Oncology Specialization

Transcription

Appendix VI: Definition of the proposed specialty area and minimum criteria
Specialists in oncologic physical therapists are to be designated as ONCS, which stands for
Oncologic Certified Specialist.
The oncologic clinical specialist has demonstrated advanced knowledge and skills in foundational
science, behavioral science, clinical science, client management, practice management, and clinical
research in the area of oncologic physical therapy. Oncologic physical therapy is delivered across the
lifespan and full continuum of cancer care including prevention and survivor care (restorative
interventions, supportive interventions, palliative interventions and end of life care). The oncologic
clinical specialist is qualified to provide leadership and consultancy in oncologic rehabilitation.
Minimum criteria to become ONCS are as follows:
Applicants must be licensed physical therapists and submit fees as determined by ABPTS.
In addition, Applicants must meet requirements for Option A or Option B.
Option A:
Applicants must submit evidence of 2,000 hours of direct patient care in the specialty area
within the last ten (10) years, 25% (500) of which must have occurred within the last three (3)
years. Applicants must also submit (1) one case reflection demonstrating specialty practice in
oncologic physical therapy across the lifespan, e.g . pediatric, adult or geriatric. This case study
must be based on a patient/client seen within the last three (3) years.
Option B:
Applicants must submit evidence of successful completion of an APTA-credentialed post
professional clinical residency in oncologic physical therapy. Applicants who are currently
enrolled in APTA-credentialed clinical residencies may apply for the specialist certification
examination in the appropriate specialty area prior to completion of the clinical residency.
These applicants will be conditionally approved to sit for the examination, as long as they meet
all other eligibility requirements, pending submission of evidence of successful completion of
the APTA-credentialed clinical residency to APTA’s Specialists Certification Program.
Applicants applying under Option B must also submit one case study demonstrating specialty
practice in oncologic physical therapy across the lifespan, e.g . pediatric, adult or geriatric. This
case study must be based on a patient/client seen within the last three (3) years.
ABPTS Review:
1.2 Estimate number of physical therapist positions that physical therapists with the
specialized training and knowledge currently fill and estimate those positions that are
vacant
Decision: Did Not Adequately Meet Requirement
Apart from statements like ‘the need for oncology trained physical therapists is reasonably
obvious’ there was not an estimate of positions that were vacant. Estimates noted seem to be
based solely on positions within a limited number of NCI Centers, and it is not clear that these
numbers alone demonstrate a demand that should and will be met by ABPTS specialization. In
summary, the information provided is vague with generalities. Additional data is requested.
1.3 Estimate number of filled and unfilled positions in each of the past three years to
demonstrate a sustained or increased demand for physical therapists with specialized
Criterion #1:
knowledge
andDEMAND
training.
ABPTS has similar concerns for criterion 1.3 as were noted in criterion 1.2. More specific
numbers are requested. The narrative provides an expected increase in demand, but does not
provide much in terms of specifics of demand apart from population growth (and increased life
expectancy). Information contained within this section seems to support the area of need much
more so than demand. In addition, competency information noted within this section does not
appear to address a level of advanced practice or specialization.
REVISED SECTIONS:
1.2 Include estimates of the number of physical therapist positions that physical therapists
with the specialized training and knowledge currently fill and those that are vacant. Identify
these positions by types (e.g., academic, hospital, private practice, managed health care).
Describe how these estimates were determined.
Estimates of positions currently filled
To generate estimates of numbers of current physical therapists with oncology training and
experience, it is necessary to extrapolate from limited data. In the field of epidemiology, when
directly measured data are not available, a standard methodology is to calculate expected rates
based on related robust data that is available. The American Physical Therapy Association has
published robust data on its membership rate as compared to the total number of physical
therapists in practice in their 2011 APTA Membership Development Plan. The APTA document
1
“A Model to Project the Supply and Demand of Physical Therapists 2010-2020” utilized data
from the Federation of State Boards of Physical Therapy to estimate the current number of
physical therapists at 182,000.1 While no direct population data exist on how many oncologic
physical therapists are in practice in the United States, we postulate that the Section on
Oncology membership and classification of primary clinical focus at the time of APTA
membership renewals serve as surrogates of PTs filling positions requiring oncologic knowledge
and training. The percentage of these persons within the APTA should parallel that of the
general population of physical therapists. We used this methodology to estimate the number of
physical therapist positions requiring oncologic knowledge and training that are currently filled
in the U.S.
APTA PT membership
-Number reporting oncology as primary clinical focus
-Number of Oncology Section members reporting
oncology as primary clinical focus
59,552
2,065 (3.5%)
165
Total number of APTA PT membership
reporting oncology as primary clinical focus
after removing duplicates from Section membership
Number of Oncology Section PT members
Total number of PTs with oncologic knowledge and training
within APTA PT membership
1,900
Estimate of current number of PT positions filled
requiring oncologic knowledge and training
within the U.S. (based on 182,000 PTs)
Facility/Setting
Acute care hospital
Health system or hospital-based outpatient
facility or clinic
Private outpatient office or group practice
Skilled Nursing Facility (SNF)/Long Term Care
Patient's home/home care
School system (preschool/primary/secondary)
974
2,874 (4.8%)
8,736 (4.8%)
2010
%
11.4
20.9
Estimated PT positions filled
specific to Oncology
996
1826
33.6
5.1
6.8
3.6
2935
446
594
314
2
Academic institution (post-secondary)
Health and wellness facility
Research center
Industry
Inpatient Rehab Facility (IRF)
Other (please specify)
9.6
0.5
0.2
0.5
3.0
4.7
839
47
17
44
262
4144
Estimates of positions vacant
The Bureau of Labor Statistics(BLS) describes a nationwide shortage of physical therapists.2 The
demand for physical therapists is expected to spike upward by 30% between 2008 and 2018--a
much quicker rate than average. The BLS reports that there were approximately 198,600
physical therapy jobs in the US in 2010 (the most recent data available) and that number is
expected to rise by 39% to 276,000 in 2020. Although data does not exist specifically for
oncologic physical therapy, SEER data indicates that over 12 million cancer survivors were alive
as of 2010, and over 1.6 million new cases of cancer are expected to be diagnosed in 2012
across all age groups.3 The National Cancer Institute (NCI) lists 53 major cancer centers across
the United States, but there are many major cancer centers that have developed outside the
NCI umbrella.4 Approximately 2/3 of them provide physical therapy service on-site. Over 1500
cancer centers of various types are accredited by the American College of Surgeons Commission
on Cancer, and current accreditation standards state that such programs must have a policy or
procedure that “ensures access to rehabilitation services…either on-site or by referral.”5 It is
clear that demand for physical therapists with advanced training and board certification in
oncology is present and will increase in all practice settings given these requirements, and given
the fact that cancer survivorship is steadily increasing .
In the original petition we reported that based on a telephone survey of the Directors of
3
Rehabilitation in 10 NCI cancer centers, we identified 133 positions among the 10 centers and
only 2 vacancies in one center at the time of the study. These telephone surveys were
conducted in May 2011, specifically for the purpose of informing this document. The program
directors were representative of a variety of practices and geographical areas across the
country. Directors were asked about added positions over the three years immediately prior to
the date of phone survey and about vacant positions in their clinics across that same time
period. This was a cross sectional sample of course, so that those data represented vacancies
existing at that moment in time only; the data did not reflect vacancies that had occurred and
been filled over the past year. We did also reported that the among the 10 centers 38.5
positions had been added for oncology over the previous 2 years, thus there were over that
time period 38.5 vacancies due to newly added positions (plus an unknown number of
vacancies related to normal forces of staff attrition) and all but two of those had been filled. In
addition all of the NCI cancer surveys surveyed had plans to add new positions in the next 1-3
years, ranging from 1 to 8 positions.
In using vacancy rates to measure demand, it is important to remember competing
interpretations of vacancy rates. There is a general shortage of physical therapists, thus
physical therapists often have a choice which job they may choose to accept. All of the NCI
centers surveyed in 2011 were actively growing in number of therapists and updated data as of
August 2013 show that those centers not only added the planned positions, they continue to
plan new growth. Their growth is occurring in response to increased demand on their services
as evidenced by increasing referral numbers and increasing PT service counts. In conclusion,
based on our methodology from Section 1.2, we estimated that 4.8% of the PT practice is filled
4
by physical therapists with oncologic knowledge and training. Therefore, it is reasonable to
assume that a similar percentage of PT shortages based on APTA workforce reports.
2013 PT supply
2013 PT demand
182,000 general positions
2013 PT Shortage
2013 PT Content-specific shortage
(based on 4.8%)
960 oncologic positions
A more conservative estimate can be extrapolated from APTA documents. The APTA
Workforce data documented in 2010 that a 10% vacancy rate existed for acute care settings. Of
the 703 respondents, over 60% reported at least one vacancy at their facility.6 Outpatient
private practice settings (n=1234) reported an average vacancy rate of 1.35 positions for PTs
per facility. The mean number of full-time physical therapist vacancies in skilled nursing
facilities was 1.2 based on 481 responses. We utilized these numbers to estimate total
vacancies and then calculated oncologic PT vacancies based on a 4.8% representation per our
previous calculations. Even with the small sample size which is normal with survey data, we
were able to estimate 128 vacancies for PTs with oncologic training and knowledge.
Using data from American Hospital Association, we identified 5,724 registered hospitals
in the US.7 The Centers for Disease Control and Prevention reported 16,100 nursing homes in
the U.S. based on 2004 data.8 We understand the difference between skilled nursing facilities
versus nursing homes, but this was the most current data located by the Section. We were
unable to identify an estimate of the total number of private practice outpatient clinics in the
U.S. We used these numbers to further expand our projections based on growth potential.
5
Facility/Setting
Reported
vacancy/facility
# of
responses
Estimated
PT
vacancies
Acute care
hospital
1
703
703
Private outpatient
office or group
practice
Skilled Nursing
Facility
(SNF)/Long Term
Care
1.35
1234
1,666
Estimated PT oncologic
positions vacancies
Based on
Based on
APTA
public
Workforce
source
Data
data7, 8
19
5,724 all
avail
275 ONC
positions
80
N/A
1.2
481
578
28
2,418
2,947
127
Total
19,320ALL
available
927 PT
ONC
positions
25,044 all
1202 ONC
1.3 Include estimates of the number of filled and unfilled positions in each of the past three
(3) years to demonstrate a sustained or increased demand for physical therapists with
specialized knowledge and training. Describe how these estimates were determined.
Documented Vacancies in Ten NCI Cancer Centers
The telephone survey of ten NCI cancer center physical therapy directors provided data specific
to oncology to inform the process of generalizing predictions from the workforce study. Most
NCI cancer centers have more than one cancer-related service area including both acute care
and outpatient services. A total of 133 physical therapy positions existed in these NCI major
cancer centers at the time of the survey, and this number was expected to increase because
these centers also reported significant growth plans, as noted below. Among the NCI centers
surveyed, the number of current physical therapist positions ranged from two to 51, and the
vacancy rate was low at the time of the survey, with only one of the ten centers reporting two
6
current vacancies.
Vacancies in the relatively young practice area of oncology rehabilitation are
demonstrably occurring in major cancer centers as a result of growth in response to increasing
numbers of cancer survivors with need for services, and increasing awareness among referral
sources regarding the benefits of rehabilitation for these patients. Nine of the ten NCI major
cancer centers surveyed by telephone had added therapist positions over the past three years,
ranging from 1 position to 18 positions for a total of 38.5 positions added across the 10
facilities; average number of positions added 3.8. Each of the ten NCI centers surveyed
reported plans to add at least one and as many as eight new therapy positions over the next
three years, depending on budget.
Using the APTA Workforce data6, we utilized supply as a surrogate of positions filled and
demand to represent not filled positions. We then extrapolated oncologic PT positions filled
and not filled based on the 4.8% representation calculated in Section 1.2.
** All sites
2010
Number of PT positions filled
176,000 180,000 180,000 182,000
Number of oncologic PT positions filled (based on
4.8% representation)
8,448
8,640
8,640
8,736
Number of PT positions not filled (based on demand)
19,000
18,000
18000
20000
864
864
960
Number of oncologic PT positions not filled (based on 912
4.8% representation)
2011
2012
2013
7
In the original petition we reported that based on a telephone survey of the Directors of
Rehabilitation in 10 NCI cancer centers, we identified 133 positions among the 10 centers and
only 2 vacancies in one center at the time of the study. This was a cross sectional sample of
course, so that those data represented vacancies existing at that moment in time only; the data
did not reflect vacancies that had occurred and been filled over the past year. We did also
reported that the among the 10 centers 38.5 positions had been added for oncology over the
previous 2 years, thus there were over that time period 38.5 vacancies due to newly added
positions (plus an unknown number of vacancies related to normal forces of staff attrition) and
all but two of those had been filled. In addition all of the NCI cancer surveys surveyed had plans
to add new positions in the next 1-3 years, ranging from 1 to 8 positions.
In using vacancy rates to measure demand, it is important to remember competing
interpretations of vacancy rates. There is a general shortage of physical therapists, thus physical
therapists often have a choice which job they may choose to accept. One very important
explanation for a high vacancy rate is low desirability of the job in question. Jobs stand open for
reasons of offering non-competitive pay, less desirable locations, poor management, and other
reasons. We submit that the growth trends in these centers as well as in other centers that we
now report on stand as evidence of demand for specialized therapists with advanced knowledge
and skills in oncology. All of the NCI centers surveyed in 2011 were actively growing in
number of therapists and updated data as of August 2013 show that those centers not only added
the planned positions, they continue to plan new growth. Their growth is occurring in response
to increased demand on their services as evidenced by increasing referral numbers and increasing
PT service counts.
8
1. APTA Membership Development Plan: 2011. In: Association APT, ed., 2011.
2. Statistics BoL. Bureau of Labor Statistics Occupational Outlook Handbook 2010.
3. Surveillance Epidemiology and End Results Fact Sheets, vol. August 2013: National
Cancer Institute, 2012.
4. National Comprehensive Cancer Network, vol. July 2013: National Cancer Institute,
2011.
5. Cancer Program Standards 2012: Ensuring Patient-Centered Care: American College
of Surgeons Commission on Cancer, 2012.
6. 2010 Physical Therapy Workforce Project: Physical Therapy Vacancy and Turnover
Rates in Acute Care Hospitals: American Physical Therapy Association, 2010.
7. Fast Facts on American Hospitals, vol. August 2013: American Hospital Association,
2013.
8. Fast Stats: Nursing Home Care: Centers for Disease Control, 2013.
9
ABPTS Feedback:
2.1 Identify specific public health and patient care needs that are not being met currently that physical therapists in the
proposed specialty area can meet effectively.
(Decision: Did Not Adequately Meet Requirement)
The need for specialized training when working with cancer patients/survivors was well made. The point that was not as clear
was
the ‘patient
needs that are not currently being met.” The narrative did demonstrate (with Healthy People Objective
Criterion
#2:care
Need
#C14) that this need was important, but it did not clearly demonstrate that the need was not being met. A more focused,
organized description of unmet needs (e.g., prevention / wellness of population, unique pre / post-surgical needs, etc) should be
provided. It would be helpful for the petitioner to explain why an advanced generalist would not have enough breadth of
knowledge or depth within that breadth to adequately care for patients with cancer.
REVISED SECTION
2.1 Identify specific public health and patient care needs that are not being met currently that physical
therapists in the proposed specialty area can meet effectively.
On December 2, 2010, the United States Department of Health and Human Services “unveiled Healthy
People 2020, the nation’s new ten-year goals and objectives for health promotion and disease
prevention.”1 Objectives listed in the Healthy People report are based on data from the National Health
Interview Survey, a robust population-based cross-sectional survey of the United States population
conducted by the Center for Disease Control since 1956.2 By definition, health and patient care
objectives listed in the Healthy People document are not currently being met to the intended standard
since the purpose of the Healthy People coalition is to improve health care and public health. Objectives
C13 and C14 relate to oncology care:
Healthy People Objective #C13: Increase the proportion of cancer survivors who are living five years or
longer after diagnosis.1 The baseline for this objective is a 66.2% five-year survival rate as of 2007; the
target rate is a 10% improvement, bringing the five-year survival rate to 72.8%.3
Healthy People Objective #C14: Increase the mental and physical health-related quality of life of cancer
survivors.1 This is considered a developmental objective, meaning that there are not previous data for
comparison of achievement of the objective.
1
These objectives illustrate a societal need for the physical therapist to participate in the care of
cancer survivors. Physical therapists are experts in movement and function and contribute directly to an
individual’s physical health. Cancer, the disease and its treatment, introduces unique needs among this
patient population that require a specialized level of knowledge and skill. Currently this need is not being
met by other health care providers and importantly, this need is not being met by other physical therapy
professionals. The oncology specialist will provide a unique skill set, different from other physical
therapy clinical specialists. In addition, the oncology specialist, by definition focused on this population,
can provide focused leadership to prioritize development of more effective services to meet the needs
of this population.
Needs across the Continuum of Cancer Care
The nature of cancer disease treatment lends itself to sequelae, both acute and late, that often persist
as chronic conditions. Examples include; fatigue, pain, lymphedema, gait and balance abnormalities, soft
tissue restriction and other contractures, limb loss or complex limb salvage, pelvic floor dysfunction,
cardiopulmonary impairments, and chemotherapy-induced peripheral neuropathy.4 Many patients
experience an aggregate burden of impairment that goes relatively unaddressed across the care
continuum. When cancer rehabilitation services are prescribed today, they tend to have a onedimensional focus rather than comprehensive assessment and treatment of needs. For example, in a
study of services offered by National Cancer Institute –designated comprehensive cancer centers, 70%
of centers had a lymphedema management program, but no comprehensive cancer rehabilitation
programs were reported.5 However, physical therapists with specialized knowledge in oncology are the
only professionals capable of addressing all of these issues comprehensively in an integrated
intervention.
