT, CLT-LANA, FAPTA Dr. Nicole L. Stout is a renowned health care researcher, consultant, educator, and advocate.  She is research assistant professor in the School of Medicine, Department of Hematology/Oncology at West Virginia University Cancer Institute.    Dr. Stout is an internationally recognized expert and leader in the field of cancer rehabilitation and survivorship care. She has given over 300 lectures nationally and internationally, authored and co-authored over 60 peer-review and invited publications, several book chapters, and is the co-author of the book 100 Questions and Answers about Lymphedema. Her research publications have been foundational in developing the Prospective Surveillance Model for cancer rehabilitation.   Dr. Stout is the recipient of numerous research and publication awards. She has received service awards from the National Institutes of Health Clinical Center, the Navy Surgeon General, and the Oncology Section of the American Physical Therapy Association. She is a Fellow of the American Physical Therapy Association and was recently awarded the 2020 John H. P. Maley Lecture for the American Physical Therapy Association.   She holds appointments on the American Congress of Rehabilitation Medicine’s Cancer Rehabilitation Research and Outcomes Taskforce, the WHO Technical Workgroup for the development of Cancer Rehabilitation guidelines, the American College of Sports Medicine President’s Taskforce on Exercise Oncology, and also chairs the Oncology Specialty Council of the American Board of Physical Therapy Specialties. She is a federal appointee and co-chair of the Veterans Administration Musculoskeletal Rehabilitation Research and Development Service Merit Review Board. Dr. Stout is a past member of the American Physical Therapy Association Board of Directors.   Dr. Stout received her Bachelor of Science degree from Slippery Rock University of Pennsylvania in 1994, a Master of Physical Therapy degree from Chatham University in 1998 and a clinical Doctorate in Physical Therapy from Massachusetts General Hospital Institute of Health Professions in 2013. She has a post graduate certificate in Health Policy from the George Washington University School of Public Health.   Read the full transcript below: Karen Litzy:                   00:01                Hey Dr. Nicole Stout, welcome to the podcast. I am so excited to have you on today. So today we're going to be talking about for all the listeners, cancer, survivorship and morbidity burden among growing populations, probably around the world, certainly in the United States. But Nicole, before we even get to all of those sort of big topics, can you define for the listeners what cancer survivorship is? Nicole Stout:                                         Yeah, thanks Karen. That's a great question to start off with. And it's a little bit of a Pandora's box right now. So we've historically defined cancer survivors as anyone from the point of their cancer diagnosis, really through the remaining lifespan that that individual has. So we consider a survivor from point of diagnosis and you know, it's sort of different or it's kind of different than what the word expresses. Nicole Stout:                 01:06                The word survivor, I think in some kind of patient means they're done with treatment, they've survived. And you know, we've seen a bit of pushback in the last few years around people who don't necessarily identify with the word survivor. So if we go back to 2006, there was a very important report that the Institute of medicine released called lost in transition from cancer patient to survivor. And this is where the term came from. Basically that IM report was critical because it said, Hey, medical community, you're doing a great job of treating cancer, that disease, but you're doing a terrible job of helping these people transition back to their life when they're done with treatment. They have a lot of functional morbidities, physical, cognitive, sexual, not managing those things. So this term survivorship was put forward. The idea of managing people to become survivors was put forward. Nicole Stout:                 02:05                And what's been very exciting is to see the evolution of emphasis and focus on better managing the human being that goes through the disease treatment in addition to managing the disease. But we've come so far with treatments and in some regard, some people who have advanced cancers for example, will be on cancer treatments for the rest of their life. And you know, I participate in a lot of social media groups and I hear these people say, I'm not a survivor and I'm never going to be one. Eventually I'm going to die from my cancer. I know that. And it's a matter of time. And so they don't identify with the word survivor or survivorship. So, you know, we're sort of moving away from that a bit and we're talking for now without individuals who are living with and beyond cancer. And I like to use that terminology. Even though survivorship is prevalent in the literature and prevalent in, you know, our conversations and in oncology circles is how we describe it. But I think we're trying to be more sensitive to the much, much broader population of individuals who are going through cancer treatments today. Karen Litzy:                   03:19                Yeah. And I liked that phrase, living with and beyond cancer, it seems a little more inclusive to me. Is that why you prefer that phrase? Nicole Stout:                 03:29                I do. I think that encompasses anyone who ever had a cancer type know who is in treatment, who is a, what we call an ed has completed treatment and has no evidence of disease. And it's also those individuals who may be in palliative care, who are progressing towards end of life, who are still being treated or managed in various ways. So I think it is more encompassing and reflective really of the broad, broad scope of this population. Karen Litzy:                   04:04                Yes. Because I think oftentimes, and myself included, people think you either have cancer or you don't. After you've gone through treatment, you don't have it in you're a survivor. So you forget about that population of people, like you said, who have cancers that they'll be in treatment for the rest of their lives. Nicole Stout:                 04:26                Yeah. And that that is actually a growing population with more sophisticated treatment technologies and changes that we've seen around the immunological therapies, the hormonal therapy treatments. Many of these targeted agents as we've come to so call them. And we are seeing individuals live much, much longer with disease, with stable disease, we're able to stabilize it. And so therefore what they would have died from in six months or a year, they're now surviving. I have years on continued temporization treatments. And so how would we describe those individuals? And yeah, let me make sure that the supportive care needs of those people are met and identified and met. It is a very broad population. So I think sometimes we say survivorship and it is not nearly as homogenous as, you know, that group of you either have cancer or you don't. You've been treated and you're finished. Now some people, for some folks that is the case. But for many, there's this very gray area that is the remainder of them. Karen Litzy:                   05:39                Yeah. And I think saying living with cancer treatment or living through cancer treatment and beyond is just a little more sensitive to the person. Like you said, the person behind the cancer. Because oftentimes when you read articles or even whether it's in a scientific journal or mainstream media and you think about cancer, they are always talking in percentages and numbers but not in the person. And so this kind of brings it down to the personal level. Now you mentioned it a couple of times, as we were talking here about different morbidities related to cancer or cancer treatment. So can you talk a little bit about what people undergoing treatments or maybe have completed their treatments might be experiencing? Nicole Stout:                 06:37                Yeah, that's a huge topic. We could spend hours just talking about that. But first of all, just in general, when we say morbidity, we're talking about the complications and the side effects that impact an individual's ability to function. So we're talking about functional morbidity. And the good news, the good news is this. The good news is we have a growing population of individuals who are living with and far beyond their cancer diagnosis. We talk about the population of cancer survivors growing. And you know, we look back to like the 1970s, all types of cancers. We were looking at about somewhere between a 40 and 50% survival rate to five years. So we have, and today we have dramatically driven that number much, much higher when we look across all cancers. That number today is around 70%. But when you drill into some of the more commonly diagnosed cancers like breast and prostate, those survival numbers to five years or even higher, upwards of 90% plus. Nicole Stout:                 07:47                So the good news is more people are being treated and getting to that side of your Mark of survival with no evidence of disease. And that tells us a story that they're more likely to live the rest of their lifespan, but they are living with significant functional morbidity. And so the side effects of cancer treatments are things that we absolutely anticipate. We know that when people go through different types of chemotherapies or mental therapies, radiation therapy, you named the therapy, they are going to be side effects that negatively impact their function. The issue is how severe is the impact? How disabling does it become and does it persist? So multisystem impacts from these interventions. Chemotherapy is a multi, it's a systemic approach to managing disease burden. And unfortunately chemo is not selective. It doesn't go into your body and say, Hey, here's a cancer cell and there's a cancer cell and it wipes out rapidly dividing cells. Nicole Stout:                 08:54                So is the systemic impact to the body. Your immune system is suppressed, you know, your blood counts drop, you become anemic, you become fatigued. Some chemotherapeutic agents cause cardiac complications and cardiotoxicities some chemotherapeutic agents we know are highly neurotoxic and cause peripheral neuropathies. None of these. And there's a spectrum, right, of the severity of that toxicity that people experience. And so some of those are mild, some of those are more severe. That it is the majority of patients going through treatment will experience at least one or more many experience, more than at least one about 60% experience, at least at one or more functional morbidity. And so when I talk about function, I want to say just sort of as a caveat, I always say I talk about Function with a capital F, meaning that it's not just the physical function. You know, I think in physical therapy we think about movement and mobility and gait and balance and you know, activities. But there's cognitive functioning as well. There's sexual functioning, there's being able to assume your psych. Karen Litzy:                   10:10                Yes. Nicole Stout:                 10:10                Social and psychological functioning and all of that, assuming your roles and your daily life. So we have to think very broadly, but when we talk about the morbidity burden, it's very real associated with cancer treatments in the short term. So while people are going through treatment, we expect to see it. But here's the trick. When treatments are done and withdrawal, people do recover to a very high degree. They regain their strength and mobility. But many of them suffer with persistent morbidity. And that disables many from going back to work or resuming their prior roles. And again, those can be across systems. And they can be encompassing of the physical, the cognitive, et cetera. Karen Litzy:                   10:55                And that gives me a lot to think about as a physical therapist. So if I might be seeing a patient too, let's say they have completed their chemotherapy, radiation, whatever their treatment was a year ago as the physical therapist, it sort of behooves me to ask these questions of them. So even though I may have a patient who's recovering from breast cancer that's coming to see me for knee pain, but these are things that if you are the treating healthcare provider, you have to have in your head and kind of ask these questions of them, of those different systems. Right? Nicole Stout:                 11:41                Absolutely. And that's actually a great and very critical point to make for physical therapists. And you know, even more broadly, occupational therapist, speech and language, all of our rehab cohort, you know, you said one year after treatment that the thing about cancer treatments, and I refer to them as the gift that keeps on giving because even though an individual finishes treatments, the treatments are oftentimes not done with them. Radiation therapy is a great example. We see individuals have side effects of radiation therapy in the acute timeframe, of course that we can see for example with chest wall radiation and breast cancer, we can see changes to the lung tissue, the bone and the cardiac function even years beyond the completion of treatment in five years, 10 years. So it behooves us to think about the history of cancer but not just did it have a history of cancer and concerned about recurrence of disease with what I'm seeing in my assessment. Nicole Stout:                 12:41                That's one little piece of it. But the bigger question is, is the impairment that I'm seeing in this patient in front of me somehow related to their cancer treatments? Quite possibly, I would say yes. And if it is, are there things that I need to know about cancer and its treatments so that I can optimally manage this patient? And I would say yes to that as well. It's funny because in, I've been a PT for over 20 years now. I've worked in cancer for the majority of that time. Almost 19 of those 20 plus years have been exclusively cancer. And I still today have physical therapists say to me, I don't really see cancer patients in my practice. And my response to them is they see you every day. They see you everyday. Someone who has had a history of breast cancer with radiation therapy to the chest wall on the left side 10 years ago. Nicole Stout:                 13:38                And you're seeing them as they are deconditioned, they may have dyspnea, they're now having some cardiac complications that can absolutely be related to radiation cardiotoxicity. You're seeing someone's three years out from prostate cancer treatment who is now having some balance deficits and issues, has had a fall at home for example, do a close assessment of their sensation, because they probably have residual peripheral neuropathy directly related to their neurotoxic chemotherapeutic agents. So we know that many of these side effects persist and can cause what we call these late effects, which are the downstream side effects that patients will experience. And a lot of it is musculoskeletal, neurological as well. You know, there are changes that can happen with regard to sensation, cognition, memory, those types of things also can persist for, can come on more substantially later after the completion of treatment. Nicole Stout:                 14:43                So there are functional needs someone's going through treatment, but those needs may be, they may be less, they actually may be more in some folks as they age. Because by the way, there's that pesky thing called aging. I'm done with cancer treatments five years, 10 years later. But you know, you've also aged whole cluster of what are the co-morbidities that we're facing that this individual is facing. You know, what type of lifestyle behaviors are they choosing. So really looking at that from that very encompassing perspective and in the short and the long term, not negating that history of cancer, even though it was, you know, five or seven years ago. Karen Litzy:                   15:26                Yeah. And you know, you kind of answered the question I was going to ask and that's as a physical therapist, why should we care? Well, I think you answered that one very well, but let's talk about the evidence for rehabilitation. And exercise interventions for these individuals with cancer. What does the evidence tell us? Nicole Stout:                 15:43                Yeah. And so when you asked why should we care, not just to alleviate their morbidity and to give a good quality of life and better function, but there are big, big issues that these folks face that caused downstream medical and healthcare utilization than escalate costs, pain medications, imaging, additional hospitalizations. So we should care from an individual perspective. I want my individual patient to be functioning. We should also care from a system and a societal perspective that we can help to alleviate that burden. So the exercise or the evidence, boy, where do I start? The good news is, as I said, multi-system impact for many of the cancer treatment interventions. And that's everything from surgery through hormonal treatments, including everything in between. But the goodness is there is evidence to demonstrate the benefits of rehabilitation intervention for nearly any patient with any disease type across the continuum of cancer care. Nicole Stout:                 16:50                From the point of diagnosis through end of life, there's evidence to support our interventions. And you know, I always say that about cancer oncologist everywhere. Cancer does not discriminate based on body region. It does not discriminate based on system impact. It doesn't discriminate based on race, based on gender. Everybody is at risk for having a cancer diagnosis. Now you know, there are some nuances there that level of risks. So we have to be thinking about that evidence very broadly. And so if we start at the beginning, at the point of diagnosis, there are some populations for whom a prehabilitation exercise intervention is highly recommended. We have seen over the last decade, the idea and