Date Presented 04/04/19
Cancer care and oncology is an emerging area of practice in OT. It is imperative to compare current practice trends to the literature that supports evidence-based OT interventions in order to maximize therapeutic outcomes for cancer survivors. Results from this survey research aim to describe how OT practitioners are addressing side effects of survivorship within intervention and compare these practice trends to a systematic review of the literature.
Primary Author and Speaker: Katie Polo
Additional Authors and Speakers: Meghan Harkness
Kelsey Badger, Jennifer Lynn, Addie Jacobs, Elizabeth Mathews
PURPOSE: The number of cancer survivors in the United States is expected to increase to 20.3 million cancer survivors by 2026 (National Cancer Institute, 2018), and AOTA has deemed cancer care and oncology an emerging practice area. While there has been a systematic review on the effectiveness of cancer rehabilitation interventions within the scope of OT practice (Hunter, Gibson, Arbesman, D’Amico, 2017a; Hunter Gibson, Arbesman, D’Amico, 2017b), there is a paucity of literature showing current practice trends in cancer survivorship and oncology. This study aims to describe how OT practitioners are addressing the side effects of survivorship and compare findings to this systematic literature review.
DESIGN: This study utilized survey methodology, expert review of the preliminary questionnaire, pilot and pivotal phases. Inclusion criteria required participants to be english speaking occupational therapy practitioners, who worked with adult (18+) cancer survivors. No exclusion criteria was indicated. The pivotal phase of this study used non-probability purposive sampling to recruit participants.
METHODS: Based on a literature review of side effects in cancer survivorship a 19-item questionnaire was developed. Due to a lack of established psychometric properties of the survey, five expert reviewers and 11 participants for the pilot study were utilized from various practice settings to correct technical issues with the survey and establish content validity. The pivotal phase included a 25-item questionnaire collecting data on demographics and current practice trends relating to interventions for side effects of cancer including pain, neuropathy, fatigue, psychosocial issues, cognitive impairment, lymphedema, and sexual dysfunction. An online survey platform was used to collect and analyze data using descriptive statistics.
RESULTS: 267 surveys were sent to potential participants, 70 surveys were returned (26.20% response rate). Respondents reported addressing occupational performance deficits in dressing, functional mobility, bathing/showering, personal hygiene/grooming, leisure, and health management and maintenance most often in practice with cancer survivors. However, respondents reported minimally addressing sexual activity, return to work, shopping, driving and community mobility, or financial management even though literature suggests these occupations can be impacted by side effects of cancer or its medical treatment.
The primary intervention approach reported when addressing pain was education (18.21%, f=59) while the main intervention for addressing fatigue was energy conservation (21.10%, f=65). Respondents addressing neuropathy reported using compensatory and adaptive strategies (46.55%, f=54) most often during treatment. Cognitive impairment was reported to be addressed primarily through compensatory strategies (36.08%, f=57). Respondents treating lymphedema in practice mainly utilized exercise regimens (19.75%, f=32).
CONCLUSION: Participants’ responses of commonly used interventions for pain, fatigue and neuropathy align with current evidence. Cognitive impairment has been found to impact instrumental activities of daily living such as bill pay, yet the occupation of financial management was infrequently identified by respondents as being addressed in practice. For the use of exercise in treating lymphedema, occupational therapy practitioners are likely using evidence-based practice to guide their clinical reasoning. Findings of this study suggest that continued research is necessary to identify the reasons why practitioners often are not addressing sexual dysfunction, return to work, and financial management in order to address this gap in OT service provision within this emerging practice area.
References
Hunter, E. G., Gibson, R. W., Arbesman, M., & D’Amico, M. (2017). Systematic review of occupational therapy and adult cancer rehabilitation: Part 1. Impact of physical activity and symptom management interventions. American Journal of Occupational Therapy, 71(2), 7102100030p1-7102100030p11.
Hunter, E.G., Gibson, R.W., Arbesman, M., & D’Amico, M. (2017). Centennial Topics-Systematic review of occupational therapy and adult cancer rehabilitation: Part 2. Impact of multidisciplinary rehabilitation and psychosocial, sexuality, and return-to-work interventions. American Journal of Occupational Therapy, 71, 7102100040. https://doi.org/10.5014/ajot.2017.023572
National Cancer Institute. (2018). Cancer statistics. Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics.