2
The array of potential impairments related to cancer introduces multiple complexities in
examination and treatment that require the nuance of a specialized and highly knowledgeable physical
therapist. It is also the case that oncologic physical therapy takes place in a variety of settings that
include general hospital practice, private practice, home health, pediatric settings, rehabilitation centers,
skilled nursing facilities, hospice and palliative care settings, exercise facilities, academia and research
centers. Physical therapists are a common denominator present among all of these facilities.
Encouraging specialization in oncologic rehabilitation will serve to promote improved care to meet the
needs of this population as physical therapists pursue specialization.
A recent initiative; the Survivorship Training and Rehab (STAR) program has initiated efforts in this
regard. The STAR program provides facilities and individual clinicians with tools and systematic, proven
programs to deliver oncology rehabilitation care. Initiated in 2009 by Oncology Rehabilitation Partners,
LLC the STAR program purports to provide facilities and individual clinicians with hospitals, cancer
centers, group practices and individual clinicians and providers with “the training, protocols and other
tools needed to deliver evidence-based “best practices” cancer rehab services.”6 Institutions and
individuals who complete the training earn a STAR certificate. To date the STAR program has developed
cancer rehabilitation programs at over 300 hospitals nation-wide with over 5,000 clinicians participating
in oncologic rehabilitation programs.
Currently, Rhode Island, Massachusetts, and Connecticut have acknowledged STAR certification
as the standard for cancer rehabilitation care delivery. The growth of the STAR program supports our
claim of the increased demand and need for oncology rehabilitation programs and highly trained
providers. The STAR program focuses on workflow within organizations to support early identifications
of cancer related side effects and appropriate referrals. The program provides education and training
3
regarding rehabilitative interventions for physical, occupational, and speech therapies. The Oncology
Section has served as a resource for advanced training and education for STAR certified institutions and
clinicians. The oncologic specialty DSP will provide a more comprehensive guide specifically to the
practice of oncologic physical therapy. Providing these therapists with the opportunity to become
certified oncologic specialists through APTA will further solidify their relevance in the care continuum
and will serve to meet the needs of patients and survivors.
Care Delivery Model Inadequacies
Physical therapy is poorly integrated into the medical service delivery model for cancer care in hospitalbased settings and fragmented community-based care further exacerbates this problem pushing
rehabilitation further from mainstream patient care. Cancer care and rehabilitation care are
disconnected even in some institutions that have streamlined transition services and many community
cancer programs lack rehabilitation care altogether.7, 8 Oncologic physical therapy services are relevant
and necessary in primary, secondary and tertiary regards. There is a need to provide oncologic
rehabilitation services throughout the continuum of care from the aspects of; prevention and screening,
pre-operative assessment and prospective surveillance to identify pending impairments, provide
rehabilitative interventions during the course of cancer treatment, and to provide follow up care
through the post-disease treatment time frame including palliative care for those patients who’s disease
returns.
Pre-operative and prospective surveillance:
One emerging model of physical therapist practice that can serve to meet the needs of the cancer
population proactively is the Prospective Surveillance Model (PSM) for cancer rehabilitation. The PSM
has been championed by the American Cancer Society as it provides a strong evidence-based, proactive
4
framework for the physical therapist to interface with patient with cancer throughout the continuum of
care.9, 10 The relevance of this model to physical therapist practice is obvious; it improves the interface
with the cancer population and promotes proactive care. The American Physical Therapy Association
featured this model in its “Innovations in Practice” series.11
Comprehensive cancer rehabilitation using PSM can address pre-existing or treatment-related
comorbid conditions; Diabetes, cardiovascular disease, congestive heart failure, bone loss, adverse body
composition, and renal disease which are common in cancer survivors. These co-morbidities can have
significant impact on the patient’s tolerance to and response to cancer therapies. It is critical for the
oncologic clinical specialist to engage with the cancer population at the point of cancer diagnosis to
improve the patient’s quality of life and maintain function throughout the care continuum. (Figure 1)
Currently this model is emerging and is being implemented nation-wide, however reports from various
cancer centers who are seeking physical therapists to fill these roles site the difficulty that they have in
identifying a physical therapist who “feels comfortable treating patients with cancer”. This is a primary
reason that the oncologic specialty is needed in physical therapy.
Triage-based rehabilitation during cancer treatment
Throughout the course of cancer treatment patients may experience various medical
interventions including surgery, chemotherapy, and radiation therapy among other treatment. Each of
these modalities introduces potential for functional decline and impairment. During the course of
treatment referral to rehabilitation is not a standard of care and as a result, patients are suffering.
Rehabilitation for patients going through cancer treatment is a critical piece that must be embedded
into the current medical standards.4, 12 Physical therapists are experts at managing functional
impairments and have evidence-based mechanisms to promote recovery when impairments present.
5
Triage to rehabilitation services is lacking however in the traditional medical model. Patients frequently
report that they seek out care and have difficulty finding physical therapists who are expert in
understanding their cancer treatments and who are comfortable in treating their condition.13, 14 Even
physical therapists themselves, who are cancer survivors, note that their skill set did not prepare them
to deal with the functional impairments that they experienced during their cancer journey. They noted
that the side effects they experienced, although familiar to them as rehabilitation professionals (eg.
fatigue, scar tissue adhesion), were things that they and their colleagues were unfamiliar with treating in
the context of cancer.15 In focus groups these patient/therapists noted that they frequently sought out
care from physical therapists who were specialists in oncologic rehabilitation to address their
impairments.15 This speaks to the dearth in understanding that the generalist and, even the advanced
generalist, have in managing patients with common physical and functional impairments due to cancer
treatment. The impairments are familiar in the rehabilitation paradigm but cancer and its treatment
make managing those impairments different. For example; physical therapists are familiar with how to
manage balance deficits but there are specific nuances to balance deficits in the patient with cancer, in
fact, the etiology may be completely different requiring a nuanced intervention specific to the
chemotherapeutic culprit that brought on the deficit. (eg. ototoxicity vs. vestibular radiation damage vs.
peripheral neuropathy; each presents with different underlying mechanisms that impact gait and
balance and without knowledge of the chemotherapy agents and delivery mechanism and side effects of
radiation therapy and an understanding of the acute and late effects of such agents, the generalist
becomes paralyzed in treatment planning.)
The oncologic specialist can also intervene during the cancer care continuum providing selfmanagement skills and health promotion interventions to decrease the risk of additional late effects—
6
for example, the cardiac, pulmonary, endocrine, or bone complications of cancer treatment and may
even reduce the risk of second malignancies.16-22 A final benefit is the joint focus on optimizing
functional status and quality of life, preserving the ability to remain in the workforce and other life roles,
and maximizing health and longevity.23
Currently, in the continuum of cancer care, the physical therapist is marginalized for various
reasons: 1. In general therapists do not have the knowledge and skills that give them a level of
confidence in treating patients with cancer in their individual scope of practice and have not sought to
elevate their presence in cancer care. 2. There is a general lack of awareness among health care
providers that rehabilitation interventions are both safe and effective for patients with cancer. The latter
is demonstrated in several studies: Cheville et al found that in 163 women with metastatic breast
cancer, 92% had at least one physical impairment, with a total of 530 impairments identified overall; 484
of these impairments (91%) required a physical rehabilitation intervention and 469 (88%) required
physical and/or occupational therapy.24 Despite more than 90% of the participants needing cancer
rehabilitation services, fewer than 30% received this care.24
Thorsen et al evaluated 1325 survivors of the 10 most prevalent cancers and found that 63%
reported the need for at least one rehabilitation service, with physical therapy being the most frequently
reported need (43%).25 They also reported that patients were often not referred for services; 40% of the
participants reported unmet rehabilitation needs.
A study by Schmitz et al found that at least 60% of breast cancer survivors had one or more
treatment-related impairments at each checkpoint over a 6-year follow-up period.26 Cheville et al
evaluated the detection and treatment of functional problems in cancer survivors and concluded that
7
“Functional problems are prevalent among outpatients with cancer and are rarely documented by
oncology clinicians.”7
Not only does this evidence speak to the unmet needs of patient, it highlights the importance of
the role the physical therapist who is an oncologic specialist can play in improving care. Other health
care providers are not educated in impairment identification. Physical therapists are experts in
movement dysfunction and have evidence-based tools and interventions to ameliorate or mitigate many
of the aforementioned issues. Other health care providers are not educated to treat physical
impairments and their scope of practice is limited to providing general, often broad recommendations
towards activity and exercise and frequently there is not recognition of the need for therapeutic
interventions.12, 27, 28 Safety is a significant concern when prescribing exercise in the cancer population
and requires an advanced knowledge and understanding of the unique responses to exercise
prescription these patients will exhibit. The oncologic specialist is the provider with the greatest
knowledge base to appropriately screen, examine and recommend interventions for therapeutic
exercise as well as physical activity. Lack of appropriate screening or treatment may result in injury or
other medical complications.29, 30
8
Figure 1. APTA Innovations in Practice Prospective Surveillance Cancer Model11
Beyond Cancer Treatment: Survivorship
After patients complete their medical treatment for cancer, they are often followed in community-based
care programs typically by a primary care physician. The needs of the cancer survivor in a posttreatment setting are woefully unmet. In 2006, the Institute of Medicine in a seminal report titled “Lost
9
in Transition, From Cancer Patient to Survivor,” highlighted the unmet needs of cancer survivors with
regard to follow up and care.31 This need arises from the many long term side effects and potential late
effects that patients face long after cancer treatment is completed. The oncologic specialist can serve an
important role in meeting the needs of survivors. The specialist has an advanced understanding of the
side effects of cancer treatment that may be persistent or late in presentation and can serve as a critical
partner on the health care team to promote improved survivorship care. This also speaks to oncologic
specialists taking on advanced professional roles and responsibilities to hold them selves out as the
provider of choice to meet the needs of this population following disease treatment.
In recognition of national goals as are articulated in Healthy People and of the known growth in
cancer survivorship, the American College of Surgeons Commission on Cancer has mandated that cancer
centers provide access to rehabilitation.32 Physical therapists with advanced training are qualified to
manage comprehensive oncology rehabilitation programs. However, comprehensive oncology
rehabilitation programs require advanced education and training due to the complex nature of cancer and
cancer treatment side effects. Oncology rehabilitation specialists require advanced skills in clinical
practice that transcend the current physical therapy specialty areas (e.g. orthopedics, cardiology,
neurology, etc.) not only across the practice patterns of musculoskeletal, neuromuscular,
cardiopulmonary, and integumentary conditions, but across the continuum of cancer care from prevention,
through diagnosis and treatment, in extended survivorship and for end of life care. Physical therapists
require integrated training of caring for patients before, during, and after cancer treatments to
individualize rehabilitation programs to accommodate acute, chronic, and long-term cancer side-effects.
Physical therapists also require advanced training in management in order to manage the complex
interdisciplinary rehabilitation programs that are necessary for cancer care.
10
1. Healthy People 2020 Objectives: U.S. Department of Health and Human Services, 2011.
2. National Health Interview Survey, vol. November 2012: Centers for Disease Control and Prevention, 2011.
3. American Cancer Society: Cancer Facts and Figures 2012, vol. November 2012: American Cancer Society, 2012.
4. Stubblefield MD. Cancer rehabilitation. Semin Oncol 2011;38(3):386-93. Available from
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=21600368
5. Alfano CM, Ganz PA, Rowland JH, Hahn EE. Cancer survivorship and cancer rehabilitation: revitalizing the link. J
Clin Oncol 2012;30(9):904-6. Available from
6. Oncology Rehab Partners, 2011.
7. Cheville AL, Beck LA, Petersen TL, Marks RS, Gamble GL. The detection and treatment of cancer-related
functional problems in an outpatient setting. Support Care Cancer 2009;17(1):61-7. Available from
8. Silver JK. Strategies to overcome cancer survivorship care barriers. PM R 2011;3(6):503-6. Available from
9. Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, et al. A prospective surveillance model
for rehabilitation for women with breast cancer. Cancer 2012;118(8 Suppl):2191-200. Available from
10. Gerber LH, Stout NL, Schmitz KH, Stricker CT. Integrating a prospective surveillance model for rehabilitation
into breast cancer survivorship care. Cancer 2012;118(8 Suppl):2201-6. Available from
11. Collaborative Care: Innovations in Practice: Prospective Surveillance Cancer Model ACO Video Series: American
Physical Therapy Association, 2011.
12. Stubblefield MD, Hubbard G, Cheville A, Koch U, Schmitz KH, Dalton SO. Current perspectives and emerging
issues on cancer rehabilitation. Cancer 2013;119 Suppl 11:2170-8. Available from
13. Binkley JM, Harris SR, Levangie PK, Pearl M, Guglielmino J, Kraus V, et al. Patient perspectives on breast
cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer.
Cancer 2012;118(8 Suppl):2207-16. Available from
14. Stout NL, Andrews K, Binkley JM, Schmitz KH, Smith RA. Stakeholder perspectives on dissemination and
implementation of a prospective surveillance model of rehabilitation for breast cancer treatment. Cancer 2012;118(8
Suppl):2331-4. Available from
15. Levangie PK, Drouin J. Magnitude of late effects of breast cancer treatments on shoulder function: a systematic
review. Breast cancer research and treatment 2009;116:1-15.
16. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer
diagnosis. JAMA 2005;293(20):2479-86. Available from
17. Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, et al. Greater survival after breast
cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 2007;25(17):2345-51.
Available from
18. Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML, et al. Physical activity and
survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res (Phila)
2011;4(4):522-9. Available from
19. Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, et al. Influence of pre- and
postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin
Oncol 2008;26(24):3958-64. Available from
20. Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and
progression in the health professionals follow-up study. Int J Cancer 2007;121(7):1571-8. Available from
21. Meyerhardt JA, Giovannucci EL, Ogino S, Kirkner GJ, Chan AT, Willett W, et al. Physical activity and male
colorectal cancer survival. Arch Intern Med 2009;169(22):2102-8. Available from
11
22. Meyerhardt Ja, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, et al. Impact of physical activity on
cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. Journal of clinical
oncology : official journal of the American Society of Clinical Oncology 2006;24:3535-41.
23. de Boer AG, Taskila T, Tamminga SJ, Frings-Dresen MH, Feuerstein M, Verbeek JH. Interventions to enhance
return-to-work for cancer patients. Cochrane Database Syst Rev 2011(2):CD007569. Available from
24. Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in
patients with metastatic breast cancer. J Clin Oncol 2008;26(16):2621-9. Available from
25. Thorsen L, Gjerset GM, Loge JH, Kiserud CE, Skovlund E, Flotten T, et al. Cancer patients' needs for
rehabilitation services. Acta Oncol 2011;50(2):212-22. Available from
26. Schmitz KH, Speck RM, Rye SA, DiSipio T, Hayes SC. Prevalence of breast cancer treatment sequelae over 6
years of follow-up: the Pulling Through Study. Cancer 2012;118(8 Suppl):2217-25. Available from
27. Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: An essential component of quality care
and survivorship. CA Cancer J Clin 2013. Available from
28. Stout NL. Exercise for the cancer survivor: all for one but not one for all. J Support Oncol 2012;10(5):178-9.
Available from
29. Cousins N, MacAulay F, Lang H, MacGillivray S, Wells M. A systematic review of interventions for eating and
drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus. Oral
Oncol 2013;49(5):387-400. Available from
30. Cristian A, Tran A, Patel K. Patient safety in cancer rehabilitation. Phys Med Rehabil Clin N Am 2012;23(2):44156. Available from
31. Hewitt M, Ganz P, Eds, From Cancer Patient to Cancer Survivor – Lost in Transition. Institute of Medicine, 2005.
32. Cancer Program Standards 2012: Ensuring Patient-Centered Care: American College of Surgeons Commission on
Cancer, 2012.
12
ABPTS Feedback:
2.3 Describe and document, with references, how the public’s health and well-being may be at risk if
practitioners do not provide services in the proposed specialty area.
{Decision: Did Not Adequately Meet Requirement}
The major concern with this section of the petition is the fact that the cited statistics focused only on fatigue. Is
there further data available addressing other areas of impairment beyond fatigue? It was noted that information from
pages 28 and 29 of the petition may be well suited to further support this section of the petition.
REVISED SECTION:
2.3 Describe and document, with references, how the public's health and well-being may
be at risk if physical therapist practitioners do not provide the services in the
proposed specialty area.
Patients are surviving cancer diagnoses to a greater degree than ever before. Survival rates vary
according to stage of cancer at diagnosis and differ among cancers. Current reports of
Surveillance Epidemiology and End Results (SEER) data indicate a 66.7% five-year survival rate
on average for all cancers combined. Certain cancers have much higher survival rates, such as
cancer of the breast, which when discovered early has a five-year survival rate of 89.9%.1 The
number of cancer survivors living in the United States has increased from approximately three
million in 1971 to over 11 million as of 2007.1 Survivors of cancer have approximately 3.5 times
the likelihood of having disability affecting physical function as individuals with other chronic
diseases, and when cancer occurs in combination with other chronic diseases the likelihood of
physical disability doubles over that rate.2 It has been clearly demonstrated that mobility
related impairments persist or occur as late effects for months and years after successful cancer
therapy is completed.3-11 Every patient who goes through any form of treatment for cancer is
at risk for physical impairments to varying degrees (see Table 1). The risk incurred is one that
persists for a lifetime following disease treatment.