concept of prehab is, you know, many times we make a diagnosis for a patient with cancer and it is not emergent to treat them. Now some types, it is some types of leukemias. Nicole Stout:                 17:49                We immediately begin treatment like the sun doesn't set, we treat them. But for a number of populations, there's testing, there's workups that are done. There's lab work, there's imaging and that can take several weeks. And so in populations like lung and colorectal, we had started to see these prehabilitation exercise programs put into place and there's a nice body of literature that has grown and has strengthened demonstrating the benefit of therapeutic exercise, aerobic conditioning, moderate intensity supervised over the course of about two to three weeks. What it does is it prepares them to enter, whether it's surgery or chemotherapy. First it prepares them to enter. They are cancer care continuum in a much better physical performance status. Really the exciting thing in lung cancer with the pre habilitation exercise that we've seen some evidence, the lung cancer population in general, many of them are not in good physical performance status when they're diagnosed. Nicole Stout:                 18:52                And some of them by virtue of that are not candidates for surgery. They're not candidates for the ideal regimen of chemotherapy because of their performance status. And we're starting to see evidence that that prehabilitation exercise intervention can actually convert someone for being a non surgical candidate to the surgical candidate. And that is, that's where we need to really be looking longer term and saying, does the rehab intervention improve survival in that population? The question is not, you know, something that we haven't answered yet but not far from being plausible. So that's evidence sort of from the point of diagnosis. We also have a large body of evidence around that post usually surgery is the first stop for some, for most folks and that perioperative time period. And it just makes sense. You know, the PT, the rehab consults, for especially our head and neck population, we talk about oropharyngeal, laryngeal parasite as we sort of put those into the head and neck population. Nicole Stout:                 19:56                Immediate referral for speech and language pathology should be done in that patient population. Immediate referral for PT or OT console for upper quadrant for cervical mobility, first those things should be standards that should become standards of care. The evidence is building in that regard. And then as patients move through treatment, the chemotherapy, radiation therapy, sometimes chemo, radiotherapy combined, is sometimes the next stop. And around that time period the exercise literature supports intervention during chemotherapy, the conditioning to help to mitigate fatigue, moderate intensity, low intensity exercise for individuals to alleviate distress, anxiety, depression. So exercise prescription is something that we're really starting to see more focused on. The American college of sports medicine just released new guidelines last week, providing some very specific evidence around exercise prescription. So we're getting to the point where we can actually prescribe exercise for targeted impairments that individuals are experiencing during cancer treatments. Nicole Stout:                 21:17                There's strong evidence around fatigue management exercise.  To moderate and low intensity for fatigue management. There's strong evidence around lymphedema using exercise to help for women who have, especially in the breast cancer population. There's strong evidence also around using weight bearing exercise to mitigate bone density loss that happens with many of the hormonal agents. So I know I'm sort of picking and choosing out of the air here, but in general, what do people experience when they go through cancer treatments? Debilitating fatigue is probably one of the most prevalent impairments across all cancer types. There's also so deconditioning that comes along with that and you know, that's a starting place for exercise interventions and you know, half the battle I feel with the rehabilitation intervention. And I feel like my role sometimes as the PT on the team, half of the battle is engaging the patient repeatedly in a conversation about enabling them because as they go through treatment, they feel terrible. Nicole Stout:                 22:30                You're sick. They're fragile, they're medically complex, right? Their blood counts drop, okay, let's maybe low. So there's risks and you know, it's sort of like the docs will say things like, well, you know, I guess you can exercise but don't overdo it. And that's almost worse than saying don't exercise. And so sometimes it's just, you know, our role in rehab is so critical during that time period of treatment to see them in a repeated fashion. And by that I don't mean, you know, two, two times a week for the duration of their cancer treatment. But you know, maybe it's a monthly basis, maybe it's every other month, maybe it's every three months as they're going through treatment for those check-ins. Re-assessing how their function has changed. Giving them guidance and support and enabling them. Karen Litzy:                   23:23                Yeah. And it reminds me of some of the work that I do with patients who have chronic pain is that it's not like you said, two times a week for six weeks. It's checking in, it's helping to build their self efficacy so that they can do yeah. And they can do more for themselves. Nicole Stout:                 23:47                And within their own bodies and giving them permission to do it. Cause like you just said, well you can work out but not too hard. Well like, yeah, that saying, well that's confusing and sometimes our patients need permission to feel more confident with their bodies. I had a patient say something to me once and I will never forget it and I use it in all of my talks and it's always sort of at the core in my mind. And she said to me, you know, the medical oncologists, they may have saved my life that you gave me my life back and if I'm going to survive cancer, what is it worth if I can't have my life back, at least to some degree to do things that I love to do. That just really hits at the heart of why rehabilitation is so critical for these individuals. Nicole Stout:                 24:39                Because yeah, that treatments that we have now, I mean, we're detecting cancers earlier. The treatments are so much more sophisticated. Many people will go on and live their full lifespan and die from something else and however, it's not good enough anymore for us to say. He said, I have cancer. You should be happy to be alive. You know, even if you're suffering with pain or lymphedema or conflict fatigue or neuropathies and, or cognitive dysfunctions and you're frustrated because you can't think straight and you don't have good short term memory. It's not good enough for us to say you should just live with those things and be happy to be alive. Not when we have the evidence like we do around rehabilitation interventions. And I mean, I could go on about the evidence. We could get into specific impairments, pelvic floor, for example, returning people to continent. Nicole Stout:                 25:32                Again, that's a place where prehab and then following them through the continuum of care. Makes sense. And you know, we in PT and in rehab has to get out of this episodic care mindset when we're working with patients who have cancer. So that's really where we went and we develop the prospective surveillance model. Way back in the early two thousands when I went to work at the Naval hospital in Charleston, Garvey and Cindy falls there, had developed this protocol for a research study and I went in and this prospective surveillance model said, Hey, we know people going through cancer treatment are gonna experience just awful side effects that are going to negatively impact their function. And if we know that ahead of time, why aren't we using rehab prospectively to help to identify the changes, manage them early when they're less intense and can be managed more conservatively. Nicole Stout:                 26:28                So we ran those studies over the course of the next 10 years and published extensively on this concept of prospective surveillance, which is start with rehab at the point of diagnosis, assess function at baseline, know what's normal, follow that patient then at punctuated intervals, throughout treatment, one month after they start treatment, they're going to have had surgery or they're going to have started treatment. They're going to start to decline. See them at that one month period, reassess baseline and identify clinically meaningful change. Everything might look great and then you say, good, I'll see you in three months. And then we follow them on an every three month basis after that for the first year, every six months, then up to two years and you're only out to buy. And what we found was that I do think that we indeed identified impairments early because for most people it's not if they occur, it's when, when is it going to happen? Nicole Stout:                 27:23                So we're able to identify them early. We can treat them much more conservatively when the impairment is less severe rather than waiting for severe, debilitating fatigue or a big fat swollen leg, and trying to fix or rehabilitate, right? We have to be much more proactive and we have the tools to be able to do that. We have the clinical measurement tools, we have the problem solving skills as rehab providers. What we have got to change is our perspective on an episode of care. This really is a more consultative role for rehabilitation and I think that's great. I think it's a great place for us to think about moving to as a profession. Consultation in that, like you said, sometimes you just see the patient, we tweak a little bit on their program and you coached them a little bit and talk about some of the behaviors they want to move towards and talk about. You're going to get there and you enable need and then I'll see you in three months. But sooner if anything goes wrong, you know? Karen Litzy:                   28:21                And now this brings up to me an interesting question for you. So this, you said back in the early two thousands, this work was done on this, prospective surveillance. So now it is 2019 so you know where I'm going with this, right? So, as rehabilitation professionals, where are we? Are we doing this? Has this been put into mainstream practice? And if not, what do we need to do as the rehabilitation professions? Nicole Stout:                 29:00                Yeah. So my heart is really as a researcher and it takes time. It takes time to do good studies. So that protocol kicked off in 2000. We didn't publish really our first remarkable studies until 2008 so it took us that eight years to enroll enough patients, analyze the data, come up with a full data set. You know, we completed our enrollment, we had the full data set. So in 2008 we published the first article from that prospective surveillance trial and then we published many, many more that the first was lymphedema, we published on shoulder morbidity, we published on fatigue and it was sort of this cascade after that, you know, once we had the data collected. So I'll start by saying it takes a long time to do good quality research. So really I sort of start the clock around 2008 and we've all heard the adage it takes 17 years for something to go from, you know, the research being published to actually implementing it in practice. Nicole Stout:                 30:08                So I looked around at my research, okay, I'm out waiting 17 years. How did the escalate the timeline to get this into practice? And, I encourage individuals who do publish, to think about how you advocate for your research. And so where are we right now as a profession? Well for the first few years it was challenging to get people around their head around this concept of prospective surveillance. We had some uptake in some larger cancer centers who said, this makes sense, let's implement and put a physical therapist in the cancer center, which I think is an ideal situation. It's hard to do though because again, in hospital systems we're in our cost centers and you know, the rehabilitation department, you have to have her referral to PT. I mean, we've got to find ways to overcome all of those barriers. Nicole Stout:                 31:03                So, I would say one moment that was a real catapult for us was in 2010, the American cancer society had identified the evidence around prospective surveillance and they said, do you think that this is ready for sort of an expert review panel? And I said, hell yeah. And so I got to work collaboratively with them and some other colleagues in putting together an expert consensus panel on prospective surveillance. We ended up after a two day symposium look, did the research, worked in groups and teams for about another year and publish 16 articles that came out in a supplement to cancer in 2012. And that I feel like was a bit more of a pivotal moment for us. You know, these research studies were great, but to pull all of that together with a group of experts in a consensus forum and say, this is a model that we need to think about for cancer patients because if we start at the beginning, not just with physical function, but if we start at the beginning with things like assessing someone's cognition, assessing their family status, assessing their financial status, assessing their nutrition status, and we follow them prospectively, all of those things are going to take a negative hit at some point during cancer treatments. Nicole Stout:                 32:21                So I think prospective surveillance lends itself to a much larger cancer supportive care model, which is how I have been describing it. And it is my intent to really focus on how we can study that model and look at better avenues for implementation in this new position that I'm in now at West Virginia university. This is my goal, which is amazing. Now how, so, you know, if we look toward the future and hopefully what you will be able to achieve in your colleagues across the medical spectrum, what are there policies that need to change that will impact the future of cancer survivorship or the future of living with cancer and beyond? Yeah, so the good news to that is there are a lot of things we can impact because we've laid this foundation of the evidence. We have laid this foundation of expert consensus and there's been a lot between that 2012 and today, more and more providers in rehabilitation services are becoming aware and engaging in cancer. Nicole Stout:                 33:36                You know, it's not something we prevalently teach in our curriculum in PT school. Think about how you learned about cancer. You learned about cancer in the negative. You learned all of the contraindications to your modalities and exercise and cancer was always one of them, right? You would say in your practical, okay, ultrasound, great, don't do it over the eyes. Don't do it on a pregnant uterus and cancer. So we find it in the negative for so many years. We have generations of therapists out there who love cancer and negative that never learned about the interventions to help to impact improve someone's function going through cancer treatment. So we're seeing that change and it's changing in how do we know it's changing? Individuals are engaging in cancer rehabilitation networks. We're seeing far more publications. We've published on this. A couple of years ago we did a billion metric analysis of the cancer rehabilitation literature and we've seen this tremendous upswing in the evidence base and an increase in volume. Nicole Stout:                 34:39                We're also seeing more therapists move towards specialty practice and evidence of that is what we have seen culminate in the last year with the first ever deployment of the oncology board specialty certification exam. We had 68 people pass the first exam. So we now have a growing conduct contingency and it will continue to go of therapists who are oncologic clinical specialists, which is fantastic. So we are positioning ourselves, we are moving forward. But when you ask where do we go in the future, I really think of three things. Number one is impacting policy, like you said, second is impacting education. And third really is impacting research. And so I think where do we need to move to in the future? We're starting to see the clinical practitioners really grow. We're starting to see residency programs develop. So from that perspective of the clinical focus, there's evidence, there are pathways that's developing. Nicole Stout:                 35:41                We have to start thinking about how do we embed this better into our curriculum. And this was last January in PTJ, the January issue of physical therapy journal. I coauthored a commentary article with Dr Laura Gillcrest, Dr Caringness and Dr Julie silver and Dr Catherine Alfano. We were all putting forward commentary on a recent national Academy of science, engineering and medicine report about longterm survivorship for cancer. And basically that report said rehabilitation should be utilized throughout the continuum of care, cancer care in order to contribute to that are longterm outcomes. And if that not doing so, not including rehabilitation during cancer treatment is almost negligence based on the breadth and depth of the literature that we have. So that was a pretty strong statement in that workshop document. So those are the types of things. Recommendations from the national academies will help us change policies. Nicole Stout:                 36:48                And by policies, I mean, you know, it's not just how do we get paid for what we do, but also policies around, standards, policies that our accreditation bodies use to designate cancer centers. In fact we are seeing, I think they were just released today, the commission on cancer, which accredits probably 95%, I think it is, of cancer centers around the country. So they're a big gorilla, their standards for an accredited