With survivorship rates continuing to climb, a great public health need has developed
for health care providers who are able to recognize and treat the sequelae of cancer.
1
Depending on the specific treatment exposures, survivors of cancer can face numerous adverse
consequences of cancer treatment, many of which are amenable to rehabilitation
interventions.(See Figure 1) These include fatigue, depression, anxiety, fear of recurrence,
cognitive dysfunction, pain syndromes, peripheral neuropathy, sexual dysfunction, balance and
gait problems, upper or lower quadrant mobility issues, lymphedema, bladder and bowel
problems, stoma care, problems with swallowing or dysphagia, and communication difficulty.12
The practice of physical therapy is uniquely situated to alleviate many of the negative sequelae
and to mitigate their impact on function however, an advanced level of knowledge, skill and
abilities among physical therapists is necessary as the nuances of the cancer disease process
and side effects of treatment warrant an advanced understanding specific to cancer.
Impairments present during active treatment:
Many of the common impairments that the cancer population faces are familiar to the
general physical therapist however when the nuances of cancer treatment are considered, the
need for specialized education and training is elucidated. Cancer and its treatment introduce
myriad considerations that impact a physical therapy plan of care. It is necessary for a physical
therapist to have an advanced level of knowledge and a clinical skill set that is uniquely focused
on the aspects of cancer treatment that impact impairment. Functional impairments associated
with cancer treatment require consideration of; the disease process, the side effects of disease
treatment agents, the late effects of these agents and the possibility that impairments are
related to a recurrent disease process. Impairments in the cancer population are different; in
etiology, in response to intervention, in interaction with therapeutic interventions and in
anticipated outcomes. Recognizing the unique and specialized needs of integrating
2
rehabilitation and exercise with the cancer survivor’s needs, the American College of Sports
Medicine (ACSM) convened an expert panel to provide an evaluation of the literature, and
invited a multidisciplinary team of researchers and practitioners to evaluate the evidence and
issue guidelines on exercise for cancer survivors.13 The ACSM recognized the need for an
evaluation of the risks and benefits of exercise-based interventions for cancer survivors by a
body that understands clinical medicine, oncology, and exercise. Their findings, outlined in the
report by Wolin et al note that there is a substantial and significant need for the rehabilitative
and exercise interventions for the patient with cancer to be overseen by a specialist in cancer
and cancer rehabilitation.14 From a rehabilitation perspective, consideration of these critical
points is best achieved by an oncologic clinical specialist. Impairment levels are high among
patients treated for cancer. Some of the common impairments and their unique consideration
include:
Fatigue: Upwards of 60% of patients suffer chronic fatigue after cancer treatment.
Fatigue is present in as many of 75% of persons newly diagnosed with cancer, and prevalence
of fatigue rises as high as 96% in patients undergoing chemotherapy and as high as 93% in
patients undergoing radiotherapy.15 This interferes with their participation and activity levels
and may negatively impact return to work as well as impact psychosocial function. Aerobic
exercise that is prescribed by a knowledgeable specialist with depth of understanding of the
medical and radiographic treatments that the patient is undergoing has been shown to
positively impact the fatigue burden.15 Therapeutic interventions aimed at mitigating fatigue, as
identified by the general physical therapist, may impede the rehabilitative process or may
introduce unsafe interventions if there is not an understanding of the unique presentation of
3
Cancer-related fatigue.14 Vital sign responses to intervention are different in the patient with
cancer, strength training interventions need to be conducted with consideration for lab values
unique to cancer care. NCCN guidelines recommend that certain survivor groups (eg, patients
with comorbidities, recent major surgery, functional or anatomical deficits, or substantial
deconditioning) obtain referral to physical therapy to facilitate exercise during fatigue.(NCCN
guidelines) The general therapist and even an advanced specialist in another area of
rehabilitation does not have this knowledge as a part of their individual scope of practice.
Pain: Pain is a prevalent complaint among patients with cancer. It is estimated that 30%
to 50% of patients undergoing acute cancer treatment will experience pain and up to 70% of
those with metastatic disease will have pain.16 Promotion of wellness behaviors and the use of
physical therapy examination and intervention early in cancer recovery may help to diminish
the intensity and incidence of chronic pain in long-term survivors.17 The presentation and
etiology of pain in this population are differ
Peripheral Neuropathy: Chemotherapy-induced peripheral neuropathy, a possible side
effect of some chemotherapy drugs, is the most prevalent neurologic complication of cancer.18
It is estimated that peripheral neuropathy may develop in 50% to 60% of patients treated with
taxanes and can result from paraneoplastic phenomena as well.19 (Bristol Meyers-Squibb
Insert*) Postural instability and balance impairments are noted to be significant impairments
associated with peripheral neuropathies.20 Interventions include balance training, an emphasis
on using visual compensation for proprioception, and orthotics. Patients need education about
foot care and environmental hazards such as throw rugs.21 To ensure survivor safety, the ACSM
*
http://packageinserts.bms.com/pi/pi_taxol.pdf
4
guidelines for cancer survivors recommend that survivors undergo neuropathy evaluation prior
to initiating an exercise program.14 This need can best be met by the oncologic clinical
specialist.
Soft Tissue Impairment: Cancer and/or its treatments can cause significant soft- tissue
abnormalities. One of the most frequently observed is lymphedema, which is extremity swelling
resulting from disruption of the lymphatics following axillary or groin lymph node dissection.
The prevalence of lymphedema in patients with breast cancer has been generally reported to
be between 15% and 30%.22 Complete decongestive therapy, which includes the use of manual
lymph drainage and compression garments, is effective in controlling edema. When applied
early in the course of treatment, before the development of a significant volume increase (eg, a
greater than 250-cc increase in the arm), lymphedema can almost be reversed.23, 24 Weight
lifting, traditionally believed to be contraindicated in patients with lymphedema, has
subsequently been shown to be beneficial.25
Aerobic Capacity: Multimodal rehabilitation has also been studied in patients with
cancer during chemotherapy. Adamsen et al randomized 269 patients to an intervention set or
a control set.26 Of note, patients had 21 different types of cancer diagnoses, including solid
tumors and hematologic malignancies. Patients in the intervention set received high-intensity
and low-intensity supervised physical training, relaxation techniques, and manipulation.
Supervision was performed by a physical therapist or trained nurse specialist. Those in the
control set received standard medical care and were permitted to perform unsupervised
physical activity as tolerated. After 6 weeks, patients in the intervention set demonstrated less
fatigue, improved aerobic capacity, greater strength, improved vitality, and better emotional
5
well-being.26 The ACSM recommends that exercise testing and prescription for the patient with
cancer are best done by exercise professionals or physical therapists with advanced education
in oncology domains and in consultation with the cancer care team.13, 14
Impairments in various populations
Prostate Cancer: In survivors of prostate cancer, a recent review found that
incontinence, fitness, fatigue, body constitution, and QOL can be improved by “clinical exercise”
during and after acute cancer treatments.27 Of note in this systematic review, the authors
concluded that “supervised exercise” is more effective than “nonsupervised exercise”
recognizing the need for a specialist to oversee the plan of care.
Head and Neck Cancer: McNeely et al randomized 52 survivors of head and neck cancer
to a control group that received a standard, supervised, therapeutic exercise program or to an
intervention group that received a supervised progressive resistance program that was tailored
to treat their individual needs associated with cancer-related impairment of the shoulder.28
Outcomes were measured at baseline and at the end of the 12-week intervention. The patients
who underwent the progressive resistance exercise that was tailored to their needs
demonstrated reduced pain and improved upper extremity muscular strength and endurance
compared with the control subset.
Advanced Stage Cancer: Cheville et al found that of 163 women with metastatic breast
cancer, 92% had at least one physical impairment, with 530 impairments identified overall, and
that fewer than 30% of the participants received the appropriate care.29 In 2011, Cheville et al
reviewed the causes of underuse of rehabilitation services for individuals with advanced
cancer.30 In this review, the authors suggested that much of the disability associated with
6
advanced cancer may be avoided and stated that this is “an important public health issue.” 30
One of the central questions in this review was, “Why does functional loss in patients with
cancer fail to trigger rehabilitation referrals?”30 Cheville et al explored several reasons,
including that cancer-related disability is often insidious and that cancer care delivery systems
are not conducive to the early detection of functional problems. In this particularly fragile
population, the authors encouraged health care professionals to avoid underestimating the
functional loss that may occur with minor impairments and stated, “Even seemingly benign
impairments warrant attention, given their capacity to erode diminishing functional reserve.” 30
Albrecht and Taylor reviewed 16 articles published between 1994 and 2010 to
determine the effect of physical activity in patients with advanced-stage cancer.31 They found
that even patients with advanced-stage cancer can benefit from rehabilitation in terms of
improvements in mood, pain, fatigue, shortness of breath, constipation, and insomnia.
Cost of Cancer-related Morbidity
The Union for International Cancer Control has recently reported that at a figure of $895 billion
the economic cost of cancer in terms of years of disability and cost of lives lost (not including
cost of treating the disease) is now the leading health care economic burden placed on
countries world-wide.32 The oncologic specialist is uniquely positioned with a knowledge base
that transcends body structure and function as well as a skill set that can impact every body
system impacted by cancer. The advanced skills that enable the therapist to understand the
disease, its side effects and adverse effects through the continuum of care will propel the
oncology physical therapist specialist to the forefront in reducing not only the morbidity burden
associated with the disease, but may directly impact the cost of ongoing lifetime care for this
7
chronic illness. These skills enable the oncologic specialist to participate in advanced
professional roles as a consultant and advocate for the unique needs of these patients. As
survivorship rates continue to escalate the oncologic specialist must step to the forefront as the
only health care provider with the knowledge, skills and abilities to comprehensively manage
the functional domains of patients with this disease.
Care Delivery Model Inadequacies
Physical therapy is poorly integrated into the medical service delivery model for cancer care in
hospital-based settings and fragmented community-based care further exacerbates this
problem pushing rehabilitation further from mainstream patient care. Cancer care and
rehabilitation care are disconnected even in some institutions that have streamlined transition
services and many community cancer programs lack rehabilitation care altogether.29, 33
Oncologic physical therapy services are relevant and necessary in primary, secondary
and tertiary regards. Comprehensive cancer rehabilitation can address pre-existing or
treatment-related comorbid conditions. Diabetes, cardiovascular disease, congestive heart
failure, bone loss, adverse body composition, and renal disease are common in survivors of
cancer2 and can be managed through rehabilitation interventions including medication,
counseling, behavior change and promotion of healthy diets, physical activity, and weight
control.12 Self-management skills and health promotion interventions provided in the context of
comprehensive cancer rehabilitation also have the potential to decrease the risk of additional
late effects—for example, the cardiac, pulmonary, endocrine, or bone complications of cancer
treatment and may even reduce the risk of second malignancies.34-40 A final benefit is the joint
focus on optimizing functional status and quality of life, preserving the ability to remain in the
8
workforce and other life roles, and maximizing health and longevity.41 The need to integrate
rehabilitation and physical therapy into the continuum of cancer care is best met by the
oncologic clinical specialist who brings an advanced skill set, knowledge base and can promote
the advanced professional role of physical therapy for the cancer population.
Currently, health care providers caring for patients along the continuum of cancer care
do not adequately identify and refer patients for rehabilitation. Cheville et al found that in 163
women with metastatic breast cancer, 92% had at least one physical impairment, with a total of
530 impairments identified overall; 484 of these impairments (91%) required a physical
rehabilitation intervention and 469 (88%) required physical and/or occupational therapy.42
Despite more than 90% of the participants needing cancer rehabilitation services, fewer than
30% received this care.42 Thorsen et al evaluated 1325 survivors of the 10 most prevalent
cancers and found that 63% reported the need for at least one rehabilitation service, with
physical therapy being the most frequently reported need (43%).43 They also reported that
patients were often not referred for services; 40% of the participants reported unmet
rehabilitation needs. This work demonstrates need for the oncologic specialist to take on a
professional role as an advocate and leader in promoting the services that physical therapy can
offer to the patient population.
Further evidence of need includes a study by Schmitz et al found that at least 60% of
breast cancer survivors had one or more treatment-related impairments at each checkpoint
over a 6-year follow-up period.44 Cheville et al evaluated the detection and treatment of
functional problems in cancer survivors and concluded that “Functional problems are prevalent
among outpatients with cancer and are rarely documented by oncology clinicians.” 29
9
Not only does this evidence speak to the unmet needs of patient, it highlights the
importance of the role the physical therapist who is an oncologic specialist can play in
improving care. Other health care providers are not educated in impairment identification.
Physical therapists are experts in movement dysfunction and have evidence-based tools and
interventions to ameliorate or mitigate many of the aforementioned issues. Other health care
providers are not educated to treat physical impairments and their scope of practice is limited
to providing general, often broad recommendations towards activity and exercise and
frequently there is not recognition of the need for therapeutic interventions.45, 46 Safety is a
significant concern when prescribing exercise in the cancer population. Lack of appropriate
screening or treatment may result in injury or other medical complications.47, 48 In this regard
the oncologic clinical specialist, with advanced knowledge and skills regarding exercise
prescription for the patient with cancer, can promote improved screening, identification of and
treatment for impairments.
10
Figure 1. Rehabilitation interventions commonly used in cancer rehabilitation.45
11
Difficulty returning to
premorbid activities
General
physical
physical
Specific
REHABILITATION
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Weakness
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Neuropathic pain
pain)
(eg, myalgias, myofascial
Musculoskeletal pain
arthralgias)
Joint pain, diffuse (eg,
Fatigue
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REHABILITATION
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Neck pain
Muscular asymmetry
Lymphedema
Lumbosacral plexopathy
limitations
Joint range-of-motion
Joint pain, localized
Jaw excursion, limited
History of falls
Headaches
disease
Graft-versus-host
Gait dysfunction
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Cognitive impairment
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PROSTATE
Compression neuropathy
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BREAST
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LUNG
Chest/thoracic pain
peripheral neuropathy
Chemotherapy-induced
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Psychosocial
REHABILITATION
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Psychosocial dysfunction
dysfunction
proprioception
Visuospatial and/or
Urinary dysfunction
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Scar adhesions
Scapular winging
Radiculopathy
syndrome
Radiation fibrosis
Plexopathy
Paralysis
Osteopenia/osteoporosis
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Workplace evaluation
Driving evaluation
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Home safety evaluation
equipment needs
Durable medical
needs
Adaptive equipment
reacher, etc)
Assistive devices (cane,
Prosthetics
Orthotics
(chores/shopping, etc)
Difficulty with IADLs
(dressing/bathing, etc)
Difficulty with ADLs
REHABILITATION
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Functional
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ADVANCED
23
1. Institute NC. Surveillance Epidemiology and End Results Fact Sheets 2012.
2. Hewitt M, Rowland J, Yancik R. Cancer survivors in the United States: age, health, and disability. The Journals of
Gerontology: Series A 2003;58:M82-M91.
3. Nagarajan R, Mogil R, Neglia JP, Robison LL, Ness KK. Self-reported global function among adult survivors of childhood
lower-extremity bone tumors: a report from the Childhood Cancer Survivor Study (CCSS). Journal of cancer survivorship : research
and practice 2009;3:59-65.
4. Ness KK, Hudson MM, Pui C-H, Green DM, Krull KR, Huang TT, et al. Neuromuscular impairments in adult survivors of
childhood acute lymphoblastic leukemia: associations with physical performance and chemotherapy doses. Cancer 2012;118:828-38.
5. Ness KK, Hudson MM, Ginsberg JP, Nagarajan R, Kaste SC, Marina N, et al. Physical performance limitations in the
Childhood Cancer Survivor Study cohort. Journal of clinical oncology : official journal of the American Society of Clinical Oncology
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Criterion #1umbeU7LPH
ABPTS REVIEW:
3.1 Include a documented estimate of the number of physical therapists currently practicing in the
proposed specialty area. Identify the types of practice settings for these physical therapists.
It was unclear, based on data provided, how the estimated number of PTs was determined. Please
provide the number of respondents and the details of the survey used to establish the documented
numbers. Questions were also raised as to whether or not simply surveying oncology section members
adequately addresses this criterion. The petitioner may want to consider expanding the survey group.
3.3 Estimate the number of physical therapists who would likely seek board certification in the
proposed specialty area during the first five years board certification would be available. Provide
supporting documentation.
Before granting approval for this criterion, the board asks for clarification on the data provided. Please
provide better linkage of numbers and % of noted survey respondents within this section to the survey
conducted (Appendix VIII). Does 71% represent respondents who completed all or a portion of the
survey? It was noted as well that only an approximate number of individuals was noted when
stipulating 71%. An exact number should be available for inclusion. It was also unclear how the
referenced 10% figure within this section was derived and request that this be clarified. Due to the lack
of more definitive data, it was difficult for the board to see how the final estimate of 372 was
determined.
Finally, it was unclear why the final paragraph within this section was included as it focuses solely on the
development of residency or fellowship programs. Is it believed this in some way will impact the
number of individuals who will sit for the specialist certification examination within the first five years?
If so, please clarify.
REVISED SECTIONS
Thank you for the opportunity to clarify this information. In our response we will explain how we
determined our original estimate, and we will present a new estimate based on different data. No
direct population data exist to describe how many physical therapists practice in the specialty area of
oncology. In every response where we faced this situation we have used standard epidemiological
method where we have estimated the size of the group in question by interpolating from robust existing
related data.