comprehensive cancer center and include a standard for rehabilitation care services. It used to just be a criteria that you had to have a referral source to rehabilitation. But in 2020, the new standards that will come out from the commission on cancer actually has a rehabilitation care service standard. So it's been elevated. That's going to be critical for us because it will require your cancer committee in your hospital to identify policies and procedures for rehabilitation practices in oncology. Nicole Stout:                 37:56                So, you know, this is a place where we've got to start to see uptake in from our rehabilitation directors or administrators in large healthcare systems. The PTA, you know, we were really gonna need to see them start to put forward recommendations. How do we do this to practice? What is the best practice? What are some tools and tool kits that we can rule out. So those things, those policy changes are drivers for us. The education piece, I've spoken to a bit, I think embedding more education into curriculum for the entry level PT. And I think it's critical. You know, we get so bogged down in, well, you know, the capte requirements are, but they are in our curriculum's already too tight and it's a bit of a red herring argument because I see places around the country who have champions for oncology rehab who has put it into the curriculum. Nicole Stout:                 38:51                It just takes someone to understand what is the best practice look like for an educational model and how do we implement it. So places like Oakland university in Michigan, Emory in Atlanta is working right now on elective modules. So there are some real novel ways that these are being incorporated into PT curriculum. And the third area that I think of for the future is research. And you know, as I said, wow, we've seen an explosion in research in the last decade. It's phenomenal. A greater volume. A lot of that has focused on intervention. It's been within some very specific populations like breast and prostate. There is a lot of breast and prostate, understandably. But we need to look at going beyond. We really should be thinking about how do we look at populations with regard to our rehab interventions of cohort studies, large population studies, and we've got to start thinking a little bit beyond end points. Nicole Stout:                 39:54                Like function, function is important, don't get me wrong, it's the core of what we do. But if we improve function through rehab intervention, does it change the downstream utilization of healthcare services? Does it mitigate costs? Do we see them spend less time in the hospital? Did they have less than, do they adhere to their chemotherapy better? Do they have less severe toxicities? Do they have better overall survival? So they've got to think about some different end points and take a bit of a health services research approach. I think in oncology rehabilitation going forward. That's what I would love to see as the future and really at the core, the change in clinical practice so that we are a proactive consultative risk stratifying, triaging, screening, and proactively assessing profession when it comes to dealing with oncology. Karen Litzy:                   40:52                Yeah. And, and you really teed it up for me to ask you this last question here. My question is what advice would you give to your everyday clinician working, whether that be an inpatient or outpatient to allow them to begin to think differently about cancer? Nicole Stout:                 41:19                And that's critical because the fact of the matter is we look at places like Johns Hopkins and university of Penn and MD Anderson and those are like the preeminent cancer centers in the country. The truth of the matter is the majority of people get treated for cancer and community hospitals right down the street from where you live and in outpatient, freestanding oncology clinics. So the likelihood that you're going to see them is very high. So it is important for, as I said, the general therapist. It's also important for specialty practice therapists to improve their knowledge base in cancer. So how do you do that? There are some great resources. I'm always going to point to the APTA oncologic Academy for physical therapy. We're now an Academy. We used to be the section, I still call it the section. Nicole Stout:                 42:13                But we have an Academy for oncologic physical therapy and there are phenomenal resources there. They do continuing education programs. They provide fact sheets. They often have great evidence base that you can access to understand what are the measurement tools they should be using, what are the questions I should be asking someone. I feel there are also some, you know, continuing education courses focused specifically on the general therapist and I teach one of them. So there's my bias opinion and my disclosure there with great seminars, but I tell people that in the beginning of the course, one of the first things I say is my goal is not to spend two days with you to get you to become an expert in cancer rehab. My goal is to change the way you think about every single patient that you see regardless of the diagnosis, regardless of the setting that you are in. Nicole Stout:                 43:05                If they had a history of cancer, what questions do you need to ask? What might you be seeing in your intake that is indicative of side effects of disease treatment, late effects or even metastatic process. The other flip side of that that we haven't talked about and certainly helped me to delve into is that as primary providers, as frontline providers as we are in rehab, right? The direct access. Now, how many of us ask, about screening, cancer screening? How many of us ask questions? How many of us even know what the screening guidelines are for cervical cancer, for breast cancer, for prostate cancer, new screening guidelines for lung cancer. Again, I think that's a great way for physical therapy professionals to brush up in their knowledge base and to start to have these conversations. I'm not going to be the one to order a low dose CT scan for my patient who's at risk for lung cancer, but I might be the person to plant the seed with them and to incite a behavior change if no one else on their medical team has talked to them about it or if they're hesitant about it. Nicole Stout:                 44:12                Colorectal cancer screening as well. So all of those, we should take responsibility to have those conversations. And that is 100% of the patients that we see to ask those questions. So I think we need to sort of self-assess and say, how can I do this? Knowing that we had, we have 17 million individuals in the United States right now that we call cancer survivors. We are expecting that number to double, double by 20, 40 just because of the growing population, first of all. And because of the escalating rates of survivors, because we're treating the disease so much better. So there are going to be far more of them with the aging population and far more needs for us to meet. So yeah, therapists should be asking themselves, what are the resources out there? There are a lot of places now hospitals, health systems do cancer rehabilitation programs. Nicole Stout:                 45:10                They're doing continuing education courses and they're doing conferences as well. So take a look at some of the, I know Mary free bed, rehabilitation center up in Michigan, Brooks rehabilitation hospital down in Jacksonville, Florida, Marion joy, Northwestern. Many of these rehab hospitals are looking at doing one day, two day symposium open, you know, for folks to attend. So many hospitals as well are doing these cancer rehabilitation one day symposium and NYU is doing one next year, university of Miami. There's also an on pitch this because it's fantastic. And the ICPTO, which is the international conference in oncology, physical therapy, physical therapy oncology. I see PTO, it will be in Copenhagen in may of 2020. That's not a terrible place to go. This is the second that we, the second conference that we've done, the first conference we had over 280 participants from over 25 different countries around, well just physical therapists just in oncology. Nicole Stout:                 46:17                It was just amazing. It gave me tingles to be in that room. And so we're hoping to have an even bigger groups. So those are just, you know, again, sort of a snippet of some resources that I can provide. But looking at each of those, I think you can delve deeper into the resources that they have and have them have available within the APTA within the Academy and within some of those other ACRM is another one. The American Congress for rehab medicine has a cancer networking group and that's a beautiful place to go because it is interdisciplinary PT, OT, speech. You have behavioral psychologists, you have interventionalists, you have lifestyle medicine, desire, interest. It's really great. And they have continuous track of cancer rehabilitation content at their conferences. Unfortunately their conferences in early November. So it's coming up quickly, but every year it's in the fall. Next year it will be in Atlanta. So you know, another great place to look for. How do I start to build my knowledge base in this area? Karen Litzy:                   47:30                Yeah, this is great. Thank you so much for all of those resources and we will put as many of those up in the show notes at podcast.healthywealthysmart.com. Quick question on some of those resources. When you were talking about the different screening tools, can you find those screening tools under the APTA's oncologic PT? Nicole Stout:                 47:50                So if you're talking about the Academy for oncologic physical therapy, the hotly debated title. Yes, there are. So screening tools for identifying functional morbidity. Yes. So the course that was the evidence database to guide effectiveness, the edge test scores for oncology has published over 25 systematic reviews and have looked at measurement tools with by disease type within different measurement domains. So for example, you can find how do I measure functional mobility in colorectal cancer? How do I measure best measure lymph edema in head, neck cancer? So it's broken down by disease type and then domain of measurement. So that's there. It's an annotated bibliography on their website. So they give you a nice little simple compendium. But for the larger screening population screening guidelines, many of those are American cancer society and the us health prevention preventive task force. Those are, you know, large scale guidelines that are developed and put forward for screening for disease. Karen Litzy:                   49:02                Yeah, perfect. Perfect. Well that's great. That is a lot of resources for people. So hopefully any rehab professional listening can, if you have no familiarity with any of this information, would you say where's the first place they should go? Nicole Stout:                 49:21                Well, the first place, that's a great question. And I can help you put some seminal articles up there too. I think there are one and the open access articles. Julie silver wrote a fantastic article in 2013, about impairment driven as a rehabilitation. I feel like it's foundational. It's a great starting place for someone to get their head around all of the stuff involved with cancer treatment and the functional morbidity. And then I think the PTs for PTC oncology Academy is a great place. But also if you're an OT or speechie, you can join the Academy of oncology, PT, you can be an affiliate member, you can get access to our journal and our resources. Karen Litzy:                   50:06                Oh, that's cool. Good to know. That's very good to know. And you know, I think as from what I've got out of this conversation, because I am not embedded in with the oncological Academy but what I am have come to realize through this conversation is that regardless of your setting, you may in your career encounter a patient that has had cancer or is going through cancer treatment and regardless of whether you're in sports, PT, orthopedics, neurological pediatrics, odds are you're going to treat someone at some point with a cancer diagnosis present or past. And to understand the basics of how that might affect overall systems is incredibly important regardless of whether you work at Sloan Kettering full time within specifically cancer population or you are the physical therapist for the New York Knicks, you know, you may encounter this population. Nicole Stout:                 51:32                Yeah, that's really a beautiful summary. Karen, I appreciate the way you articulated that because I like to say oncology is everywhere and that's exactly it. It doesn't matter the setting you're in, it doesn't matter what specialty you practice. It doesn't matter geographically where you live. It does not matter, you know, age, gender, et cetera is, it's there, it is everywhere. Multi-system impact across body systems. So I think that's it. And across the lifespan. So I think it's beautifully summed up with that. You just said that, that's how we think about it. Oncologists everywhere. So every patient that you see there is either the risk of them having a cancer diagnosis in the future. So are you talking about the screening guidelines for the chances they'd had a diagnosis in the past and then asking yourself, is that impacting what I'm seeing here in front of me? There's so much we can spend an hour talking about pediatric oncology right now we're talking about red flags, you know, but look around many of the continuing education consortia around the country, med bridge. You know, many of those have a variety of content or are in process of building content for continuing education always look at the references. CSN is a great place to go to get a ton of oncology resources. Karen Litzy:                   53:00                Got it. And that is coming up in February over Valentine's day weekend in Denver, Colorado. So if you're a physical therapist or not, maybe you just want to go and hang out with 13,000 other PTs. You can go to Denver and you look at the oncology track for CSM. Nicole Stout:                 53:20                Definitely bring your sweetheart, make a ski weekend, I guess with the ecology content. Yep, definitely. Karen Litzy:                   53:32                Excellent. All right, so before we wrap it up, I asked the same question to everyone and that's knowing where you are now in your career, in your life. What advice would you give yourself as a new grad out of PT school? So this is the advice you would give to you. Nicole Stout:                 53:48                The advice I would give to me, it's funny. People would say, if you look back, what would you change? And I always say not a damn thing. I guess my advice to myself is what I hold close to my heart and what I convey to others is go for it. Don't be hesitant to take on something new or different because the new and different is what is going to expose you to a pathway you never would have imagined. I never would have imagined coming out of school that I would be doing oncology work. I was worried about in PT school. I didn't know that this career pathway could exist. I didn't know a clinical research pathway was something that I could even pursue. And as the opportunity came up, if I would've been hesitant, if I wouldn't have been interested in taking the risks, so go for it. Don't be afraid to take a risk. And sometimes that means moving to a different city, that might mean taking a pay cut. You know, a lot of times if we chase the things we love, we're not necessarily chasing the money along with it. I think if we chase a big paying salary, sometimes miss things above, so go for it and be open to try and taking those different pathways. Karen Litzy:                   55:02                Yeah, great advice. And now where can people find you if they have questions or they want to talk about oncology physical therapy? Nicole Stout:                 55:12                Oh, you can find me on Twitter, on social media outlet. I really used to try to engage professionally. So it's @NicoleStoutPT. And you know, you can certainly find me there. My Facebook accounts were private. That's where like family and friends stuff. But definitely access and hit me up on Twitter or LinkedIn yet. Another great place. I post a lot of our research articles there. I'm on LinkedIn, so you can certainly connect with me there. Or just email me and always see how many times you can just cold call or cold email. It's some of the most engaging conversations I'll get on the phone with anyone. I will fly anywhere to talk about kids or rehabilitation and you know, some of the best conversations that started with, Hey, I don't want to bother you, but you have some time to talk and I'm happy, you know, to start a conversation via email. So more than happy to engage. Karen Litzy:                   56:09                Perfect. And Nicole, thank you so much for a really great talk and I think that you have given the listeners a lot to think about and also a lot to look up into research and hopefully spark someone out there to, this might be the path I would like to take. So thank you so much. Nicole Stout:                 56:24                Well, I thank you for the opportunity. I'm just grateful for everything that you've done to put PT on such a stage and I'm really excited to have been a part of that, so thank you. Karen Litzy:                                           Thank you so much. And everyone out there listening, thanks for listening. Have a great couple of days and stay healthy, wealthy, and smart.     Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities every October. TurningPoint Breast Cancer Rehabilitation Executive Director Rebecca Cowens-Alvarado joins co-hosts Carol Morgan and Todd Schnick to discuss the organization’s mission and upcoming events on this week’s Around Atlanta segment of Atlanta Real Estate Forum Radio. Founded in […] The post Think Pink in October with TurningPoint Breast Cancer Rehabilitation appeared first on Atlanta Real Estate Forum.

Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities every October. TurningPoint Breast Cancer Rehabilitation Executive Director Rebecca Cowens-Alvarado joins co-hosts Carol Morgan and Todd Schnick to discuss the organization's mission and upcoming events on this week's Around Atlanta segment of Atlanta Real Estate Forum Radio. Founded in 2003, TurningPoint is a non-profit, 501(c)3 community-based healthcare organization providing specialized and evidence-based rehabilitation for women living with, being treated for and surviving breast cancer. Rehabilitation services include physical and massage therapy, counseling and nutritional analysis. This combination of services provides each woman with hope, education and support, all within an atmosphere of wellness. Most services are complimentary, while a financial assistance program is available to allow all patients access to care. The organization's mission is to improve the quality of life for women with breast cancer by providing, promoting and advocating dedicated and evidence-based rehabilitation. Supporters of TurningPoint are invited to attend the annual Pink Affair, coming up on Saturday, March 28, 2020, at InterContinental Buckhead Atlanta. Funds raised at The Pink Affair will support TurningPoint's delivery of reduced-fee and complimentary services, community education and healthcare provider education. InterContinental Buckhead Atlanta is located at 3315 Peachtree Road NE in Atlanta. To learn more about TurningPoint, including events and activities coming up for Breast Cancer Awareness Month, listen to the full interview above or visit www.MyTurningPoint.org. A special thank you to Jackson EMC for sponsoring Atlanta Real Estate Forum Radio. Jackson EMC offers homebuyers peace of mind and lower bills with its certified Right Choice™ new home program. These homes are built to be energy efficient and sustainable with improved indoor air quality, convenience and comfort. For more information on Right Choice new homes and Jackson EMC, visit https://RightChoice.JacksonEMC.com. Please subscribe to Atlanta Real Estate Forum Radio on iTunes. If you like this week's show, be sure to rate it. The “Around Atlanta” segment, sponsored by Denim Marketing, is designed to showcase the best of metro Atlanta – the communities, attractions and special events that make this city great. To submit your event, community or attraction to the Around Atlanta edition of Atlanta Real Estate Forum Radio, contact Denim Marketing at 770-383-3360 or fill out the Atlanta Real Estate Forum contact form here.