In our original petition, the robust source of data that we used to estimate number of therapists
practicing in oncology was the American Physical Therapy Association (APTA) 2011 Membership
1
Development Plan. That document gave us the national rate of physical therapist membership in the
APTA, which was 30%.1 To estimate a number of therapists practicing in the specialty area we first
made two assumptions: 1) members of the Section on Oncology practice in the specialty area, and 2) the
rate of oncologic physical therapist membership in the Section on Oncology would parallel the rate of
general physical therapist membership in the APTA. At the time there were more than 1000 members
of the Section on Oncology (there are now more than 1100) and our estimate was predicted using the
formula (n = 1000 current members/0.30) which gave us the figure of “at least 3300.” (The actual
calculated value is 3333.33.)
For this response we have chosen to estimate the number of physical therapists practicing in oncology
using a different robust data set because it more directly estimates area of clinical practice than Section
membership would. The APTA document “A Model to Project the Supply and Demand of Physical
Therapists 2010-2020”2 utilized data from the Federation of State Boards of Physical Therapy to
estimate the current number of physical therapists at 182,000. We postulate that the physical therapist
self-classification of primary clinical focus at the time of APTA membership renewal is an appropriate
proxy to capture physical therapists working in the specialty area of oncology. APTA membership as
reported in this document was 59,552, and of those members 2065 (3.5%) indicated that their area of
primary clinical focus was oncology. Using the rate of 3.5% we can estimate using (n = 0.035 X 182,000)
that there are 6370 physical therapists practicing in the specialty area of oncology including both APTA
members and individuals who are not members of APTA.
Our practice survey sampled individuals who were both members and non-members of the
Section on Oncology, and the list of practice settings generated is comprehensive as judged by members
of the Specialization Task Force based on their considerable experience in the field. That information is
pasted below for the sake of completeness.
2
Respondents to the survey were individuals who practice in oncology and included members of the
Section on Oncology (80%), APTA members who were not members of the Section on Oncology (7%)
and non-members of APTA (13%). Details about the process of the survey, response rate, and
demographics may be found in Appendix VIII.
The majority of respondents (39%) practice in an outpatient hospital based clinic, followed by 18% in
free-standing outpatient clinics and 17% in acute care hospitals. This compares to overall APTA
membership distribution of 18% hospital based outpatient clinics, 40% free-standing outpatient clinics,
and 11% acute care. Additional work settings in rank order included; academic institutions, other
settings, research centers, home health, hospice, and long term care/skilled nursing facilities. The
reported responses of “other settings” included; radiation therapy clinics, free standing cancer center
and private consulting.
Thank you for the opportunity to clarify this information. We acknowledge with considerable
embarrassment that there appears to be an error in our calculations for this section that was not caught
by the 35 people who reviewed this document before submission. Our practice survey raw data
includes the number of individuals that responded to each question as well as the number of people
who returned the whole survey (n=368). Given that appropriate handling of survey research under
human subjects guidelines requires that respondents be told they are free to skip any question, a
variable number of people responded to each question. While there was indeed a group of people who
seem to have not finished all questions on the survey because of a page turning error, that did not affect
3
Respondents to the survey were individuals who practice in oncology and included members of the
Section on Oncology (80%), APTA members who were not members of the Section on Oncology (7%)
and non-members of APTA (13%). Details about the process of the survey, response rate, and
demographics may be found in Appendix VIII.
The majority of respondents (39%) practice in an outpatient hospital based clinic, followed by 18% in
free-standing outpatient clinics and 17% in acute care hospitals. This compares to overall APTA
membership distribution of 18% hospital based outpatient clinics, 40% free-standing outpatient clinics,
and 11% acute care. Additional work settings in rank order included; academic institutions, other
settings, research centers, home health, hospice, and long term care/skilled nursing facilities. The
reported responses of “other settings” included; radiation therapy clinics, free standing cancer center
and private consulting.
Thank you for the opportunity to clarify this information. We acknowledge with considerable
embarrassment that there appears to be an error in our calculations for this section that was not caught
by the 35 people who reviewed this document before submission. Our practice survey raw data
includes the number of individuals that responded to each question as well as the number of people
who returned the whole survey (n=368). Given that appropriate handling of survey research under
human subjects guidelines requires that respondents be told they are free to skip any question, a
variable number of people responded to each question. While there was indeed a group of people who
seem to have not finished all questions on the survey because of a page turning error, that did not affect
3
responses to the question about interest in sitting for the specialist certification exam since 363 people
answered this question. It is possible that the 73% figure reported in the original petition came from a
calculation that was based on preliminary survey data when we first started drafting this document,
nearly a year before submission and the calculation was inadvertently not updated. We present
corrected data below, and after that we present some new data from survey updates conducted in
August 2013.
The raw data for this question on our original practice survey were as follows:
23. The Oncology Section and the American Board of Physical Therapy Specialties are working
together to develop this practice analysis in order to offer a board certification exam in Oncology.
There is a detailed application process and the cost of the application and exam is currently
$1200. The certification exam is administered through the National Board of Medical Examiners.
Certification is good for ten years. When this board certification process is available, do you plan
to take the exam?
1. Yes, definitely
111
31%
2. Yes, but not for a few years
110
30%
3. Probably not
110
30%
4. No
32
9%
Total
363
100%
Thus, 221 people (61% of survey respondents) indicated that they planned to take the Oncologic
Specialist exam.
We suggested that new therapists entering the field would increase this number by approximately 10%
(22 individuals) per year because membership in the Section on Oncology has increased by
approximately that much annually for the last several years. So, using that assumption and our original
survey data we believe it is reasonable to predict that a core of 221 people would be interested in taking
the exam and that each year after the first, for the remaining four years we could assume 22 new
therapists would emerge who would choose to take the exam, for a total of 221 + 88 people, or 309
people.
After receiving feedback on our petition we performed two quick surveys to attempt to update the
information presented in the initial petition. One survey, sent to all Section on Oncology members,
4
asked the question “If and when Board Certification in Oncology Physical Therapy becomes a reality,
would you consider seeking specialty certification?” Because of the tight turnaround time necessary to
submit this response to ABPTS, this survey was sent to the section membership electronically and
available to them only for about 10 days. In that period of time we received 187 responses (so
approximately 17% of the section membership) and 185 people responded to this question. Of the 185
responders, 156 people (84.3%) responded yes. One possible explanation of the higher rate of specialty
interest apparent in this most recent survey is growing interest in specialty certification of all types that
is apparent among newer physical therapists.
The two different surveys demonstrated a specialization interest rate ranging from 61% to 84%. If we
apply this interest rate to the calculated number of physical therapists practicing in oncology (6370) it is
potentially the case that the number of interested physical therapists would be much higher.
In addition we did a social media survey using Facebook where we invited physical therapists who were
NOT members of the Section on Oncology. That survey was available for only 6 days and it received 128
responses who reported working primarily in the following settings:
10% Academic institutions
18% Acute care
7% Acute rehabilitation
3% Subacute rehabilitation
34% Hospital based outpatient clinics
23% Free standing outpatient clinics
5% Home health
5
In this social media survey, 93% of respondents answered yes to the question “Would having a certified
specialist in oncology either on your staff or available to consult to your staff enhance your practice?”
We also asked these respondents who were not members of the Section on Oncology whether they
would be interested in pursuing a specialty in Oncologic Physical Therapy, and 75 people (60% of
respondents) said they would be interested. This group of interested individuals can be assumed to be a
different group of people than those who responded to the Description of Practice.
To briefly comment on the relationship between the availability residency training and number of
individuals interested in pursuing specialty certification, we do believe that when there is formal
comprehensive training available to prepare individuals for the specialty, numbers of therapists
interested in pursuing specialist certification will increase. This is primarily because it is daunting to
attempt to uptrain to work in oncology practice currently because each individual must construct a
learning plan from among a potpourri of continuing education courses with no curricular guide. We
believe that when there is such a guide (which will come in the form of the DSP more than simply
residencies) the process of becoming an oncologic specialist will be clearer and more individuals will
wish to pursue it.
1. APTA Membership Development Plan: 2011. In: Association APT, ed., 2011.
2. A Model to Project the Supply and Demand of Physical Therapists 2010-2020: American
Physical Therapy Association, 2012.
6
ABPTS Feedback:
4.1 Describe in detail the specialized knowledge in physical therapy practice required for the proposed
specialty area.
Decision:
Did#4:
Not Specialized
Adequately Meet Requirement
Criterion
The
summary
table
Knowledge provided did not sufficiently address this criterion and did not “describe in detail” the
specialized knowledge as required by this criterion. Additional detail should be provided to further clarify the broad
topics included by including more descriptive summaries for each area (see section 5.2 as an appropriate example).
REVISED SECTION:
Section 4.1 Describe in detail the specialized knowledge of physical therapist practice
required for the proposed specialty area.
The Oncology Practice Survey assessed the domain of knowledge over 103 separate criteria
(derived from the earlier pilot survey) asking about the importance of each area of knowledge
to the oncology specialist on a scale of 0-4. Respondents ranked 57 of these knowledge areas
3.5/4.0. Approximately 30% of these knowledge factors were specific to cancer as a disease
process and its specific treatments. The specialist recognizes the importance of understanding
this unique disease process and its impact on body system and function. We have detailed the
specialized knowledge of the oncologic clinical specialist based on the practice survey in the
table below using the format of the patient/client management model.
1
Unique to the knowledge of the oncologic clinical specialist:
History and System review:
Unique knowledge related to cancer and
its treatment need to be ascertained by
the physical therapist who is an
oncology specialist. While the
knowledge of the therapist in patient
interviewing is standard, the
interviewing and processing of cancer
related information impacts the
knowledge needs of the therapist to
effectively and efficiently the history and
physical exam.
1.
Foundational Sciences
Cancer Biology
a)
b)
Cancer Pathophysiology
c)
Cellular biology (eg. changes associated with
cancer treatment and cancer disease)
d)
Neurophysiology (eg. Etiology of chemotherapy,
muscle weakness, balance deficits)
e)
Radiation physics
2.
Clinical Sciences
a)
Physiological and anatomic status (eg.
Cardiovascular/pulmonary, integumentary,
musculoskeletal and neuromuscular systems) with
consideration for the cancer disease process, side effects
of cancer treatment and possible recurrent disease
Pharmacology
b)
c)
Kinesology
d)
Pathokinesiology
e)
Taxonomy of cancer rehabilitation principles (e.g.preventive, restorative, supportive, palliative) (ref Dietz
here)
f)
Cancer tumor staging
g)
Tumor Pathology
h)
Genetics and genomics (oncologic specific)
i)
Cancer control science and epidemiology (eg.
prevention, screening and risk factor identification)
j)
Surgical oncology (including reconstructive
surgeries)
k)
Medical oncology (including chemotherapeutic
toxicities, hormonal agents, biological agents and
targeted agents)
l)
Radiation oncology
m)
Laboratory tests
n)
Diagnostic imaging
3.
Behavioral Sciences
a)
Developmental psychology (e.g., body image)
b)
Social psychology (e.g., depression, loss,
survivorship, end of life issues)
c)
Communication theory (e.g., methods of
communication and nonverbal language related to loss,
grief, and end of life)
d)
Sexuality and cancer
e)
Policy issues in cancer
2
Examination: Tests and Measures:
Many of the tests and measures
commonly used in physical therapist
practice are also used in the oncology
population. It is unique to the function
of the oncology specialist to synthesize
information pertinent to the cancer
diagnosis and treatment and
appropriately choose tests and
measures and apply them.
Knowledge to select and prioritize tests and measures based on history,
systems review, scientific merit, clinical utility and physiologic or fiscal
cost to the individual relative to criticality of data.
Effects of other cancer-related medical and pharmacological
interventions on aerobic capacity/endurance measures (eg. Cardiotoxicity
related to chemotherapy, pulmonary radiation fibrosis, cancer-related
fatigue, myelosupression, cachexia, etc)
Effects of cancer-related medical and pharmacological interventions on
attention, arousal and cognition measures (eg. Chemotherapy-related
cognitive changes, whole brain radiation, paraneoplastic disorders,
metastatic disease to the brain)
cancer-related medical and pharmacological interventions on
3
Evaluation:
Critical to the function of the oncology
specialist is the ability to appropriately
evaluate changes in the patients status
based on disease treatment. Cancer and
its treatment are inherently dynamic
and the specialist must be nimble in
recognizing changes based on the
disease and treatment trajectory and in
making changes. Further, the specialist
in oncology should have the knowledge
to anticipate changes that are likely to
occur with use of different cancer
mitigating modalities. The ability to
proactively identify these potential
impairments and anticipate changes is
unique to the function of the oncology
specialist.
Interpretation of data from examination (eg. Identify relevant, consistent,
accurate data; prioritize impairments; assess patient’s needs, motivations
and goals) with consideration for the cancer disease process, disease
treatment side effects and late effects and for recurrent disease.
Signs and symptoms that indicate referral to a physician or another health
care provider is appropriate, based on specialized knowledge of the
oncologic physical therapist and with recognition of oncologic
emergencies.
4
Diagnosis:
The oncology specialist functions
differently from other therapists in their
ability to determine the PT diagnosis and
recognize the underlying components of
cancer treatment that may lead to this
diagnosis. This is of paramount
importance when developing a plan of
care. With unique knowledge of cancer
and its treatments, the therapist
functions at an advance level in their
differential diagnosis skills and their
ability to identify underlying aspects that
may impact the plan of care.
x
Physical Therapy Prognosis
The oncology specialist utilizes all
available information regarding the
known treatment side effects and late
effects as well as their expert knowledge
of the disease trajectory to
prognosticate accurately.
x
x
x
x
x
x
5
Client, Caregiver and patient
instruction:
Perhaps one of the most important
functions of the oncology specialist is
their ability to translate their expert
knowledge of the oncologic disease and
treatment process to the patient and
their care giver. No other physical
therapist nor physical therapy specialty
provider (nor often other medical
provider) can coalesce the information
related to function, impairment,
physical, physiological and psychosocial
needs related to cancer and it’s
treatment to provide the patient with
comprehensive education and
instruction about their unique physical
mobility needs.
Use of assistive or adaptive devices based on the continuum of cancer
care (eg. Limb salvage, skin integrity following radiation therapy,
neurotoxicities, lymphedema)
6
ABPTS REVIEW:
4.4 Discuss in detail how this advanced knowledge differs from the knowledge base required
for those specialty areas already recognized by ABPTS.
Sufficient detail was not provided for this section of the petition. While the petitioner made a
brief reference to how the advanced knowledge for the oncologic specialty area differed from
the women’s health specialty area, it is requested that the petitioner also detail the distinct
differences between the advanced knowledge required of an oncologic specialist and the
knowledge base required for pediatric, geriatric, cardiopulmonary, and orthopaedic specialists.
Revised section:
The concepts revealed in the Oncology Practice Survey data separate the oncology
specialist from other ABPTS specialists as evidenced by the heavy emphasis on the aspects of
cancer care. The vital importance of recognizing effects of cancer treatment, adverse effects of
treatment and their implications on the physical therapy knowledge is well represented. The
disease of cancer and its treatment interplay with body systems and function differently than
any other disease process that physical therapy professionals experience in their clinical
practice settings. Oncology specialists recognize the importance of this advanced knowledge
and manage their clients based on this advanced knowledge. Due to the systemic nature of the
disease process and cancer therapies, the impairments related to cancer treatment rarely are
based in one body system. They tend to aggregate among systems simultaneously, and risk for
impairments due to late effects of cancer persists for a lifetime. These knowledge criteria
demonstrate the need for the specialist to recognize the importance of all systems and their
interplay with one another as well as the disease process and disease treatment modalities. We
acknowledge that core competency in foundational, behavioral, and clinical sciences exist
1
across all specialties, such as anatomy and physiology, kinesiology, psychology, clinical decision
analysis, and clinical inquiry strategies.
Although other clinical specialists may have cancer related knowledge, the knowledge is
conceptualized differently and the breadth of knowledge is focused on a particular patient
population or setting. Other areas of specialty practice such as Women’s Health may indeed
focus on specific oncologic diagnoses (e.g., breast cancer) specific to a population; the oncology
specialist focuses on the oncologic population as a whole and the impairments that are elicited
by the disease and its treatment across all types of patient populations.
To clarify distinct differences between advanced knowledge of oncology specialists and
the knowledge base of specialists in orthopedics, pediatrics, geriatrics, cardiopulmonary and
women’s health we created the table below that briefly outlines knowledge areas from the
Cardiopulmonary, Neurologic, Pediatric, Orthopedic, and Women’s Health DSPs that may imply
a knowledge base greater than a general practitioner related to cancer care. However, the
description does not represent the extensive knowledge that an oncologic clinical specialist
would need to deliver an advanced level of care; for an in-depth review of these DSPs beyond
the review of knowledge in this section, see the DSP review in the table in section 5.4. We
searched the journals of various Sections for the past three years with the keywords “cancer”
and “oncology” to identify cancer-specific publications. The search yield very few results such
as one article in Orthoapedic Physical Therapy Practice 2012;24(1):8-11 resulting from a search
of the past 3 years, entitled, “Conservative Management of a Postsurgical Patient with
Chordoma and Back Pain” by Mary Calderan. We conducted a similar search of CSM program
over the past 3 years. Interestingly, the majority of cancer-specific programming was delivered
2
through collaboration with the Oncology Section. The recognition of Oncology Section as
“content expert”, few journal populations, and minimal recognition of cancer-specific
knowledge and functions in the DSPs of other specialties further support that the advanced
knowledge of a oncologic clinic specialist will differ from the knowledge base required by
current ABPTS specialty areas.