Guest: Andrea L. Cheville, M.D. Host: Jeffrey S. Brault, D.O. (@JeffBrault) What exactly is cancer rehabilitation? How can we keep our patients working and living their best life during cancer treatment? How do these patients differ from other rehabilitation patients? Dr. Andrea Cheville shares her insights on the Mayo Clinic multidisciplinary approach to providing rehabilitative care for cancer patients. This includes those actively going through chemotherapy and/or radiation treatments, as well as patients whose treatment has concluded. Connect with the Mayo Clinic’s PM&R Department on Twitter @MayoClinicPMR. 

Dr. Wisotzky is the program director for Georgetown, MedStar NRH and the director of Cancer Rehabilitation at MedStar NRH. He was also the Spotlight Speaker at the annual Association of Academic Physiatrists (AAP) meeting. Listen to Dr. Wisotzky talk about his road to becoming program director and on how to give yourself the best chance of attaining the residency of your dreams.

ONS members Melissa Thess, PT, CLT, director of education and quality, and Amanda Hodges, BSN, RN, OCN®, director of implementation, from ReVital Cancer Rehabilitation, join Chris Pirschel, ONS staff writer, to discuss the role of physical therapy in oncology care, how nurses and physical therapists can work together for cancer rehabilitation, and the importance of physical activity for patients with cancer. Music Credit: "Fireflies and Stardust" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 Episode Notes: Check out these resources from today's episode: Complete this evaluation for free nursing continuing professional development. Supportive Care Programs for Patients With Cancer The Power of Prehabilitation Cancer Rehabilitation and Survivorship: Transdisciplinary Approaches to Personalized Care Exercise Interventions – Putting Evidence Into Practice Get Up, Get Moving Survivorship, Quality of Life, & Rehabilitation—ONS Communities American Physical Therapy Association ReVital Cancer Rehabilitation ONS members Melissa Thess, PT, CLT, director of education and quality, and Amanda Hodges, BSN, RN, OCN®, director of implementation, from ReVital Cancer Rehabilitation, join Chris Pirschel, ONS staff writer, to discuss the role of physical therapy in oncology care, how nurses and physical therapists can work together for cancer rehabilitation, and the importance of physical activity for patients with cancer. Music Credit: "Fireflies and Stardust" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 Episode Notes: Check out these resources from today's episode: Complete this evaluation to earn free CNE. Supportive Care Programs for Patients With Cancer The Power of Prehabilitation Cancer Rehabilitation and Survivorship: Transdisciplinary Approaches to Personalized Care Exercise Interventions – Putting Evidence Into Practice Get Up, Get Moving Survivorship, Quality of Life, & Rehabilitation—ONS Communities American Physical Therapy Association ReVital Cancer Rehabilitation

Dr. Lisa VanHoose comes onto the HET Podcast to talk about diversity, equity, and inclusion in the physical therapy profession and in academia.   Resources Mentioned: Ujima Institute Website Ujima Institute Facebook EIM Hybrid learning courses CSM After Dark 2018: Part 1, Part 2, Part 3 Hopkins' 16 Dimensions of Diversity   Biography: Dr. VanHoose received her PhD in Rehabilitation Science and MPH from the University of Kansas Medical Center. She completed the NHLBI PRIDE Summer Institute with an emphasis in Cardiovascular Genetic Epidemiology. Her BS in Health Science and MS in Physical Therapy were completed at the University of Central Arkansas. Dr. VanHoose's teaching interests include pathology, physical agents, oncology rehabilitation, population health, and cultural competency. Dr. VanHoose's research focuses on the incidence, prevalence, and severity of cancer related side effects with an emphasis on the disease burden of minority cancer survivors. She also investigates strategies to diversify the healthcare workforce to reduce health disparities. She has received both NIH and industry funding to support her research agenda. Dr. VanHoose is the Principal Investigator of the Cancer Rehabilitation and Wellness Laboratory. She is also the past President (2012-2016) of the Oncology Section of the American Physical Therapy Association. Contact information: Twitter: @LisaVanHoosePT Facebook: Lisa VanHoose Linkedin: Lisa VanHoose       The PT Hustle Website Schedule an Appointment with Kyle Rice HET LITE Tool Anywhere Healthcare (code: HET)  

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. In this podcast, we’ll discuss lymphedema, or swelling, in the legs after cancer treatment, including what can cause lymphedema, and how to prevent and manage it. This podcast will be led by Dr. Andrea Cheville, the Director of Cancer Rehabilitation and Lymphedema Services in the Department of Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, Minnesota, and Jenny Bradt, a LANA-Certified Lymphedema Therapist and Clinical Lead Physical Therapist in the Department of Physical Medicine and Rehabilitation at Mayo Clinic. ASCO would like to thank Dr. Cheville and Ms. Bradt for discussing this topic. Dr. Cheville: Hi, I am Dr. Andrea Cheville, the director of Cancer Rehabilitation and Lymphedema Services at the Mayo Clinic in Rochester, Minnesota. And I am joined today by our lead lymphedema therapist, Jenny Bradt. Jenny, do you want to tell our listeners a little bit about your background? Jenny Bradt: My name is Jenny Bradt, and I am the Clinical Lead Physical Therapist at the Lymphedema Clinic here at Mayo Clinic. I am a LANA certified therapist. We'll be talking about that a little bit later, and what I do in and out, every day, are treat patients with lymphedema. Dr. Cheville: And I think it's worth noting that Jenny and I have been in this business for quite a while. I've been directing Lymphedema Services, largely for cancer patients, since 1999. I initially started my work at the University of Pennsylvania in Philadelphia. And, Jenny, has it been 30 years yet for you? Jenny Bradt: Since 1995. That's a long time. Dr. Cheville: No, not so long. Okay. Well, to start out with, we thought it might be useful to talk about what is lymphedema? And how does lymphedema differ from other kinds of swelling? And why does it happen frequently among patients with cancer? And it really comes down to a matter of plumbing. The cells of your body need oxygen and nutrients in order to survive. In fact, they don't last very long without both of those. And so the body transports very large volumes of oxygenated blood throughout the body. But once the blood has reached the tissue, it has to get back to the heart, which is not a mean feat. And in addition, all of the debris, the garbage that cells make—just like we make garbage, our cells make garbage—that also has to get out of the tissue. And so, we have 2 sets of pipes to accomplish this task. We have our veins and the lymphatic vessels. And the veins principally carry fluid. Roughly 90 to 95 percent of the fluid that your heart pumps into any tissue is returned by the veins. And veins also will remove smaller molecules, and these proteins, fatty acids. But the big ones, and again, these are tiny by our perspective. Those are returned to the general circulation by the lymphatic system. So these are bits and pieces of dead cells, cells that die in our tissue, what we call long-chain fatty acids, large proteins, and bacteria. And all of that solid waste material can build up outside of our cells, and it's the tiny, little lymphatic, what we call capillaries, that absorb those, and then through larger and larger lymphatic vessels, they eventually transport those. And actually, the lymphatic system pumps. It has muscle in the walls of the vessel, and it's remarkably efficient at moving this proteinaceous and other debris out of our tissue and to the lymph nodes. And the lymph nodes do 3 things. They regulate the viscosity of lymph, how thick it is. They remove debris that the body doesn't feel a need to recycle. And they identify harmful pathogens, and those are principally bacteria, because our skin is not a perfect barrier and bacteria get in through our skin all the time. And at the level of the lymph node that the immune system learns, "Hey, there's a problem." And that's assuming that there aren't just a few bacteria, but when we really have an infection. And it's a lymph node that the body mounts a response, which is why you may have palpated enlarged, tender lymph nodes in your neck, or in your armpit because those lymph nodes are busy fighting off an infection. So for cancer, both for staging, to accurately stage our cancers, and to achieve local control, we remove or irradiate lymph nodes. There's also increasing evidence to suggest that some chemotherapeutic regimens can compromise our lymphatic system. But it's principally radiation and surgery have been implicated in causing lymphedema. Which brings us to, well, what kinds of cancer treatments are associated with lymphedema? And in truth, any cancer treatment that involves the removal or irradiation of lymph nodes can cause lymphedema. And one aspects of lymphedema that continues to puzzle us is why it's delayed. And so large data sets have accumulated over time that guide us in understanding when lymphedema starts. And what we've learned, for the most part, it starts by the third year out, the third year following treatment. With most patients presenting in the first 2 years. But not immediately, and we think this is because that solid debris, that the lymphatics are responsible for removing, that builds up slowly in the tissue. It's not an immediate phenomenon. Although, for some patients who have severe damage or compromise of the lymphatics in the course of their cancer treatment, they may have swelling immediately. But often, it's a more gradual onset, and the protein builds up, the other debris, it's irritating to the body. The body is doing its best to handle the problem, which it knows isn't normal. And eventually, it causes low-grade inflammation, which many times, is the first indicator that a patient is developing lymphedema. They may have heaviness in their arm, their leg, or the affected body part. Jenny, what are some other symptoms that patients often describe when they're—what we call Stage 0 or subclinical lymphedema—before we can appreciate swelling? Jenny Bradt: Sometimes, those changes are sort of subtle. Obviously, they might notice that their ankles are bigger are at the end of the day, but by morning, they're back to normal. But some patients, especially lower extremities, say, "Well, my jeans fit tighter on one leg, or in one buttock, more than the other side." Or they just don't feel the muscles underneath their skin as much, where the skin just doesn't wrinkle as easily as it does with a less affected leg. The skin might feel thicker. It doesn't necessarily have to make a thumbprint, it's just this overall thickness. They might have veins on the top of their foot that are kind of disappearing. They don't notice them as much as the other side, and those would be early signs of lymphedema. Dr. Cheville: So first, we have—not in everybody, but often—just the symptoms. Heaviness, maybe some aching, and a really important point is that this is a general diffuse feeling. Lymphedema, for the most part, does not cause focal pain. So cancer survivors who have pain in a knee or a wrist or a specific part of their affected limbs, that should not be blamed on lymphedema, and it should not delay a workup for an alternate explanation. But that heaviness, aching, particularly after activity, or if it's the leg standing for a long time, those can be the first signs followed by the subtle changes in volume that Jenny had described. But over time, the debris, the solid material builds up in the tissue, causes inflammation, and will cause scarring or what we call fibrosis. And it's simply collagen, loose disorganized connective tissue that over time, can accumulate and lead to an enlarged—sometimes, very enlarged—extremity. The arms and legs are most frequently affected. But because every tissue on our body, that's face, trunk, breast, genitals, create lymph, lymphedema can, essentially, affect any of our somatic tissues.  So, Jenny, could you share some strategies that patients can use to reduce their risk of lymphedema? Jenny Bradt: Yeah. I think it's important to emphasize that the most important thing to do is to observe your leg and if you note any swelling to treat it right away. Because it is easier to treat in early stages. And never feel that you have too little swelling to report. There's never going to be a time where there's too little swelling to report. An important symptom to watch for is infection of the skin. The risk of developing a skin infection in the leg or legs that are at risk for lymphedema is greater because there's a delayed lymphatic flow in that leg. A skin infection, also called cellulitis, is relatively easy to diagnose and treat. However, if an infection is not treated quickly it can lead to much more swelling in the limb and make it more difficult for the lymphatic system to work well after the infection has resolved. So any changes in color or temperature of the leg should be reported the same day you see them if they are there. So observe your leg. Become familiar with its normal color and appearance so that you can recognize changes if they occur. So for example, if your leg's usually a little pink when your feet are on the floor but not as much when they're elevated, and then you see that your feet stay red or pink when they're elevated, and they're red and warm, well, that's something that should be checked. Because it wasn't what's normal for your leg. There's usually an identifiable cause to most cases of cellulitis, like an open area that allows microorganisms to invade the normal barrier of the skin. And for this reason, it's important to avoid situations that can cause cuts or scrapes in the skin. So if you do have a cut or a scrape on the affected leg, watch and make sure it is healing without any increase in redness to the area. And if you have an open area in the skin, avoid situations where bacteria can invade the wound, such as swimming in a lake. Cellulitis in the leg can be related to fungal infections between the toes, and that's why it's absolutely important to treat and avoid athlete's foot. Athlete's foot causes cracks and web spaces between the toes. This allows microorganisms to invade the foot, so take care of your feet. Avoid walking with bare feet in public shower areas and locker rooms, and if you do have an athlete's foot infection, treat it with over-the-counter anti-fungal medications. There's powders and there's ointments, and if cracking of the skin is a problem, maybe an ointment might work better. But if you're always having sweaty, damp feet, well, a powder anti-fungal medication might work better. But the goal is to make your feet unwelcome for fungus. And it's important to keep your toes clean and dry. Most lymphedema prevention is aimed at preventing excess inflammation, in general, that can occur in the leg at risk. And there's obvious sources of increased inflammation or swelling. For example, a broken bone would cause more swelling. And, of course, everyone tries to avoid traumatic injury, but the other more subtle types of injuries are like the overuse type of injury. So if you want to do something new that you haven't done, start by doing it gradually. What we do know about exercise is that it's beneficial, and eventually, your exercise will make your body stronger and less likely to be injured. But the fact that injuries can cause a greater demand on your lymphatic system is the reason why it is important to be strong but to do that in a slow and measured way. So, for example, if there's an activity that you enjoyed doing before you had cancer treatment, it's very likely that you can continue to do that activity. But be mindful of the time off that you had to take for your cancer treatment and work slowly back to your prior level of fitness. Physical therapists can be very helpful in guiding you back to your fitness goals and can help you treat and avoid injury. If you're interested in starting a new strengthening program for your legs, it's important to start at a very low level and a manageable level increasing in intensity much slower than you normally would if your leg was not at risk for lymphedema. But I cannot emphasize enough it is important to stay active, lean, healthy, strong muscles, good joint motion. That all helps to circulate the blood and return the lymph fluid to your heart, and of course, if you smoke, you need to take active steps to stop smoking. So how do we treat lymphedema if it happens? We've talked about the different stages of lymphedema, and it is not inevitable that lymphedema will gradually become worse and worse. It getting worse can be avoided by treatment. And the goal of treatment is to reduce the swelling in the leg, but then to take steps constantly to keep that swelling from returning. So treatment of lymphedema is not a curative treatment. It is management. We have not found a cure for lymphedema yet. So it's important to understand that there are 2 parts to lymphedema treatment, and they can be referred to as phase 1 and phase 2. Phase 1 treatment involves reducing the limb, getting it smaller, while phase 2 involves maintaining it. In order to reduce the leg initially, it is necessary to apply compression, but you have to apply compression that can shrink with the leg. And that's the reason why we use compression bandages, or sometimes, I'll also call them compression wraps. Most people think of a compression wrap as an ace or elastic wrap when they think of a compression bandage. But in lymphedema treatment, we use something called a short stretch bandage, and it has no elastic in it. The short stretch wraps are used because they create a containment of a leg so that the bandage itself does not expand when the muscles contract and expand. So what happens is when the leg muscles contract, they push up against the bandages, which don't expand, and the muscle pump squeezes the vein's lymphatic vessels more effectively. What this does is it helps moves the excess fluid up and out of the leg, and as a therapist, I can customize a short stretch wrap by including foam pieces inside that short stretch wrap that helps to mold and contour out the leg if it's gotten very swollen and help soften the tissue that might've gotten more brawny or more hard. When we add foam under a wrap, it also gives something for the leg muscles to work against. And when you move in a leg where there's foam inside it, it also kind of massages and softens the skin. And so it does help improve the skin quality, and it improves skin mobility. Legs should move through a series of exercises after every wrap. And these exercises are called remedial. Their purpose is simple. They are done to encourage the muscles to contract against the bandage. And they're not difficult. They can be made up of simple range of motion exercises or muscle contractions. There are other tools we use to reduce swelling along with the compression bandaging. Sometimes, we'll do a massage, which is also called manual lymphatic drainage, or MLD, and that helps mobilize swelling and soften tissue. But MLD needs to be used in conjunction with compression to be effective.  Pneumatic pumps are used similarly in phase 1, but they also should involve compression between pumping. All phase 1 therapy should include education on how to take care of your skin, how to observe for those skin changes, keep the legs moisturized yet dry, keep the skin intact, and treat any wounds right away. Now, phase 2, which is the maintenance phase, is often more difficult than phase 1 because it involves a bit of trial and error. Compression socks or stockings are used in phase 2 to maintain the size of a limb, but they are not necessarily superior to bandages in terms of compression. They simply allow you to go about your life without bulky compression bandages on the leg. We think of compression socks, like compression stockings, as defense, where the bandages are offense. So the bandages work to actively reduce the leg, but the compression socks maintain the smaller size. A well-fitting compression sock should be tolerable all day long. It should keep your leg the same size from morning to evening. And that takes a bit of work to find the right sock for you. And so it's important to work with a knowledgeable fitter and therapist together to figure out what works best for you. So in less severe cases of lymphedema, when you're in that stage 1 where it still reduces at night, a compression stocking during the day might be all that is needed as part of the maintenance program to keep the legs the same size. But for more stubborn cases, additional means of maintaining the reduced size might be needed. And you would know this is necessary if, in your compression sock during the day, your leg swells up and kind of creeps up by the end of the day. Sometimes, we'll add compression wrapping again at night because that will reduce the limb while you sleep with the added benefit of softening a leg that has developed some of those skin changes and thickening. Some days are simply more demanding on a leg, and an occasional wrap at night for some people might be necessary. Wrapping at night is what we use simply because it doesn't interfere with your daytime movement. And for those patients who find that they need to wrap their leg at night fairly regularly, they do have compression devices on the market that mimic these compression bandages. It's important to work with a lymphedema therapist to help you decide what device might be best for you. And we don't wear compression socks at night simply because they are fit really tightly, and they have that more elastic compression that presses against the skin. And when your leg isn't moving, that can start to become uncomfortable. A well-wrapped leg—a good bandage should be more padded and more comfortable when somebody's asleep at night. And remember, every compression wrap is a custom fit to your leg, so it works to reduce the size of a leg better than a compression sock. And there are other tools that can be used in a phase 2 program, such as self-manual lymphatic drainage, maybe a pneumatic pump, but exercise is essential in all of your maintenance programs. So exercise is the key. Dr. Cheville, would you like to talk about how patients could find an appropriate provider to help them manage their lymphedema? Dr. Cheville: I was just going to ask that question [laughter] because it's hard. First, Jenny did a beautiful job of kind of giving a remarkably comprehensive overview of lymphedema, and I just wanted to call out a few things that I think are key take homes and, Jenny, correct me if you disagree. But one, as Jenny said the importance of exercise. And we want to create better pump, and to do that, we use resistive exercises. So both to help the venous blood get back to the heart but also the lymphatics. Having strong muscles, and not atrophied or not collapsed muscles in your leg is important. So that's one type of exercise we would prescribe. The other is the remedial exercises that Jenny mentioned, and that's just creating a pumping action. The idea of becoming intimately aware of your leg, and if you’re starting to change your activity profile either in intensity or type, just exactly as Jenny said, keeping an eye on your leg for changes, particularly after prolonged standing or activity. I really liked what you said about the garments being the defense and the wrapping the offense. I'm going to use that because I think that encapsulates the role of the different compression devices that we use very nicely. And I wanted to just touch, again, on cellulitis because this is a skin infection categorized by patchy redness. Usually, it's a very discreetly demarcated area of redness, also warmth. There can be associated pain and worsening swelling. Typically, it presents after a patient has developed lymphedema but not always. At times, it's the first indicator that a patient has lymphedema. It should trigger an immediate, as Jenny said, communication to your care team, your primary provider, going to an ER because the infections can be dangerous. But also, they can cause permanent worsening of the lymphedema that can be challenging for us to reverse as practitioners. So if you have established lymphedema, this is something that should be on your radar, and I would encourage you to talk to your care team about it. And even if you don't have athlete's foot, because even minuscule amounts of fungus on your toes can create a larger portal for bacteria that normally lives on your skin to enter. So these days, I tell all my patients to use an anti-fungal powder or spray on their feet, roughly 3 times a week. I like the sprays because they get in the little crevices, and they can be less cakey and chalky than the powder. Any other key take-homes Jenny? Do you agree with those? Jenny Bradt: I definitely do. And I think that it is important to have—if it's possible—for you to find a therapist who's a lymphedema specialist in your area, because over the course of the time when you will be managing your leg, if there is something that is a setback, it's important to get back in touch with a therapist. They'll know you. They know your leg, and they know what works well for you. There is a designation of CLT-LANA Certified Therapist. That's the Lymphatic Association of North America. If a therapist has received an additional 135 hours of training beyond their normal physical therapy or occupational therapy degree, they can sit for that exam and get a designation of CLT-LANA. They can be occupational or physical therapists, but they would-- Dr. Cheville: Massage therapists? Jenny Bradt: Massage therapists? I kind of prefer a medical model. We do very well having therapists who are LANA certified, but work carefully, closely, with the actual medical team of that person, so we can take care of the entire person. Dr. Cheville: Yeah, I would agree. I think a key feature though is connecting with a good therapist. And the LANA Lymphology Association of North America website has an interactive search function that will help you identify individuals in your area. And even if you don't find somebody who's in your immediate proximity, often reaching out and contacting that person—lymphedema, it's a small community. We tend to know each other, and they very likely will be able to direct you to appropriately trained individuals, that are convenient for you. And as a physician, hopefully, medical school has changed, but we received almost no training when I went through. This was longer ago than I'd like to think, but in lymphedema, or the lymphatic system, and what I have discovered amongst my patients over the years is they've had to become self-advocates and often educating their own care teams about their unique needs as lymphedema patients. There aren't a tremendous number of physicians specialized in lymphedema. But if you're really struggling with a condition, and feel that you're not getting appropriate local support, I would encourage you to reach out and identify a physician specialist. Which may require some travel, but it may be well worth the effort. So thank you for your attention. Jenny Bradt: Well, thank you very much for listening, and we hope that you have many healthy and enjoyable years of exercise with your legs. ASCO: Thank you, Dr. Cheville and Ms. Bradt. Learn more about how to prevent and manage leg lymphedema at www.cancer.net/lymphedema. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