Section/
Specialization
Cardiovascular
and Pulmonary
Description of
Specialty Practice
Neurology
Epidemiology and
public health
(prevention)
knowledge identified
in clinical sciences
Interpretation of
special tests, system
based evaluations for
geriatric patients,
epidemiology of
chronic disease
Not available
Orthopedics
Not available
Geriatrics
Cancer
related
Section
publications
over the last
3 years
None
None
Cancer-specific CSM
programming over the last 3
years
CSM 2011: none
CSM 2012:
Inflammation, Atherosclerosis,
Neurodegeneration, and Cancer
CSM 2013: none
CSM 2011: none
CSM 2012: none
CSM 2013: none
none
CSM 2011: none
CSM 2012: none
CSM 2013: Balance Screenings
for Cancer Survivors (joint
programming with Oncology
Section); Impairments
Associated with Pediatric Brain
Tumors (joint programming with
Oncology and Pediatrics
Sections)
2012: 1
publication
CSM 2011: none
CSM 2012: Managing Low Back
Pain in a Direct Access Setting
CSM 2013: An Evidenced-based
Approach to Strength Training in
Breast Cancer Survivors (joint
3
Pediatrics
Public health and
epidemiology
Women’s Health
Not available
2011: 2
publications
2011: 1
publication
programming with Oncology
Section)
CSM 2011: none
CSM 2012: none
CSM 2013: Physical Therapy
Across the Continuum of Care in
Pediatric Oncology (joint
program with Oncology Section)
CSM 2011: none
CSM 2012: none
CSM 2013: The Complicated
Patient; A Prospective
Surveillance Model for
Rehabilitation for Women With
Breast Cancer
(joint program with Oncology
Section); Physical Therapy
Considerations for the Patient
Post Prostatectomy (joint
program with Oncology Section)
In addition to the data above to clarify distinct differences between advanced
knowledge of oncology specialists and the knowledge base of specialists in orthopedics,
pediatrics, geriatrics, cardiopulmonary and women’s health; we reviewed the examination
content outline for each of the specialties and communicated with individuals who hold
relevant specialty certification but who currently spend a significant portion of their current
working time within the context of oncology. While the committee did not ask us about the
neurologic specialty area, we have chosen to comment on it because it could be argued that
some cancers affect the neurologic system and therefore could be handled by neurologic
specialists.
CARDIOPULMONARY
4
The cardiopulmonary specialty examination content outline includes very detailed lists of
medical conditions, categorized as “seen frequently, seen occasionally,” and “seen rarely”
based on their practice survey. There is only one mention of cancer in the pulmonary
conditions that are seen frequently, and that is “carcinoma in situ of the lung or bronchus.”
Conditions that are reported to be seen occasionally include “malignant neoplasm of the
trachea, bronchus, lung, and pleura,“ and in the “seen rarely” category is found “graph[sic]
versus host disease.” It is not surprising that therapists who do not focus on oncology see graft
versus host disease only rarely since it is a rare condition with less than 200,000 cases seen
annually in the United States* Therapists who specialize in oncology, however, see this
condition commonly because patients undergoing Bone Marrow Transplant and organ
transplants require highly specialized care and are cared for in highly specialized settings such
as major cancer centers. Furthermore, it is important that therapists specializing in cancer have
the experience of seeing this and other types of complication of cancer treatment during their
careers, because that experience helps them better recognize the symptoms of these
complications when they appear during the course of patient rehabilitation and as early or late
effects of treatment. The implications of the early symptoms of this very serious complication
(such as itchy rash) would very likely be missed by a generalist or a therapist with advanced
training in a different specialty area, leading to delay of care.
It is telling that there appears to be confusion about terminology with several errors in
terminology appearing in the cardiopulmonary examination outline, revealing a clear difference
in knowledge base about oncologic concepts and cancer as compared with oncologic
*
1.
http://www.rightdiagnosis.com/g/graft_versus_host_disease/prevalence.htm).
5
specialists. Knowledge and use of standard terminology by which knowledgeable practitioners
in cancer care describe location and severity of disease (TNM staging) would have prevented a
couple of these errors described below. The addition of certified specialists to physical therapy
practice will provide a much needed resource to consult with generalists and other specialist
about such matters, just as the availability of other specialists provides a critical resource to
oncology specialists for consultation in their areas of most strength. These errors in the outline
include:
x The condition “graft versus host disease” is misspelled. In the cardiopulmonary
document the condition is listed as “graph versus host disease.”
x The practice survey apparently listed “carcinoma in situ” of the lung, and the majority of
survey respondents stated that they commonly work with “carcinoma in situ” of the
lung, not recognizing that in fact no one commonly works with carcinoma in situ of the
lung. Carcinoma in situ of the lung is Stage 0 lung cancer. Stage 0 lung cancer is rarely
diagnosed since it is asymptomatic and there are no screening tests available to reveal
lung cancer at that stage. When it is diagnosed at all it is usually an incidental finding
that is discovered in the process of testing for something else. Patients with Stage 0
lung cancer are not commonly (knowingly) seen by any physical therapist including
physical therapists who currently specialize in oncology, indeed carcinoma in situ of
the lung is not even commonly seen by oncologists much as they would like to have
the opportunity to treat lung cancer at that stage because of the absence of effective
screening procedures. That is a key reason why the overall survival rate of lung cancer
6
at all stages in 2006 through 2010 was 16.6%. The prognosis for survival of lung cancer
is typically grim precisely because we have no means of early diagnosis.
x The survey respondents indicated that they occasionally see patients with “malignant
neoplasm” of the bronchus, trachea, lung, larynx, or pleura, apparently seeing that
term as mutually exclusive of the term “carcinoma in situ.” The term “malignant”
appears to have been used here as a synonym of the word “metastatic.” The two
words are not synonyms. “Malignant” means that the tumor cells have the capacity to
metastasize, that is, when the cells divide, they have the capacity to invade
neighboring tissues and organs. “Cancer” is by definition “malignant neoplasm,” all
cancers, regardless of stage, are “malignant neoplasms.” The term is relatively general
and is not used to describe stage among professionals in cancer. Oncologic specialists
would define the presence of metastasis and the extent of it by using the standard
staging system that is the universally agreed upon language for describing cancer.
Anne Swisher PT, PhD, CCS, current Editor of the cardiopulmonary journal; has published
articles both on cardiopulmonary topics and on oncologic topics. She describes herself as a
“person with a CCS who has been practicing in oncology for 10 years.” Asked about the
distinction between oncologic specialists and cardiopulmonary specialists, Dr. Swisher gave the
following well-articulated response which includes but is not limited to comments about
cardiopulmonary specialists: “A patient with cancer can, and often will, have many
manifestations of the disease and/or its treatment that are familiar to physical therapists
practicing outside of oncology. However, without the specialized knowledge of cancer and its
very complex treatment regimens, those physical therapists are not prepared to fully diagnose
7
and manage the issues. For example, a patient may develop adhesive capsulitis following
breast cancer surgery and radiation therapy, however, the orthopedic physical therapist would
not understand the influence of radiation on blood flow and bone density in the region, which
impacts both the course of the condition and the options for treatment (e.g. avoiding grade IV
mobilization, extra precautions for thermal modalities, skin changes that may limit ultimate
gains in flexibility), nor the influence of aromatase inhibitor-associated arthralgia as a
differential diagnosis for shoulder pain. A neurological physical therapist might recognize
impaired balance due to chemotherapy-induced peripheral neuropathy, but not understand
that the use of taxane chemotherapy agents also impair cognition and ability to remember
safety precautions for a home balance training program. The cardiovascular and pulmonary
physical therapist might recognize that cancer-related fatigue should be treated with moderateintensity aerobic exercise, but not be aware that anthracycline chemotherapy regimens can
cause cardiac dysrhythmias with exercise or that other agents may cause impairments in
cardiac or pulmonary function. Similarly, pediatric or geriatric physical therapists might
recognize developmental delay or impaired sensory modalities and their effects on these age
groups, but not have an understanding of how cancer and its treatment would impact
diagnosis, prognosis and intervention planning across the lifespan. These are just illustrations
of situations where a “simple PT problem” like impaired aerobic capacity, joint limitations,
impaired posture or impaired balance are quite complicated to diagnose and manage without a
thorough understanding of the pathophysiology of cancer (literally hundreds of specific
diseases) and treatments (surgery, chemotherapy, radiation therapy, bone marrow transplant,
biological agents, etc, etc) and their effects on mobility. Thus, the oncology specialist physical
8
therapist must be able to manage not only impairments in the neurological, musculoskeletal,
cardiovascular/pulmonary and integumentary systems, but must have a unique understanding
of how cancer and its treatments (thousands of options, individualized to the patient) impact
movement and function.”
GERIATRICS
The geriatric examination content outline includes a relatively detailed list of conditions
and diagnoses that are covered on the exam. This list reveals considerable overlap with other
specialties including orthopedics, cardiopulmonary, and neurology. What distinguishes the
geriatric specialist from these other overlapping specialties is the level of expertise and focus on
the geriatric population. This distinction is a deep and nuanced understanding of the context in
which the patient presents plus the focus on that context and population that gives the clinician
the ability to anticipate risk for newly developing pathologies and the direction of change in
patient function as changes occur. This is analogous to what distinguishes oncology from other
specialty practice areas including geriatrics.
Cancer is an age related condition. Surveillance, Epidemiology and End Results (SEER)
data demonstrate that the median age of diagnosis for all cancers combined from 2006 to 2010
was age 66 years.1 Risk of developing cancer in numerous sites including bladder, breast, lung,
kidney, prostate, pancreas, colon, and others increases with advancing age. Yet, despite the
importance of cancer in the geriatric population, neither the geriatric examination content
outline nor the geriatric DSP demonstrate placing the importance of cancer in the practice area
necessary to take to manage a cancer survivor. The geriatric examination content outline
mentions the word “cancer” one time, under the category “medical conditions, other.” The
9
position of this mention under the category “other” reveals the level of focus on cancer in the
geriatric specialty. The geriatric DSP demonstrates focus on content such as osteoporosis,
diabetes, fall prevention, and cardiopulmonary conditions in the elderly both in examples given
in the content outline and in their choice of case scenarios presented. Beyond vague general
phrases such as “epidemiology of chronic disease” the DSP mentions cancer only once in the
phrase “Considering the prognostic impact of other medical interventions (e.g., implanted
devices, pumps, radiation therapy, chemotherapy” as an example under “Practice
Expectations.” In the same section there is a mention of end of life care without specific
reference to cancer: “Considers quality of life in regard to end-of-life wishes, transitions, and
advanced directives (eg, quality of life scales…” While this lack of focus on cancer may initially
seem surprising, it is less so in view of the fact that the content of the practice survey leading to
the Geriatric DSP was “based on the Guide to Physical Therapist Practice” which also had no
mention of cancer. A communication from Jennifer Blackwood PT, PhD, GCS, Assistant
Professor, Coordinator of the Geriatric Post Professional Physical Therapy Certificate &
Residency Program, Physical Therapy Department, University of Michigan-Flint addresses this
issue: “I have considered your question regarding the amount of information regarding cancer
and other oncological related diagnoses described to be covered in the Description of Specialty
Practice (DSP) in Geriatrics. After a thorough review of the DSP in Geriatrics (2009 edition), a
very limited amount of information exists specifically addressing the age related changes in the
older adult in those who have had a cancer diagnoses. Specifically, on page 21 of the DSP,
cancer is listed as a medical condition covered in the ‘Other’ category aligned with both frailty
and autoimmune disorders. The DSP for geriatric specialization tends to focus and categorize
10
subject matter based on a three systems approach grounded in foundational sciences, clinical
sciences and behavior sciences with advanced age. Given the complexity of age related changes
as well as how these might be exacerbated by either the pathogenesis of cancer or the
treatments provided as a result of the disease process, it benefits the physical therapists who
treat older adults with cancer to have available an area of specialty practice that takes into
consideration the complexity of both of these areas of advanced practice. For example, the risk
of falling in the older adult increases with age and more so in those with cognitive impairment.
However, for the older adult with a history of chemotherapy induced peripheral neuropathy,
the risk is increased further, which also may be exacerbated by the cardiovascular changes that
may have occurred from various chemotherapy agents which can increase their risk of falling
through orthostatic hypotension.
I believe that the DSP in Geriatrics does a fine job in covering the three areas of science
listed above for the older adult, however there is quite a limitation in how oncological
diagnoses are addressed in this population. Therefore, in order to best serve the older adult
with a history or current cancer diagnosis, I believe they would be best served through
acquiring services from a physical therapist with an oncology specialization.”
Mary Bessette, PT, GCS is a highly experienced therapist who has taken a special
interest in cancer related fatigue and taken initiative to learn everything she can about that to
use in her practice, which emphasizes home health care in the context of military veterans. She
said the following when interviewed: “Becoming a geriatric specialist did not prepare me for
oncology at all. The things that come to mind for me include the psychological issues which are
huge for that population. All of the information about targeted cancer therapy and the human
11
genome information is very important and goes well beyond the focus of the geriatric specialty.
Understanding metastases and even pain control for the person with cancer goes beyond what
is typically included in the geriatric specialty. We absolutely need oncologic specialists. We
need to be able to collaborate with one another to solve these very complex problems. “
This review stands as evidence for the need of genuine specialists in oncologic physical therapy
to help develop the necessary knowledge and awareness of cancer among all physical
therapists including geriatric physical therapists.
NEUROLOGIC Physical Therapists
The neurological DSP emphasizes degenerative and traumatic conditions affecting the
nervous system. Oncologic diagnoses are only generally mentioned and used to elucidate
neurological system impairment rather than being the primary content focus. Additionally an
analysis of practice in 2008 noted that advanced neurological therapists have minimal exposure
to oncological diagnoses (brain tumors are approximately 4% of total caseloads.2
Earllaine Croarkin, PT, NCS has worked predominantly for the National Institutes of Health
since 1996. Earllaine said made the following remarks when interviewed: “Having seen
numerous neuro and oncological cases, I can attest that these two fields (neurology and
oncology) are unique and deserve their respective acknowledgement of advanced practice. I
believe there is little overlap in knowledge, skills and abilities among those who practice
advanced neurological and oncological physical therapy. And given the disease- based
framework that the study of oncological physical therapy lends itself to and the inherently
different subject matter, I believe there is sound reasoning to pursue the oncological
specialization.”
12
ORTHOPEDICS
The orthopedic specialty examination content outline makes no mention of any concept
specific to oncology whatsoever. Commonalities between the orthopedic examination outline
and the outline of knowledge specific to oncology presented in the oncology Description of
Practice (DSP) are limited to foundational categories such as knowledge of anatomy and history
taking, which are categories that appear in and are common to every specialty content outline
since they are basic to the practice of physical therapy regardless of focus area. Indeed those
are categories that also appear in the CAPTE criteria for education of the entry-level physical
therapist. While the specialist in orthopedics is has advanced training and competency in the
management of many of the individual impairments that affect cancer survivors, there is
nothing in the preparation of a specialist in orthopedics that gives that individual advanced
competency in managing patients comprehensively within the context of cancer. Advanced
practice management of the patient with cancer requires more than simply understanding
management of each potential impairment in a general population. The specialist in oncology
must be cognizant of the enormous and constantly changing literature related to new
developments in cancer management in order to be able to manage the various impairments
with a sophisticated and nuanced understanding of the impact of the medical, surgical, and
radiologic treatments that the patient undergoes on those impairments and the safety and
potential effectiveness of PT interventions. Patients in this population deserve to be managed
by specialists who, due to extensive experience in working with this specific population and
ongoing focus on this population, have a deep understanding of the social, spiritual, emotional,
and functional needs of persons who experience cancer throughout the lifespan. The oncologic
13
specialist physical therapist is distinguished from the orthopedic specialist physical therapist in
terms of the frequency with which they deal with the cancer population, the importance of
cancer related concepts to their practice, and the sophisticated level of judgment that they
bring to the process of preventing cancer, preventing morbidity resulting from cancer,
managing morbidity when it occurs, and supporting patients across the entire experience of
cancer from the point of diagnosis to the final outcome whether that be death or return to
normal life.
Melissa Mercogliano, PT, OCS has a private practice specializing in the treatment of
women after surgery for breast cancer. Melissa stated the following about her OCS
preparation: “I do an ortho eval on every oncology patient because often I find those
impairments contribute to the overall picture of lymphedema and or limited ROM, but ortho in
NO way prepares a person for the side effects of chemotherapy or the issues of radiated
tissues, the prolonged period of time for dealing with radiated tissue. Ortho does not give you
any of the tools for dealing with edema in a patient who has an impaired lymphatic system
whether that damage is acute or chronic. Ortho does not require you to learn blood levels and
when it is okay to exercise, etc.
I do not recall learning anything specific to oncology when preparing for my OCS,
but that was many years ago and they may have “tweaked” the requirements. I do
know now with my understanding regarding oncology, I also make sure that anyone
with a PMH of cancer, I am certain I understand what treatments they have received
because it may change my approach.”
14
In gathering information for this document we conducted an email survey and interviews
with a number of managers of physical therapy programs in various practice settings. A
physical therapy director in a major cancer center happened to have hired a new staff physical
therapist just within the last few months. This newly hired individual had also successfully
attained the OCS just before taking the position at the major cancer center. These comments
do not include information that could identify the director, the new hire, or the specific facility
in order to protect confidentiality of personnel information. The physical therapy director said
the following about the process of integrating that individual into the staff: “(This individual) is
brilliant! (She or he) has so much potential because (she or he) has the drive to have sought
this specialization in orthopedics, (she or he) has an analytical mind and the ability to critically
analyze information in a way that will be so important to our practice. But (she or he) came to
us with absolutely no knowledge of how to manage patients in this context. (She or he) needed
the same training that new grads have needed with respect to a comprehensive understanding
of cancer, it’s treatments and how they affect patient function across the lifespan, recognition
of medical emergency situations in cancer, the language of cancer that is necessary in order to
communicate on an appropriate level with the oncologists and surgeon s here, and everything
else that is absolutely necessary in order to practice successfully and at the quality we require
here.”
PEDIATRICS
The pediatric examination content outline is the most extensive of all of the specialist
examination outlines in terms of mention of cancer related topics. The examination outline
includes a list of conditions after the phrase “Prevention and management of impairments,
15
functional/activity limitations, and participation restriction in infants, children, adolescents, and
adults whose impairments and limitations arose in childhood due to…” The condition list
includes osteosarcoma and limb salvage, and brain tumors. Interestingly, the most common
group of cancers affecting children, leukemia, is not specifically mentioned in this list.
However, the examination content outline also includes the phrase “Management of
impairments and functional limitations in infants, children, adolescents, and across the life span
arising from other diseases and syndromes, including…” and the list that follows that phrase
includes “hematology and oncology” which would include leukemia. Management of
impairments and functional limitations in long term survivors of childhood cancers across the
lifespan would overlap with geriatrics since those survivors can be often expected to have a
normal lifespan; it is unlikely this was what was meant by the phrase. The work of Kirsten Ness,
PT, PhD, a pediatric cancer physical therapy specialist who is an epidemiologist, a researcher,
and associate faculty member at St. Jude Research Hospital, describes what may be meant by
the lifespan reference. She has authored numerous journal articles reporting on the health
problems that are experienced as late effects of childhood cancer across the lifespan and
encourages surveillance for these problems in order to promote health among this population
across the lifespan.3-6
Yet, even as the pediatric specialty demonstrates awareness of childhood cancers, the
existence of that awareness does not negate the need for oncologic physical therapy specialists.
While childhood cancers are the most common cause of death for children up to the age of 14,
childhood cancers are indeed relatively rare and most cancers occur in adults.1 The incidence
rate of all cancers combined climbs steadily with advancing age, and for example the incidence
16
rate of all cancers combined is 101 times higher for persons between the ages of 60 and 65
than it is for children between the ages of 5 and 9. The fact that both pediatric specialists and
oncologic specialists would share advanced knowledge about pediatric cancers would simply
enhance care for children.1
Carol Daly, PT, DPT, PCS, Lecturer, Coordinator of the Pediatric Post Professional
Physical Therapy Certificate & Residency Program, Physical Therapy Department, University of
Michigan-Flint made the following remarks in her communication: “I believe clinical
specialization in oncology would be a step toward ensuring the best available care for pediatric
patients/clients who are receiving treatment for cancer. The only two cancer diagnoses
included under the “List of Medical Conditions Seen by Specialists” in the currently available
Pediatric Description of Specialty Practice include brain tumors as a “Condition of the
neuromuscular system” and osteosarcoma – limb salvage as a “Condition of the
musculoskeletal system.” Clearly, this approach focuses on body system impairments rather
than on the complex combination of physical, psychosocial, and life span concerns that should
be addressed by physical therapists treating children affected by a wide range of cancers.
I see the knowledge and skills required for advanced physical therapy practice in
oncology as different from those of advanced physical therapy practice in pediatrics. I believe
this is especially true as the science involved with cancer treatment continues to change at
rapid pace, and in particular the ways that chemotherapy impacts the developing systems of a
child. As an ABPTS pediatric clinical specialist, I reach out to physical therapists with expertise
in oncology when I receive a referral for a child with a cancer diagnosis so that I can gain a
17
better understanding of current cancer treatment and how it will impact the physical therapy
plan of care.”
Annemarie F. Kammann, PT, MEd, PCS is a pediatric specialist who is also a cancer
survivor states: “An oncology specialization is more than needed at this time. There are no
expert resources specifically well versed in oncology to assist with school placements,
integration back into the community and assisting the children and parents/caregivers deal
with the lifestyle changes and other issues that arise.
As a pediatric specialist, I have not felt prepared to deal with the above issues but have
learned from trial and error to assist the children and families to the best of my ability. As a
cancer survivor , I find the lack of extended care for fatigue, lifestyle changes and learning to
cope at times seems like a moving target and is inexcusable. I thoroughly hope that you are
able to establish an oncology specialty since I believe it is well overdue.”
WOMEN’S HEALTH
For the sake of completeness, we are also including comments about overlap with the
Women’s Health Specialty. The Women’s Health DSP refers to cancer under the heading
“Prognosis,” specifically using the general term “cancer” at one point in a list of chronic
illnesses that can affect prognosis. The document specifically mentions considering “recurrent
lymphedema” as a risk factor related to long term prognosis, and considering the effects of
chemotherapy and radiation on musculoskeletal function following breast or urogenital
cancers. These same areas of cancer are mentioned again in interventions. While women’s
health specialists are involved in care of these specific cancers, and they demonstrate some
advanced knowledge about that care, the key point is that women’s health specialists are
18
involved only with breast cancer and urogenital cancers. While breast and prostate cancer
specifically are common cancers and some of this knowledge represents overlap between
women’s health specialists and oncologic specialists, oncologic specialists deal with and have
advanced knowledge about all types of cancer. Oncologic rehabilitation and the specialist
physical therapists who lead care in that area must be based on a comprehensive knowledge
base across all cancer types.
In her letter supporting the oncologic specialty, Wendy Featherstone, PT, DPT, and
President of the Section on Women’s Health said the following: “None of the specialty areas
already established under ABPTS are entirely and absolutely unique. Women's Health, for
example, might include treatment of the female athlete, or the geriatric client with
incontinence. This does not negate the importance of certified specialty in women's health,
sports, or geriatric physical therapy.
There is no question in my mind that physical therapy treatment of the cancer
patient is a specialty practice area. Although there is overlap among many areas of
practice, I would challenge the notion that this detracts from the wealth of specific
knowledge required to understand the intricacies of chemotherapy, radiation, and
surgery, their effect on the various body systems, and their impact on physical therapy
treatment. “
In conclusion, the information provided in this section identifies no reason to
expect that specialists from other areas of practice will automatically have the
knowledge and skills for advanced practice in oncology. Perhaps more importantly, to
attempt to manage this complex and fragile population in a fragmented approach where
19
some of the cancers are handled by geriatrics, some pediatrics, some women’s health,
etc., with no particular specialist holding advanced knowledge about the big picture of
oncology will likely result in inefficient and less effective physical therapy care for cancer
survivors. We can provide improved quality of care with the addition of clinical
specialists in oncologic physical therapy.
1. Surveillance Epidemiology and End Results Fact Sheets, vol. August 2013: National Cancer
Institute, 2012.
2. Perry SB, Rauk RP, McCarthy A, Milidonis MK. Competency-based validation of neurologic
specialty practice. J Neurol Phys Ther 2008;32(2):62-9. Available from
8645293
3. Ness KK. Limitations on Physical Performance and Daily Activities among Long-Term Survivors
of Childhood Cancer. Annals of Internal Medicine 2005;143:639.
4. Ness KK, Armenian SH, Kadan-Lottick N, Gurney JG. Adverse effects of treatment in childhood
acute lymphoblastic leukemia: general overview and implications for long-term cardiac health. Expert
review of hematology 2011;4:185-97.
5. Ness KK, Hudson MM, Pui C-H, Green DM, Krull KR, Huang TT, et al. Neuromuscular
impairments in adult survivors of childhood acute lymphoblastic leukemia: associations with physical
performance and chemotherapy doses. Cancer 2012;118:828-38.
6. Ness KK, Morris EB, Nolan VG, Howell CR, Gilchrist LS, Stovall M, et al. Physical performance
limitations among adult survivors of childhood brain tumors. Cancer 2010;116:3034-44.
20
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Criterion 6: Education & Training
ABPTS Feedback:
6.1 Describe in detail the nature of recognized education and training programs including their length, content, and objectives.
Sufficient detail on the available education and training programs was not provided. As noted in this criterion description, the petitioner must describe in detail
the nature of recognized education and training programs, including their length, content, and objectives. Although pages 173 to 202 were referenced, ABPTS
requests that the pertinent information be extracted and appropriately placed within this section of the petition. It was suggested that providing this information
in a table format may be beneficial to the petitioner.
6.2 Provide a complete listing of such programs, detailing sponsoring organizations or institutions, locations, and individuals in charge.
As with section 6.1, insufficient detail was provided to meet the requirement for section 6.2. A complete listing of programs should be included, detailing
sponsoring organizations or institutions, locations, and individuals in charge. Although pages 173 to 202 were referenced, ABPTS requests that the pertinent
information be extracted and appropriately placed within this section of the petition.
Revised Sections:
6.1 Describe in detail the nature of recognized education and training programs including their length, content and objectives
Table 1 provides detailed information about the education and training programs that are available for the oncologic specialist.
These include:
x Annual specialty conferences in Oncology Rehabilitation – taken on by the larger academic and specialty cancer hospitals and
centers, these aim to promote and highlight evidence-based emerging trends in oncology rehab. (details in Table 1)
x Oncology Section educational programming at APTA Conferences- The Oncology Section has a long-standing history of offering
robust, relevant and well-attended programming at: (details in table 1)
o Combined Sections Meeting
o Annual Conference
o Vision 2020 Regional Conferences
o National Student Conclave
x Oncology Section regional continuing education – The section offers 4-6 courses throughout the year that cover broad regional
areas to provide educational opportunities outside of major conferences and courses. (details in table 1)
x APTA Chapter-sponsored Cancer Rehabilitation courses – A number of APTA Chapters have conducted courses focused in
oncology as a part of their educational track programming at yearly conferences. (details in table 1)
x Private Continuing Education Unit courses specific to Cancer Rehabilitation – Several private companies, recognizing the need
for specialty education, have created CEU courses specific to oncology. These courses further expand the geography of where
oncology rehab courses are offered.
x Local oncology community courses – many academic medical centers, cancer centers and community hospitals have recognized
x
x
x
the need to have physical therapists among their community of care who have advanced education and training in Cancer
Rehabilitation and have provided unique courses to promote the growth of specialty practice among their communities. (details
in table 1)
Lymphedema Training Courses- Cancer is the leading cause of lymphedema in the United States. There are several courses that
teach content specific to lymphedema management; a critical skill set to the oncologic specialist. (details in table 1)
On-line oncology courses – Offering continuing education in an on-line format enables timely access to relevant, advanced
curricula for persons unable to travel to attend courses or conferences. (details in table 1)
Additional annual interdisciplinary conferences for oncologic specialists to receive education and training
o American Society of Clinical Oncology (ASCO) Annual Conference – held in June each hear.
o ASCO Specialty Conferences:
ASCO Breast
ASCO Colorectal
ASCO Lung
ASCO Prostate
o San Antonio Breast Symposium – annual conference held in December each year.
o American Society of Therapeutic Radiation Oncology (ASTRO) – yearly conference held in October
o Biennial Cancer Survivorship Conference – a bi-annual conference, co-sponsored by the Lance Armstrong Foundation
and the American Cancer Society held in June.
o The National Lymphedema Network Biennial Conference – a bi-annual conference held in September
6.2 Provide a complete listing of such programs detailing sponsoring organizations or institutions, locations and individuals in charge
Table 1 provides a comprehensive listing of the programs outlined in 6.1, offerings are described below by category.
Education and
Training Program
April 1997
Cancer Rehabilitation
at the Forefront (9
hr)
Content
Faculty
Objectives
Topics: Outpatient
mastectomy care and
lymphedema, radiation
fibrosis, wound and skin
care.
Presenters: Douglas Arthur
MD, Lisa Bomar PT, Valerie
Cauthern MSW, Patrick
Coyne RN CRN, Margaret
Denvil BA CSG, Ken Faulkner
M Div, Stephen Gudas PT
PhD, Jane Hays PT, Kathleen
Hudson RN CETN, Bobby
Johnson OTR, Laurel
Participant Objectives:
o Identify design components of an effective cancer
rehabilitation team
o Examine role responsibilities of the interdisciplinary team
o Explores health care, economic and reimbursement issues
impacting patient care
o Discuss advocacy, decision making and clinical
management of the cancer patient during diagnosis,
treatment, recurrence and preparation for death
2
October 1999 Cancer
Rehabilitation:
Facilitating Quality of
Life (12 hr)
Topics: General physical
rehabilitation,
lymphedema treatment,
fatigue, palliative care,
oncologic emergencies
Lyckholm MD, Elaine
Naumann RC MS, Kathleen
Orme RN, Susan Scheer PT,
James Shaw MD, Thomas
Smith MD, Kathleen Speigel
RN MS OCN, Jeanne Walter
RN MS AOCN, Ashby
Watson RN MS OCN,
Patricia Whanger MSW,
Corrine Boucher-Carpenter
OTR, Linda Smith Burns
OTR, Lawrence Colley MD,
Terry Cyr MS SLP, Cathy
Gould RD MS, Phyllis Katz
Esq, Sandra Kirchner PT,
Charles McGarvey PT, Jane
Woods
Presenters: Lisa Bomar PT,
Ken Faulkner M Div, Sherry
Fox, RN MS CNRN, Stephen
Gudas PT PhD, Mary Helen
Hackney MD, Kate
Humphrey PT, Bobby
Johnson OTR, Catherine
Lantz RN MS AOCN, Laurel
Lyckholm MD, James Parrot
BS, John Roberts MD, James
Shaw MD, Cynthia Simonson
RN MS AOCN, Thomas Smith
MD, Wade Smith MD,
William Tatu PT, Ashby
Watson RN MS OCN, Jo
Lynne Wheeler RN MS,
Kristine Willis RN MS OCN,
o Recognize issues affecting quality of life in cancer patients
o Describe the impact of fatigues on the individual and
family dealing with cancer
o Identify contemporary ethical issues impacting end of life
decisions by and for cancer patients
o Describe factors affecting sexuality and sexual
adjustments in cancer patients
o Recognize the range of issues that affect managed
o Recognize new trends in metastatic disease
o Identify trends that will impact cancer care in the 21st
century
3
October 2001 Cancer
Rehabilitation: An
Interdisciplinary
Approach (12 hr)
Topics: Epidural
compression, brain
tumors, musculoskeletal
tumors, metastatic bone
disease, pediatric
malignancies, head and
neck cancer
October 2003 Cancer
& Rehabilitation:
Past, Present and
Future (12 hr)
Topics: Bone marrow
transplantation, lung
cancer, general physical
rehabilitation, colon
cancer, palliative care
Dina Boettcher MS PT LMFT,
Bernice Harper MSW
MSCPH LLD, Phyllis Katz Esq,
Sandra Kirchner PT, Lillian
Nail RN PhD FAAN, Jane
Woods
Presenters: Peggy Bishop RN
MS OCN, Jim Bonomo MDiv,
William Broaddus MD,
Brenda Early MS OTR, Chris
Foster MD, Stephen Gudas
PT PhD. Mark Huang MD.
Walter Lawrence MD, Laurel
Lyckholm MD, John McCarty
MD, William McKinley MD,
William Perkins CTRS, Seam
Powell MSW, Andrea Pozez
MD, Thomas Smith MD,
William Tatu PT, Ashby
Watson RN MS OCN, John
Barsanti MD, Lora Packel PT,
Rebecca Byrd MD, Lynn
Gerber MD, Mikel Gray RN
PhD
Presenters: Sherman Baker
MD, Harry Bear, MD PhD,
Harold Chung MD, Neri
Cohen MD, Stephen Gudas
PT PHD, Brian Kaplan MD,
James Shaw MD, Danny
Song MD, Thomas Smith
MD, William Tatu PT, Andrea
Cheville MD, John Densmore
MD
o Recognize the interdisciplinary team approach on the
management of cancer patients
o Identify current evidence abed on research in cancer
rehabilitation
o Describe management strategies ion the rehabilitation of
patients with breast, bone, and/or brain cancer
o Discuss the role of alternative therapies in the
management of cancer
o Recognize the range of issues that affects survivors of
childhood cancer
o Describe current approaches for invasive pain
management and erectile dysfunction in cancer patients.
o Identify the major principles of management in epidural
spinal cord compression, and head and neck cancer, and
the psychosocial ramifications of a new cancer diagnosis
o Describe the history of cancer rehabilitation, current
rehabilitation problems, and future trends in the
rehabilitation of cancer patients
o Describe the past accomplishments, current concepts, and
future trends for the following cancer sites: lymphoma,
lung, breast, and colorectal
o Discuss past, current, and future issues of stereotaxic
radiation, and bone marrow transplantation
o Describe past, present and future issues on palliative care
4
October 2005 Cancer
Rehabilitation:
Evidence Based
Practice (12 hr)
Topics: Fatigue
management, peripheral
neuropathy, genitourinary
tract cancer, breast
cancer, lymphedema
September 2007
Dimensions of Care:
Mind, Body and Spirit
(12 hr)
Topics: Survivorship,
innovative collaboration
and partnerships, exercise
guidelines, chemotherapy
induced disabilities,
holistic care
Presenters: Harry Bear MD
PhD, Cecelia Boardman MD,
Lisa Bomar PT CLT-LANA,
Kevin Brigle RN PhD, Debbie
Cadet MSW, David Cifu MD,
Patrick Coyne RN MS APRN
FAAN, Mary Helen Hackney
MD, Debra Lyon RN PhD,
Noreen Rossi PT, Mary
Saunders RN MS OCN,
Haidee Waters RN DNSc
ANP, Diane Wilson RD EdD,
Mary Ann Dalzell PT, Eileen
Donovan PT, Lillian Nail RN
PhD FAAN
Presenters: Anika Alvaron
MD, Sandra Barker PhD,
Woodward Beach SLP PhD,
James Bonomo MDiv, JoAnn
Bodurtha MD, Karin Bryant
RN, Debbie Cadet MSW, Ken
Faulkner MDiv, Timothy
Ford MA MS CT, Mary Helen
Faulkner MD, Stephanie
Hamilton MDiv, Alton Hart
MD, David Hess PhD ABPP,
Bobby Johnson OTR, Tamara
Orr RN PhD, Malcolm Sydnor
MD, William Tatu PT, Haidee
Waters RN PhD, Kristie Willis
RN MS OCN, Mary Lou
Galantino PT PhD,
Georgianne Ginder MSc
CHWC, Rebecca Massey BS,
o Define evidence based practice and how it relates to cancer
rehabilitation
o Describe current evidence based practice for the following
cancer sites: gynecologic, prostate, testes, lung
o Discuss evidence based practice as it embodies the
following cancer related topics: invasive pain management
techniques, fatigue and anemia, alternative therapies,
lymphedema management, and nutrition and exercise
o Outline the principles of a multidisciplinary approach in a
patient with breast cancer as presented by a panel of
cancer clinicians
Participant objectives:
o Define dimensions of care: mind, body and spirit and how
it integrates into cancer rehabilitation practice
o Outline methods of incorporating holistic aspects of care
into the cancer experience
o Discuss complementary therapies and their role in
treating the whole patient
o Explores the importance of survivorship issues on followup cancer care
5
April 2010
Cancer
Rehabilitation:
Future Directions in
Specialized Care (6
hr)
Topics: Bony metastases,
shoulder impairment,
pediatric oncology,
leukemia rehab concerns,
supportive care
May 5, 2012
Integrative Medicine
in Cancer
Rehabilitation (6 hr)
Topics: Integrative
Medicine in Cancer
Rehabilitation such as Tai
chi, Yoga, ball and falls in
patients with cancer,
exercise training for
geriatric patients with
cancer, etc…
CSM 2012
Preconference
course (1 day):
Topic: Management of
Balance Impairments
Margaret Rinehart-Ayres PT
PhD, Patricia Schmitt RN MS
Presenters: Matthew
Bitsko, PhD, Kevin Brigle RN
ANP PhD, Stephen Gudas
PT PhD, Andrea Leiserowitz
PT CLT, Charles McGarvey
PT FAPTA, Cindy Pfalzer PT
PhD FAPTA, Rick Wilson PT
PhD
Presenters: G. Stephen
Morris, PT, PhD, Cindy
Pfalzer, PT, PhD, FAPTA,
Stephen Gudas, PT, PhD,
Mary Ann Hager, MSN, RN,
Mary Helen Hackney MD,
Mary Shall, PT, PhD, Jo
Lynne Robins RN, PhD, ANR,
AHNC, CHJP, Suzanne
Fleming, OTR, MBA/HCM.