Dr. Susan Maltser is Director of Cancer Rehabilitation and oversees the comprehensive Cancer Rehabilitation program for Northwell health. She is a practicing physiatrist and an assistant professor of Physical Medicine and Rehabilitation at Zucker School of Medicine. She also serves as Chief, Physical Medicine and Rehabilitation at Long Island Jewish Hospital. A graduate of the New York College of Osteopathic medicine, her residency in Physical Medicine and Rehabilitation was completed at the Rusk Institute at NYU Langone Medical Center. She is a fellow of the American Board of Physical Medicine and Rehabilitation, and holds membership in both the American Academy of Physical Medicine and Rehabilitation and the National Cancer Rehabilitation Physician Consortium. This interview is a two-part series. In Part 2, Dr. Maltser discusses: the extent of post-surgical care aimed at social and emotional functions; from the perspective of patient-reported outcomes, steps taken to identify the felt needs of patients in conjunction with the needs identified by the health care team; whether demographic factors, such as age influence whether a woman wants to remain in the labor force and what can be done to assist women in this aspect of their lives; the degree to which sexual function affected by breast cancer treatment is discussed with patients; whether older women who undergo treatment for breast cancer are vulnerable to experiencing a balance problem that increases the risk of falling; if technological approaches, such as the development of wearable sensors and cloud-based apps are being used after patients leave the clinical setting to enable them to provide daily feedback on their condition and successes they are experiencing in self-care; and areas where improvements in diagnostic measures and rehabilitation treatment would be warranted.

Dr. Susan Maltser is Director of Cancer Rehabilitation and oversees the comprehensive Cancer Rehabilitation program for Northwell health. She is a practicing physiatrist and an assistant professor of Physical Medicine and Rehabilitation at Zucker School of Medicine. She also serves as Chief, Physical Medicine and Rehabilitation at Long Island Jewish Hospital. A graduate of the New York College of Osteopathic medicine, her residency in Physical Medicine and Rehabilitation was completed at the Rusk Institute at NYU Langone Medical Center. She is a fellow of the American Board of Physical Medicine and Rehabilitation, and holds membership in both the American Academy of Physical Medicine and Rehabilitation and the National Cancer Rehabilitation Physician Consortium. This interview is a two-part series. In Part 1, Dr. Maltser discusses:  what cancer rehabilitation is and some conditions that commonly are treated in breast cancer patients; measures employed to assess patients who have undergone breast surgery regarding the scope of rehabilitation interventions to pursue; the adverse effect of reconstructive surgery for breast cancer on shoulder function and the kinds of rehabilitation that prove effective in dealing with this problem; debilitating side effects, such as difficulty sleeping and fatigue, associated with breast cancer surgery; the risk of developing lymphedema after undergoing surgery for breast cancer; the role of self-care in treating lymphedema; and the role that physical exercise might play and when it should occur pre- and post-surgery.

With advances in early detection, treatment and support, more women than ever are surviving breast cancer.  On today’s Around Atlanta episode, Rebecca Cowens-Alvarado, Executive Director at Turning Point Breast Cancer Rehabilitation joins the show to tell listeners about the numerous ways the nonprofit promotes recovery from breast cancer year-round through services, education, and overall compassion. […] The post TurningPoint Breast Cancer Rehabilitation Provides a Sense of Community appeared first on Atlanta Real Estate Forum.

With advances in early detection, treatment and support, more women than ever are surviving breast cancer.  On today's Around Atlanta episode, Rebecca Cowens-Alvarado, Executive Director at Turning Point Breast Cancer Rehabilitation joins the show to tell listeners about the numerous ways the nonprofit promotes recovery from breast cancer year-round through services, education, and overall compassion. Cowens-Alvarado holds a Master of Public Health with a focus in Epidemiology and Biostatistics from the University of Oklahoma Health Sciences Center. She began her public health career as a Chronic Disease Epidemiologist, responsible for analyzing data for the breast and cervical cancer early detection program. In her various roles with American Cancer Society (ACS), including Vice President of Health Systems, she led regional and national initiatives to improve cancer prevention, increase cancer screening and enhance access to cancer treatment. TurningPoint Breast Cancer Rehabilitation provides specialized and evidence-based rehabilitation for women and men with breast cancer, including physical therapy, exercise consulting, massage therapy, counseling and nutritional counseling and lymphedema detection, education and management. TurningPoint is unlike any clinic in the Southeast, and there are very few in the nation that focuses on the need for rehabilitation and physical therapy after breast cancer. Services at TurningPoint range from physical therapy and exercise to counseling, education, massage therapy and nutrition. “Patients want to get back to their normal activities after being diagnosed with breast cancer or undergoing surgery,” explains Cowens-Alvarado. “But, side effects from treatment can sometimes hold them back. Chemotherapy, radiation therapy, and surgery can all affect the upper body and cause nerve damage, swelling, and soreness.” The three most common issues patients face after breast cancer treatment are neuropathy, lymphedema, and stiff, weak tissue. Breast cancer rehabilitation can help resolve or manage these types of symptoms. TurningPoint Breast Cancer Rehabilitation will be celebrating its 15th anniversary September 2019. Since opening the doors, the clinic has seen roughly 4,500 patients ranging from newly diagnosed to post-surgery. Most clientele are women, but they also see men who have the disease. The rehabilitation center began as a small clinic with one therapist, today nine physical therapists are onsite and many referrals come in weekly. “Our growing team means that we can see more patients,” states Cowens-Alvarado. “We expect to see more than 800 patients in 2019.” Mandy services at TurningPoint are made possible by critical supporting events such as the annual Pink Affair. Taking place March 23, at Grand Hyatt Atlanta in Buckhead, the Pink Affair will feature a live and silent auction, dinner and dancing all with a Jazz 1920's theme. “We rely on events like this,” states Cowens-Alvarado, “Proceeds from The Pink Affair directly benefit TurningPoint's delivery of reduced-fee and complimentary services, community education and healthcare provider education.” Tune into the podcast with the link above to hear a more in-depth description of services offered at TurningPoint. Visit www.myturningpoint.org for tickets to Pink Affair and more upcoming events. ______________________________________________________ A special thank you to Jackson EMC for sponsoring Atlanta Real Estate Forum Radio.  Jackson EMC offers homebuyers peace of mind and lower bills with its certified Right Choice™ new home program.  These homes are built to be energy efficient and sustainable with improved indoor air quality, convenience and comfort. For more information on Right Choice new homes and Jackson EMC, visit https://RightChoice.JacksonEMC.com. _____________________________________________________ Please subscribe to Atlanta Real Estate Forum Radio on iTunes. If you like this week's show,

In a round table discussion, Kessler Foundation’s communication manager, CarolAnn Murphy talked with Kessler’s experts in the field exploring optimal ways to treat the most common breast cancer symptoms – fatigue and weakness. This team is studying new approaches to the problem of cancer-related weakness in women who have been treated for breast cancer.  Round table panel: Host: CarolAnn Murphy, PA, Communications Manager, Kessler Foundation Dr. Michael Stubblefield, Cancer Rehabilitation Specialists (https://www.kessler-rehab.com/patient-center/staff/DoctorDetails.aspx?ID=65), Kessler Institute for Rehabilitation Dr. Ashish Khanna, Cancer Rehabilitation Specialists, Kessler Institute for Rehabilitation Tiffany Kendig, PT, Cancer Rehabilitation Specialists, Kessler Institute for Rehabilitation Dr. Guang Yue, Director, Human Performance Engineering, Kessler Foundation Dr. Didier Allexandre (http://kesslerfoundation.org/aboutus/Allexandre%20Didier), Engineer, Kessler Foundation Chaya Lebovic, Research Assistant, Kessler Foundation Angela Smith, Participant This podcast was produced and edited by Joan Banks-Smith, Creative Producer for Kessler Foundation on January 30, 2018 at Kessler Foundation, West Orange, NJ For more information about our breast cancer studies, go to http://kesslerfoundation.org/breastcancer To join our research studies, go http://www.kesslerfoundation.org/joinourresearchstudies.php

In this podcast series, episode 2 of “Topics in Breast Cancer Rehabilitation”, Dr. Ashish Khanna presented “Cancer Related Fatigue” to the staff at Kessler Foundation on February 8, 2018. Dr. Khanna is a cancer rehabilitation attending physician at Kessler Institute for Rehabilitation in West Orange, NJ Dr. Khanna completed his residency in Physical Medicine and Rehabilitation at the Kingsbrook Jewish Rehabilitation Institute in Brooklyn, NY, where he became interested in cancer rehabilitation early on. He presented several posters and lectures during his time as a resident and was actively involved in attaining CARF certification in Cancer for his hospital, the first in the Northeast United States to achieve this certification. He was a Cancer Rehabilitation Fellow at Medstar Georgetown University/National Rehabilitation Hospital in Washington, DC. This podcast was produced and edited by Joan Banks-Smith, Creative Producer for Kessler Foundation on February 8th, 2018 at Kessler Foundation, West Orange, NJ For more information about our breast cancer studies, go to http://kesslerfoundation.org/breastcancer To join our research studies, go http://www.kesslerfoundation.org/joinourresearchstudies.php

In this podcast series, episode 3 of “Topics in Breast Cancer Rehabilitation” Dr. Didier Allexandre was interviewed about the ongoing breast cancer study that examines the effect of exercise training on breast cancer related symptoms of weakness and fatigue. Dr. Allexandre is a Research Scientist at Kessler Foundation. This podcast was produced and edited by Joan Banks-Smith, Creative Producer for Kessler Foundation on January 18, 2018 at Kessler Foundation, West Orange, NJ For more information about our breast cancer studies, go to http://kesslerfoundation.org/breastcancer or call 973-243-6812 To join our research studies, go http://www.kesslerfoundation.org/joinourresearchstudies.php ===================================== Short Bio Dr. Allexandre joined the Human Performance Engineering Lab at Kessler Foundation as a Research Scientist in 2012. After completing his engineering undergraduate degree in France, he received his M.A.Sc. in Electrical Engineering at the University of Bristish Columbia, Vancouver, Canada. After working for General Electric in X-Ray Vascular Imaging, he went on to pursue his Ph.D. in Biomedical Engineering at Case Western Reserve University, Cleveland, OH, from whom he graduated in 2005. Before coming to Kessler Foundation, Dr. Allexandre was a post-doctoral fellow in the department of Biomedical Engineering and Center of Integrative Medicine and Wellness Institute at the Cleveland Clinic, Cleveland, OH. His main background and expertise are in biomedical modeling, signal processing, neuroimaging and cardiac, muscle and brain electrophysiology. For Dr. Allexandre Kessler Foundation bio, go to http://kesslerfoundation.org/aboutus/Allexandre%20Didier

Dr. Gabriel Lopez from MD Anderson discusses the details behind integrative medicine for cancer care.