Presenters: Jennifer
Blackwood, PT, MPT, GCS,
o Define specialized practice and how it relates to cancer
rehabilitation
o Describes specialized cancer rehabilitation care for the
following areas: breast cancer, bony metastases,
childhood cancer, cancer related shoulder dysfunction,
leukemia and related disorders
o Outline and describe physical activity as it relates to the
supportive care of the cancer patient
o Describe the importance of involving parents and other
family members in the rehabilitation of the pediatric
cancer patient
o Explore the role of the rehabilitation therapist in palliative
care
o
o Define integrative medicine and how it relates to cancer
care and specifically to cancer rehabilitation.
o Describe the role of yoga in cancer rehabilitation and
continuing care.
o Describe the role and use of Tai chi in cancer
rehabilitation and continuing care.
o Explore the impairment of balance and the significance of
falls in adult cancer survivors.
o Outline exercise training guidelines for individuals
experiencing cancer.
o Describe how the roles in patient-family relationships can
be sustained throughout the cancer experience.
o Describe the unique and diverse local and systemic effects of
6
Evidence in Action: A
Comprehensive
Management of
Balance Impairments
and Falls For Adult
Cancer Survivors
and Falls For Adult
Cancer Survivors
Min-Hui Huang, PT, PhD,
NCS, Lucinda Pfalzer, PT,
PhD, FAPTA, Amy Yorke,
PT, MPT, NCS
x
Exercise
Guidelines for
Patients with
Cancer: Where
Are We? Where
Would We Like
to Be? Where's
the Physical
Therapy? Part 1
(2 hr) and Part II
(1hr)
Morris, PT, PhD, Ann
Flores, PT, PhD, MS, MA,
CLT, Lucinda Pfalzer, PT,
PhD, FAPTA, Elizabeth Hile,
PT, PhD, NCS
x
Peripheral
Edema: Diagnosis
and Treatment
Strategies Across
All Patient
Populations, Part
I (2 hr) and Part II
(1 hr)
Presenters: Marisa
Perdomo, PT, DPT,
Antoinette P. Sander, PT,
DPT, MS, CPT-LANA, Kimiko
A. Yamada PT, DPT, OCS,
CSCS, ATC, Dawn
Franceschina, PT, DPT,
Michael Simpson, PT, DPT
x
Preventive
Rehabilitation: A
Presenters: Keren PalgiBornstein PT, DPT, Jean M.
cancer that impact balance.
Describe the local and systemic effects of cancer treatment
that impact balance.
o Apply the appropriate screening tools with the ICF model to
manage balance impairment in a patient with cancer.
o Apply evidence based examination strategies to assess
balance in a patient with cancer.
o
Apply evidence based intervention
strategies to treat balance dysfunction in a patient with
cancer.
o Discuss acute and adaptive changes brought about in the
oncology population by participating in an exercise training
program.
o Explain why participation in an exercise training program
should be considered a treatment option for most oncology
patients.
o Describe common methods of exercise testing.
o Generally understand the basics of exercise prescriptions.
o
Discuss currently available exercise
guidelines available for use in the oncology population.
o
Apply these recommendations to an
oncology patient population.
o Utilize the pathophysiology of edema in the differential
diagnosis process to determine if physical therapy is
appropriate for the patient or if referral for medical consult is
warranted.
o Examine a variety of edema interventions that can be used
across patient populations.
o
Select edema interventions based on the
etiology of the edema and best evidence available.
o Describe Memorial Sloan Kettering Cancer Center’s (MSKCC)
o
7
Novel Approach
to the
Hospitalized
Oncology Patient
(2 hr)
x
Diagnosis Dialog
for Oncology
Physical
Therapists (2 hr)
Kotkiewicz PT, DPT
comprehensive post-operative pulmonary program for eligible
surgical patients and be familiar with the guidelines of care
and relevant supporting research.
o Discuss MSKCC’s wellness program for inpatients receiving
allogenic BMT and a typical treatment plan for this not-sotypical patient population.
o Educate PTs about MSKCC’s Early Mobility Program for
intubated ICU patients and the techniques and methods for
minimizing functional decline during this tenuous period.
o Explain MSKCC’s comprehensive treatment approach for
medically complicated lymphedema and edema patients and
discuss MSKCC’S lower extremity lymphedema prevention
group and its benefits to the targeted postoperative
population.
o Describe MSKCC’s breast surgery rehabilitation group for all
immediate post operative breast surgery patients, including
all reconstructive and non-reconstructive procedures.
o Describe MSKCC’s developing program targeting patients with
planned removal of large vessels and ways to most effectively
manage postoperative lymphedema and vascular
insufficiency.
o
Apply this new prevention method using
a pre-operative team approach for compression garment
fitting.
Presenters: Catherine
o Relate the history of diagnosis in PT, the diagnosis dialog
Goodman PT, MBA, CBP,
discussions, and the dilemmas related to the development of
Barbara Norton PT, PhD,
movement system-based diagnoses.
FAPTA, Lisa Massa PT, WCS,
o Discuss the need for widespread, consistent use of commonly
Molly Reynolds PT, Stacie
Larkin PT, DPT, Med, Jean
understood terminology for diagnosing dysfunction of the
O’Toole PT, MPH
human movement system.
Explain how the use of a common
o
diagnostic scheme will impact clinical practice of physical
therapists working with oncology patients.
8
o
x
Diagnosis Dialog
for Oncology
Physical
Therapists (2 hr)
x
Cancer in
Children: A CaseBased Approach
Part 1 (2 hr) and
Part II (1hr)
x
Oncology Section
Task Force on
Breast Cancer
Outcomes (2 hr)
Introduce a process for developing a
diagnosis for patients with movement problems related to
cancer or the treatment of cancer.
O’Toole PT, MPH
o Explain how the use of a common diagnostic scheme will
impact clinical practice of physical therapists working with
oncology patients.
o Introduce a process for developing a diagnosis for patients
with movement problems related to cancer or the treatment
of cancer.
Presenters: Lynn Tanner
o Describe the process of screening and differential
PT, MPT, Colleen Coulter
diagnosis/red flags for children with signs and symptoms that
PT, PhD, Shawn Israel PT,
may indicate the presence of a hematological, nervous
DPT, Angela M. Corr PT,
system, or bone/soft tissue malignancy.
DPT, Denise Cortes PT,
o Review the pathophysiology for selected cancer diagnoses
MBA, PCS
o Establish a medical and therapeutic management plan for
selected cancer diagnoses
o Discuss potential lifelong challenges and late effects of
treatment that face children who were treated for cancer.
Ask questions about the cases and openly
o
discuss issues relating to the diagnosis, treatment, and longterm management of children with cancer.
Presenters: Pamela K.
o Briefly describe the most common impairments of body
Levangie PT, DSc, DPT,
structure and activity limitations in individuals treated for
FAPTA, Mary I Fisher PT,
breast cancer.
MSPT, OCS, Marisa
Perdomo PT, DPT, Tiffany
o Describe the role of consistency in outcomes assessment to
9
Kendig PT, MSPT, MPH
x
Orthopedic
Manual Therapy
for the Individual
with Movement
Impairments
Resulting from
Radiation
Therapy (2 hr)
x
Oncology
Physiotherapists:
Preventing
Cancer and
Treating the
Metastatic
Sequel (1.5 hr)
x
Physical Therapy
Management of
Individuals with
HIV: An Overview
monitor patient status and demonstrate intervention
effectiveness in both individuals and patient groups.
Identify selected outcome measures that
o
can appropriately be used for individuals about to undergo
treatment or who have been treated for breast cancer.
Discuss the relative merits of presented
o
outcome tools based on psychometric properties,
administration issues, and limitations.
Presenters: Marisa
Perdomo, PT, DPT, Chris A. o Select the appropriate examination tests and measures for
Sebelski PT, DPT, OCS, CSCS
the shoulder complex and hip-pelvis complex which include:
accessory mobility, muscle length, and assessment of end-feel
for the patient with complications from radiation therapy.
o Create a plan of care that integrates a progression of soft
tissue mobilizations and joint mobilizations (grade I-V) with
appropriate follow-up of therapeutic exercise.
List the contraindications and indications
o
for manual therapy for tissues affected by radiation therapy.
Presenter: Oren Cheifetz
o Describe the strengths and weaknesses of the evidence
PT, MSc
supporting the role of physiotherapists In the prevention of
cancer.
o Describe strategies to engage patients with cancer in
exercise programs.
o State the indications for the use of exercise for patients with
cancer.
o Relate to the challenges of using exercise for patients with
cancer.
o
Demonstrate an understanding of safety
considerations relevant to exercise for patients with cancer.
Presenters: David Kietrys
PT, MS, OCS, Mary Lou
o Describe the neuromusculoskeletal features of HIV and
Galantino PT, PhD, MSCE
discuss their effects on function.
o Design safe exercise programs based on the stage of the
10
and Update (2 hr)
disease for HIV-positive individuals.
Describe the role of the PT or PTA in the management of
common impairments associated with HIV and its
comorbidities, and integrate physical therapy interventions
into a multidisciplinary model.
Apply recommendations for social issues,
o
such as working with HIV-positive athletes and occupational
exposure.
o Create a template for oncology rehab education for PT
generalists in a large health network.
o List disease-specific, PT-related impairments and
interventions according to primary cancer and side effects of
cancer intervention.
o Discuss assessment tools, including the use of electronic
learning modules to measure PT competency versus direct inservice with written competency.
o
x
Oncology PT
Intervention
Performed by a
Physical
Therapist
Generalist:
Educational
Strategies to
Improve Safety
and Outcomes
(1.5 hr)
CSM 2011
x Preconference
course (2 day):
Upper Extremity
Lymphdema: The
Art and Science
of Physical
Therapy
Interventions
Presenter: Linda McGrath
Boyle PT, DPT, OCS, CLTLANA
Presenters: Elizabeth Augustine
PT, DPT, MS, Marisa Perdomo
PT, DPT, MS, Antoinette Sandler
PT, DPT, MS, CLT-LANA, Lisa
VanHoose PT, CLT-LANA, WCC
x Evaluate individuals with UE lymphedema, determine if
PT is appropriate or refer to another health care
provider for further differential diagnostic testing.
x Design an individualized intervention program that is
based on the anatomy and physiology of the lymphatic
system and is supported by best available evidence.
x Perform manual lymphatic drainage mobilizations (LD)
and modify the technique based on the quality and
nature of the edema.
x Apply appropriate UE compression short stretch
bandaging techniques and adapt the technique to
maximize therapeutic response from tissues with
fibrosis.
11
x
x
x
x
Measuring
Outcomes in
Physical Therapy
Note: This course
has been
implemented as a
repurposed online course in the
new APTA
Learning Center
(3 hr)
A Framework for
Treating Patients
with Oncological
Diagnoses Using
a Systems-Based
Approach (1.5 hr)
Presenters: G. Stephen Morris
PT, PhD, Mary Lou Galantino PT,
PhD, MSCE, Kirsten Ness PT,
PhD, MA, MPH, Laura Gilchrist
PT, PhD, Meredith WamplerKuhn PT, DPTSc, Victoria
Marchese PT, PhD
Oncology
Exercise Issues in
Outpatient
Physical Therapy:
Beyond Range of
Motion and
Presenter: Mary Lou Galantino
PT, PhD. MSCE, Matthew Taylor
PT, PhD
Presenter: Stephanie Cramme
PT, DPT, Diane Heislein PT, DPT,
MS, OCS
Develop an appropriate physical therapy based
lymphedema home program
x Recommend the appropriate compression garment
o Describe common impairments, limitations, and
participation restrictions found in the oncology
rehabilitation population.
o Describe issues related to the selection of appropriate
outcome measures.
o Select appropriate outcome measurements for various
issues related to oncology rehabilitation.
o Illustrate, through the use of case studies, the
appropriate selection of outcome measures in oncology
rehabilitation.
x Describe a comprehensive systems-based approach to
the physical therapy examination and treatment of
patients with cancer.
x Identify potential impairments and functional
limitations that may result as a direct consequence of
chemotherapy and/or radiation therapy treatment for
x Outline comprehensive evidence based interventions to
address integumentary issues in a patient with
leukemia, neuromuscular and cardiopulmonary issues
in a patient with metastatic lung cancer, and
musculoskeletal issues in a patient with metastatic
prostate cancer.
o Describe what is meant by full-spectrum movement
prescription contrasted with traditional therapeutic
exercise prescription.
o Describe how full-spectrum movement prescription
addresses the most common effects of cancer and its
12
Fitness
Prescription (2.75
hr)
treatment.
Evaluate outpatients with oncological disease for fullspectrum movement prescriptions beyond traditional
o Analyze a case report of an outpatient prescription for a
patient with oncological disease.
o Access resources for oncological patients within their
community as well develop niche programming within
their clinics.
o Describe the pathophysiology of CIPN.
o Describe medical management of CIPN, both for
prevention and symptom control.
o Describe the signs and symptoms of acute CIPN, and the
long-term structural and functional impairments and
associated performance limitations in individuals with
persistent CIPN.
o Develop an appropriate physical therapy management
plan for individuals with acute or chronic CIPN.
o Identify and describe the most common forms of
malignancy in childhood.
o Briefly describe the typical medical treatments for
childhood cancers.
o Identify the adverse effects of cancer and cancer
treatment that necessitate physical rehabilitation.
o Demonstrate a basic knowledge of how to effectively
screen patients to determine the need for occupational
and/or physical therapy services in the acute pediatric
oncology setting.
o Recognize the psychosocial issues that are common in
families of a child with cancer and determine strategies
to assist with coping
o Understand the benefits of physical therapy intervention
o
x
Medical and
Physical Therapy
Management of
ChemotherapyInduced
Peripheral
Neuropathy
(CIPN)( 1.5 hr)
Presenters: Laura Gilchrist PT,
PhD, Kirsten Ness PT, PhD, MA,
MPH, Lynn Tanner PT
x
Improving the
Quality of Life of
Children with
Cancer: The Role
of Rehabilitation
(2.75 hr)
Presenter: Susan Miale PT, DPT,
PCS
13
x
Comfort Care
Only-Therapy
Discontinued:
Can One Last Visit
Impact Quality of
Life? (1.5 hr)
Presenters: Mary-Jean Paulitz
PT, MS, Jo-Ellen Thomson PT
x
Exercise and the
Athlete with
Cancer (2 hr)
Presenter: Alison DeLeo PT, DPT
x
An EvidenceBased Approach
Presenters: Min-Hui Huang PT,
PhD, Lucinda Pfalzer PT, PhD,
in children with cancer from an evidence-based
perspective.
o Identify the dilemma of comfort care in physical therapy.
o Discuss the areas of focus for hospice physical therapy.
o Identify the safety needs of patients who are
transitioning to hospice.
o Describe ways that a PT can impact a patient’s comfort.
o Discuss family and caregiver training opportunities that
could positively impact a patient’s quality of life at the
time of discharge.
o Define the “athlete cancer survivor”
o Describe current guidelines for exercise in athlete
o Identify the potential physiologic changes to exercise
response related to treatment modalities for cancer,
including surgery, chemotherapy, radiation therapy,
hormone therapy, immunotherapy and bone marrow
transplantation.
o Identify indications and contraindications for exercise in
an athlete patient with cancer.
o Apply and modify the general principles of exercise
prescription to meet the needs of physically active
o Formulate safe and effective exercise programs for
athlete cancer survivors before, during and after medical
management of cancer.
o Generate hypotheses regarding expected outcomes for
physically active patients with cancer participating in
exercise programs.
o Identify and respond to oncological emergencies.
x Describe the unique and diverse local and systemic
14
x
x
x
to the
Identification and
Screening of
Balance for
Patients with
Cancer (1.5 hr)
to the
Examination and
Intervention of
Balance for
Patients with
Cancer (1.5 hr)
Successes and
Pitfalls:
Developing a
Sustainable
Comprehensive
Oncology
Treatment
Program (2.5 hr)
Breast Cancer
Physical
Restoration Using
the Pilates
Method (2.75 hr)
FACSM, FAPTA
effects of cancer that impact balance.