Our faculty member, Carolina Gutierrez, discusses why she chose a career in Cancer Rehabilitation and what makes this such an exciting and rewarding field.

Dr. Jack Fu speaks about the rehabilitation of cancer patients.

While cancer is still a scary word, roughly 75% of people diagnosed with cancer will survive long-term. But how are these patients supported in the long term, as they deal with late side effects from their treatments? Join Kat and Melissa as they sit down with Dr. Jennifer Jones, Director of the Cancer Rehabilitation & Survivorship Program and Senior Scientist at the Princess Margaret Cancer Centre, to discuss the importance of caring for patients throughout the entire disease process, how she developed an integrated clinical and research survivorship program, and the 3 focus areas of her research (i.e., descriptive, intervention development, knowledge translation). Eryn chats with Lloyd Davidson, a Hodgkin’s lymphoma survivor, who chronicles his cancer journey and his experience with the survivorship program. Until next time, keep it raw!

While cancer is still a scary word, roughly 75% of people diagnosed with cancer will survive long-term. But how are these patients supported in the long term, as they deal with late side effects from their treatments? Join Kat and Melissa as they sit down with Dr. Jennifer Jones, Director of the Cancer Rehabilitation & Survivorship Program and Senior Scientist at the Princess Margaret Cancer Centre, to discuss the importance of caring for patients throughout the entire disease process, how she developed an integrated clinical and research survivorship program, and the 3 focus areas of her research (i.e., descriptive, intervention development, knowledge translation). Eryn chats with Lloyd Davidson, a Hodgkin’s lymphoma survivor, who chronicles his cancer journey and his experience with the survivorship program. Until next time, keep it raw!

Today's guest, Dr. Mously Le Blanc graduated with a degree in Psychology from the University of Pittsburgh.  She received her medical degree from the University of Pennsylvania and completed her residency training in Physical Medicine and Rehabilitation at Columbia and Cornell University Hospitals. She serves as the Director of Cancer Rehabilitation at the University of Pennsylvania. In addition to her academic career, she is a certified relationship coach and Founder of Healing Hearts Relationship Coaching.  In this realm, she is fondly referred to as Dr. Mo Love Doctor. She works with professional women to empower them to make personal changes and embrace self-love to transform their relationships into fun and passionate marriages.  Her unique approach addresses the emotional, behavioral and physiological aspects of making a relationship work.  Furthermore, as a certified Laura Doyle coach, she incorporates the Six Intimacy Skills to teach women how to build loving bridges within their marriages.  Her personal mission is to save families by avoiding divorce and helping women find happiness within themselves.  Her soon to be published book, “Year of Love”, provides inspirational love tips and fun date ideas to rekindle the love back into your marriage. We talk about: How to find Happiness and Love within Yourself How we see the fault in others before we see the fault in ourselves How coaching is for anyone who wants to make themselves a priority When you make YOURSELF the priority everything else seems to fall into line How Coach/Client relationship works Dr. Mously shares 4 tips to help rekindle the spark in your relationship: L Live, love & laugh in the present Happiness is only experienced in the present tense. Find your joy daily. O Open your heart to forgiveness Self-forgiveness allows us to be imperfect, to refrain from expecting perfection from our loved ones, to focus our hearts on gratitude and gives us the courage to ask for help. V Vulnerably love Intimacy is only experienced in measure to the degree we allow ourselves to be vulnerable. Otherwise, we numb all of our emotions (including joy) and we live a shell of the life we could be experiencing. Choose to live a vibrant life. E Emotional acceptance Allow emotions to be fully experienced without self-judgement or suppression. Suppressed emotions sabotage love. Once we acknowledge our feelings then we have control over them.   Thank you for listening to the Hippocratic Hustle! I know that time is your most valuable resource so I really appreciate you spending some of it with me. If you enjoyed today's show, please share it! If you'd like to help me improve and grow the podcast, send your suggestions to Carrie@HippocraticHustle.com Lastly, don't forget to subscribe to the podcast, so you won't miss an episode!

The current healthcare climate has created an uncertainty for many physical therapists and other health care professionals.  Dr. Kenneth L. Miller, PT, DPT, MA, GCS, CEEAA  recently shared his thoughts on physical therapy, home health care and potential impact of proposed legislation on your clinic. Dr. Miller is a physical therapist and educator with more [...]

Patricia is a PhD researcher at Waterford Institute of Technology in Ireland. Patricia is finishing up her dissertation, where she looked at a physical activity program to improve symptoms of cancer-related fatigue.   In this episode, we focus on cancer-related fatigue, what it is, how it’s different from regular tiredness and how it can affect different people. We chat about Patrica’s dissertation work and how physical activity can improve fatigue. We also chat about the state of cancer rehabilitation in Ireland and what services are out there for cancer patients/survivors.   You can find Patricia on twitter @FERNTRI or through email at patricia.sheehan@postgrad.wit.ie   You can also find the MedEx program in Waterford here: https://www.wit.ie/schools/health_sciences/medexwit.   Find me on twitter at @CiaranFairman or go to reachbeyondcancer.com to find out more about what we do.   This episode doesn’t have an intro, I came down with a devastating case of the man-flu over the weekend, so I’m not able to speak to put one up. This episode is sponsored by Lampstrong.com. The LampStrong Foundation is a non-profit organization founded by Major League Soccer Goalkeeper and Stage Four Hodgkin Lymphoma Survivor Matt Lampson. The mission of The LampStrong Foundation is to provide difference-making financial, emotional and motivational support to cancer patients and families in all the stages of cancer treatment and recovery as well as to fund proven cancer researchers. For more information and regular updates on the LampStrong Foundation follow the LampStrong Foundation on Facebook or visit LampStrong.com.       1.00 – What is Cancer Related Fatigue, what are the symptoms, how long does it last, what causes it etc.   5.00 – Where should exercise advice for cancer patients/survivors come from?   7.00 – Different dimensions of cancer-related fatigue, whether its emotional, cognitive or physical fatigue, and how those patterns fluctuate during treatment.   11.29 – The transition from active treatment to survivorship and how patients/survivors can feel lost and isolated.   15.35 – Patricia’s study looking at physical activity and cancer-related fatigue.   28.45 – Fit and active cancer patients – dealing with exercise tolerance going down.   36.00 – Turning her research into a public service program at Waterford Institute of Technology.   44.00 – State of cancer rehab in Ireland. Where the field is and what is available for patients/survivors.   51.00 – The influence of policy on establishing exercise oncology as a standard of care. 

At the Voice of the Patient, we are dedicated to enhancing our ability as health care providers to truly listen to others and to establish a therapeutic alliance. In some cases, we can benefit from listening to the experience and mindset of other providers, such as Dr. Emil Berengut.  Dr. Berengut is the Outpatient Therapy Supervisor at a tertiary cancer center in New York City, where he specializes in Cancer Rehabilitation. Dr. Berengut received his Master of Social Work from the University Of Maryland School Of Social Work and his Doctorate of Physical Therapy from New York University (NYU). After NYU, he completed the Hospital for Special Surgery Orthopedic Physical Therapy Residency program and became Board Certified in Orthopaedic Physical Therapy. Dr. Berengut co-authored a monograph on Osteoarthritis for the Orthopedic Section of the APTA and serves as a manuscript reviewer for Supportive Care in Cancer. He has presented nationally on Cancer Rehabilitation and Orthopedics for the American Congress of Rehabilitation Medicine, the APTA Combined Sections Meeting and the MSKCC Annual Cancer Rehabilitation Symposium. He has also lectured on Orthopedic Rehabilitation and Psychosocial Interventions at the NYU and Hunter College DPT programs. Currently he serves as a mentor for an Oncology Physical Therapy Residency Program. Dr. Berengut and I discuss his journey as a health care provider, including the transition from social work to physical therapy. We also talk about the role of rehabilitation providers in oncology and the biopsychosocial model. Dr. Berengut also offers valuable advice for students and new graduates in health professions.  Follow Dr. Berengut on Twitter and follow him on Medium.  If you have a story to tell as a patient, provider, or both, then contact Zach Stearns on Twitter @zachrstearns. ---------- *Find more helpful podcasts & blog posts at http://TheVoiceOfThePatient.org *Check out the other podcasts in the Senior Rehab Project at http://SeniorRehabProject.com  

Norris Cotton Cancer Center Grand Rounds - Kathleen D. Lyons, ScD

Career Opportunities in PM&R: Cancer Rehabilitation Fellowship by Physiatry News

There is life after cancer. Learn about cancer rehab and how to live a healthy life after treatment is complete. What kind of rehabilitation may be helpful after having cancer? Is it possible to feel like your old self again after treatment? How can you get help for cognitive issues like “chemo brain”? Joining Kim Thiboldeaux to explore the answers to these questions is Jeanne Simard, a registered nurse with a clinical background in cancer rehabilitation and critical care. She is the corporate vice president of Oncology Rehab Partners, the developer of the STAR (Survivorship Training and Rehab) Program, a model of comprehensive cancer rehabilitation that is being implemented by hospitals, cancer centers and private rehabilitation practices in over 40 states. For more information on the STAR Program, please visit www.OncologyRehabPartners.com

There is life after cancer. Learn about cancer rehab and how to live a healthy life after treatment is complete. What kind of rehabilitation may be helpful after having cancer? Is it possible to feel like your old self again after treatment? How can you get help for cognitive issues like “chemo brain”? Joining Kim Thiboldeaux to explore the answers to these questions is Jeanne Simard, a registered nurse with a clinical background in cancer rehabilitation and critical care. She is the corporate vice president of Oncology Rehab Partners, the developer of the STAR (Survivorship Training and Rehab) Program, a model of comprehensive cancer rehabilitation that is being implemented by hospitals, cancer centers and private rehabilitation practices in over 40 states. For more information on the STAR Program, please visit www.OncologyRehabPartners.com