Describe the local and systemic effects of cancer
treatment that impact balance.
x Apply the appropriate screening tools with the ICF
model to manage a balance impairment in a patient
with cancer.
x Apply evidence based examination strategies to assess
x Apply evidence based intervention strategies to treat
balance dysfunction in a patient with cancer.
x Apply evidence based adaptation strategies for balance
dysfunction.
x
Presenters: Jennifer Blackwood
MPT, GCS, Amy Yorke MPT, NCS
Presenters: Teresa Fitzpatrick
PT, MBA, Mary Ann Calys PT,
DPT, MS, Andrea Leiserowitz
MPT,CLT, Kathie Hummel-Berry,
PT, PhD
Presenter: Suzanne Clements
Martin PT, DPT
o Outline a plan for establishing a comprehensive oncology
clinical service within the community
o Describe at least two strategies for marketing the
practice to referral sources
o Explain the rationale for structure of the necessary
rehabilitation team.
o Describe a strategy for appropriate staff training
o Analyze the benefits of automatic referral protocols
o List at least three possible pitfalls that could impede
success in program development
o Explain the short and long-term physical and
psychosocial impacts of breast cancer.
o Compare and contrast the physical and psychosocial
impacts on pre-menopausal and post-menopausal
populations afflicted with breast cancer.
o Apply an evidence-based rationale for physical therapy
intervention in the rehabilitation and post-rehabilitation
phases for survivors.
15
o
x
x
Newer
Technologies
Advance the
Evaluation and
Treatment of
Peripheral Edema
and Lymphedema
(2.75 hr)
CSM 2010
Preconference
course (1 day):
Presenters: Lesli Bell PT,
Elizabeth Campione PT, Marisa
Perdomo PT, DPT, Kathryn
Ryans PT, DPT
Presenter: Richard Briggs PT,
MA
Perform a functional evaluation to identify core/trunk
strength as well as weight-bearing (pelvic and lower
extremity) movement dysfunctions.
o Define the Pilates Method; explain, and demonstrate the
qualitative benefits and differences between the popular
Classic conditioning Method and the therapeutic
application of the Method, focusing on the Upper Core.
o Identify contraindications for Pilates/ exercise and plan
appropriate treatments in the therapeutic application of
the Pilates Method.
o Set up a home well-being program for managing the
chronic condition of breast cancer survivorship.
o Upon completion of this course, you will be able to:
Understand and discuss the physiological rationale for
utilizing laser therapy, bioelectrical impedance and
compression pumps for individuals with lymphedema.
o Perform an evidence based decision making thought
process to determine if laser therapy, bioelectrical
impedance and compression pumps are appropriate for
individuals with lymphedema.
o Develop a PT intervention plan of care that includes laser
therapy and compression pumps for individuals with
lymphedema.
Develop a PT intervention utilizing
o
laser therapy for those individuals who are at risk for
developing lymphedema.
Understand the role of these
o
modalities in the overall plan of care for individuals with
lymphedema and determine when and how to optimize
outcomes with the use of these modalities.
o Identify signs and symptoms of terminal disease
16
End of Life Care:
Issues of Living
and Dying in
Clinical Practice
x
Medical
Screening for
Oncology Issues
in Outpatient
Physical Therapy
(1.5 hr)
Presenters: Mary Lou Galantino
PT, PhD, MSCE, Laura Gilchrist
PT, PhD, Victoria Marchese PT,
PhD, G. Stephen Morris PT, PhD,
Kirsten Ness PT, PhD, MA, MPH,
Meredith Wampler PT, DPTSc
x
The Role of
Presenters: Carol M Davis DPT,
processes.
o Problem-solve clinical issues of life limiting conditions.
o Identify common syndromes and barriers to adequate
pain relief at the end of life
o Discuss both pharmacological and non-pharmacological
approaches to symptom control.
o Differentiate 5 clinical practice patterns in palliative and
hospice care.
o Explain cultural differences in dying rituals and grief
responses.
o Identify normal pediatric response behaviors to death.
o Demonstrate the integration of spiritual care during the
end of life.
o Discuss legal, ethical and physiologic concerns around
palliative sedation, withdrawal of food and fluid, and
assisted suicide.
o Describe advanced directives and their related
components (power of attorney, living will, do not
resuscitate orders.
o Identify healthy personal and professional coping skills
useful while working with the terminally ill.
o Screen general outpatients for potential oncological
disease.
o Analyze a case report of an outpatient assessment for
potential oncology “red flags”.
o Describe the most common late-effects of cancer and its
treatment.
o Screen patients with a previous history of cancer for lateeffects of cancer and its treatment.
o Determine appropriate referrals for oncology-related
issues in both patients with and without a previous
cancer diagnosis.
17
Integrative
Medicine in
Physical Therapy
for the Oncology
Patient (3.5 hr)
EdD, MS, FAPTA, Catherine
Goodman PT, MBA, CBP
x
New
Opportunities in
Physical Therapy:
Creating a
Hospice Based
Physical Therapy
Practice (3 hr)
Presenters: Ilene Decker RN,
PhD, Karen Mueller PT, PhD, JoEllen Thomson BS
x
Movement
System
Impairment
Diagnoses
Applied to the
Breast Cancer
Patient (2 hr)
Presenter: Renee Ivens PT, DPT,
MHS
o
Give examples of body work, mind/body work, and
energy work used with cancer patients.
o Participants will gain an introductory understanding of
BodyTalk and how it is used with cancer patients.
o Participants will learn 4 basic BodyTalk techniques to
use with anyone.
o Participants will observe a BodyTalk session.
o Discuss current and emerging trends in hospice care.
o Discuss the interdisciplinary structure of a typical
hospice setting.
o Discuss the benefits of physical therapy participation in
the hospice interdisciplinary team.
o Discuss opportunities for physical therapy practice in a
hospice setting.
o Discuss and apply strategies for creating a physical
therapy based hospice practice.
o Describe the types of physical therapy interventions
that can benefit patients in a hospice setting.
o Discuss appropriate physical therapy outcome measure
for use in a hospice setting.
o Discuss evidence regarding physical utilization in a
hospice setting.
o Discuss research findings related to physical therapy
outcomes in a hospice setting
o Identify which tissues are involved in a patient’s
movement dysfunction: soft tissue (muscle or joint
capsule), neural structures, lymphatic system and how
this assists in optimizing treatment
o Discuss the Physical Stress Theory as related to postsurgical or radiated tissues
o Describe the most common impairments in the
movement patterns of the shoulder girdle in this
18
population
Discuss the most common MSI Scapular and Humeral
Diagnoses affecting patients who have received
treatment for breast cancer
o Describe intervention strategies for MSI Diagnoses of
the scapula and humerus
o Understand the medical diagnostic process and
treatment of Head and neck cancers.
o Evaluate and treat the complex musculoskeletal
impairments and functional limitations most commonly
experienced by this population.
o Understand the musculoskeletal function of the head
and neck during speech and swallowing activities and
how PT interventions can compliment the speech and
swallowing therapy.
o Review and discuss appropriate orthopedic manual
therapy techniques for individuals recovering from
Head and Neck cancer.
o Develop a short-term and long -term comprehensive
multidisciplinary treatment approach for the individual
recovering from Head and neck cancer treatments.
o Develop and foster relationships with other
rehabilitative health care professionals in order to
optimize outcomes for individuals recovering from Head
and Neck Cancer.
Educate and instruct the individual
o
with Head and neck cancer in an appropriate manual
lymphatic drainage home program for lymphedema.
o
x
Multidisciplinary
Rehabilitation
Approach for the
Treatment of
Head and Neck
Cancer-Related
Impairments (3
hr)
CSM 2009
x Preconference
course (2 day):
Physical Therapy
Examination and
Presenters: Melody OuYoung
MS, CCC-SLP, Marisa Perdomo
PT, DPT
Presenters: Jacquelin Drouin PT,
PhD, Charles McGarvey PT, DPT,
MS, FAPTA, Lucinda Pfalzer PT,
PhD, FACSM, FAPTA, Margaret
Participant Objectives
o Describe sequelae of breast cancer treatment that may
lead to impairments and functional limitations.
o Assess patients for breast cancer specific impairments
19
Intervention for
Breast Cancer
Survivors
Rinehart-Ayres PT, PhD, Nicole
Stout MPT, CLT-LANA
x
Being Present
with Suffering,
Loss, or Dying
(2hr)
MA
x
Physical Therapy
and Prostate
Cancer (2 hr)
Presenter: Jacquelyn Drouin, PT,
PhD
including; lymphedema, shoulder dysfunction, postural
deviations, strength and ROM loss
o Develop a treatment plan specific to breast cancerrelated impairments with consideration for treatment
side effects.
o Understand the indications, precautions and
contraindication related to physical therapy
interventions with patients who have a history of
cancer.
o Develop an understanding of the role of the physical
therapist in pre-operative assessment and ongoing
surveillance screening of patients with breast cancer in
the absence of impairment.
o Identify personal issues of loss related to end of life
care.
o Integrate issues of dignity and independence into their
practice with declining patients.
o Practice awareness of body sense, thoughts and
emotions during clinical interactions
o Describe three methods to enhance their growth while
caring for the dying.
o Recognize language of spiritual concerns voiced in
patient care.
o Describe and appreciate factors of prevention, screening,
treatment, and rehabilitation of prostate cancer
including differences across cultures.
o Learn, reflect, and discuss current evidence on the use of
exercise training in prevention and management of
prostate cancer.
o Evaluate and apply safe, effective exercise training
guidelines for individuals with or at risk for prostate
cancer.
20
x
Guiding the
Clinical Physical
Therapist into a
New Role as
Researcher (4 hr)
PT, PhD, MSCE, Loraine LovejoyEvans PT, DPT, CLT-Foldi,
Lucinda Pfalzer PT, PhD, FACSM,
FAPTA, David Scalzitti PT, PhD,
OCS
x
Physical Therapy
Care Across the
Practice
Continuum for
Patients with
Colorectal Cancer
(2 hr)
Presenters: Meryl Roth Gersh
PT, Robert Gersh MD
x
State of the Art
Measurement
Methodology for
Evaluating
Lymphedema (3
Presenters: Minal Jain PT, DSc,
PCS, Ellen Levy PT, BGS, OCS,
Nicole Stout MPT, CLT-LANA
o Demonstrate confidence in performing a literature
review on the computer including Hooked on Evidence
and Open Door APTA’s portal to Evidenced-Based
Practice
o Demonstrate improved confidence in reading the
literature using critical thinking
o Understand the basics of research design, data
collection, and analysis
o Maximize the ability to partner with an academic facility
in their local area to promote outstanding research in
the field of specialty in PT
o Identify possible sources to secure funding
o Review the current medical practice for the examination,
evaluation, and comprehensive treatment of patients
experiencing colo-rectal cancer.
o Identify methods of prevention, early detection, and
early medical management of colo-rectal cancer.
o Describe the implications that the medical management
of patients with colo-rectal cancer, including surgery,
chemotherapy, and radiation, have for physical therapy
care.
o Explore the application of comprehensive physical
therapy care across the practice continuum for a patient
diagnosed with colo-rectal cancer.
o Integrate the Guide to Physical Therapist Practice as one
considers the comprehensive management of this
patient.
o Demonstrate an understanding of the pathophysiology
of lymphedema.
o Understand and identify the methods available for
assessing lymphedema
21
o
hr)
x
Orthopedic
Rehabilitation:
Improving
Outcomes Using
Lymphatic
System
Treatments and
Home Program
Instruction (3 hr)
Presenter: Loraine LovejoyEvans PT, DPT, CLT-Foldi
x
Will I Be Able to
Wear Heels to
the Prom?
Physical Therapy
Assessment and
Rehabilitation of
Children with
Osteosarcoma (2
hr)
PCS, Michael Smith PT, MEd,
Kieu-Phuong Thi Vu PT
x
Hemophilia 101
for Physical
Presenters: Alice Anderson PT,
MS, PCS, Sara Elizabeth Strawn
Recognize novel evaluation tools available including
perometry and bioelectrical spectroscopy as well as the
science behind these technologies
o Understand the anatomy, physiology, and
pathophysiology of the lymphatic system
o Describe the relationship between the circulatory and
lymphatic system
o Identify varying types of edema disorders and establish a
treatment program to minimize swelling
o Understand the benefits of reducing swelling in
orthopedic disorders to enhance function and to
decrease pain
o Understand the philosophy and manual techniques of
Lymphatic Mobilization and the relationship to
improving function
o Identify when it is appropriate to utilize lymphatic
mobilization in the rehabilitation program
o Maximize treatment sessions by instructing patients in a
comprehensive self-care program.
o Participants will gain knowledge in the diagnostic
methods and medical management of children with
osteosarcoma.
o Participants will understand and identify the physical
therapy needs of this population.
o Participants will be exposed to assessments and
therapeutic strategies to maximize a child’s functional
outcome and quality of life.
o Participants will understand how to use the “Guide to
Physical Therapist Practice” when working with a child
with osteosarcoma.
o Define hemophilia and be knowledgeable of its
22
Therapists (1.5
hr)
x
linical Update
and
Interdisciplinary
Care:
Rehabilitation
Following Breast
Cancer Surgery (3
hr)
PT, MSPT, OCS
inheritance, incidence and hematological values.
Describe the coagulation cascade in normal and
hemophilic patients.
o Know the red bleeding complications (red flags) of
central nervous system, gastrointestinal system and
musculoskeletal system.
o Know the key factors to identify and treat acute,
subacute and chronic hemathrosis/hemarthropathy and
its sequelae.
o Know the in key factors to identify and treat muscle
bleeds and its complications.
o Be knowledgeable in the history and current hemophilic
factor replacement therapies.
o Understand the role of exercise, fitness, and sportsin the
hemophilic patient.
o Be knowledgeable in the radiologic assessment of the
Arnold-Hilgartner and Pettersson Classification of
Hemophilic Arthropathy.
o Describe the orthopedic surgical interventions for the
hemophilic population arthroscopic synovectomy,
radionuclide synovectomy, radial head resection and
total joint replacements) and their outcomes.
o Be knowledgeable of the comprehensive model of
treatment for hemophilic patients and hemophilic
treatment centers.
o Demonstrate an understanding of the medical and
surgical management for breast cancer treatment.
o Identify common dysfunction following breast cancer
surgery and adjuvant treatment.
o Articulate the efficacy for exercise and therapy following
breast cancer surgery.
o Appreciate the potentially complex patient presentation
following breast cancer surgery and the need for an
o
Presenters: Stephanie Caterson
PT, Roya Ghazinouri PT, MS,
Daniel Ovitt PT, Rebecca
Stephenson PT, DPT, MS,
Reginald Burns Wilcox III DPT,
MS, OCS
23
interdisciplinary postoperative rehabilitation plan.
Illustrate why abnormal shoulder girdle mechanics occur
following surgery for breast cancer.
o Describe the rehabilitation principles for the shoulder
girdle following breast cancer surgery and treatment.
Design a comprehensive rehabilitation program for a patient
following breast cancer surgery.
o
Regional Courses
Offered by Oncology
Section
Courses scheduled
for 2012
x Breast Cancer
Rehabilitation
(16 hr)
Scheduled for:
o March 31April 1, 2012
in Chapel Hill,
North
Carolina
o May 19-20,
2012 in Iron
Mountain,
Michigan
o September
29-30, 2012
in Edgewood,
Kentucky
Varies
2008
Oncology
Section
Sponsored
Courses
Presenters: Barbara Nicholson
MSPT, CLT-LANA, Nancy
Roberge PT, DPT, MEd
Frequency: Annually, often
more than once a year;
Typically average of six
courses offered per year
Average attendance: 16-18
therapists per course, with six
courses per year is
approximately 96-108
therapists
o Describe techniques used to diagnose and surgically and
medically treat cancer
o Assess and treat the outcomes and impairments
associated with treatment using an evidence-based
approach
o Discuss effective strategies for reducing the risk for
lymphedema
o Develop therapeutic treatment protocols, including
patient education, manual therapy, and exercise
program development
o Develop strategies to include physical therapists in the
critical pathway of treatment for the patient with breast
cancer
o Discuss the need for physical therapist and patient
advocacy in this population
24
x
Exercise Training
Guidelines for
Individuals with
Cancer:
Endurance,
Strength,
Flexibility, and
Adherence (8 hr)
Scheduled for:
o March 24,
2012 in
Jefferson
City, Missouri
o April 14,
2012 in
Rockford,
Illinois
o October 13,
2012 in
Tulsa,
Oklahoma
Courses in 2011:
x Breast Cancer
Rehabilitation
Richland,
Washington
October 1-2,
2011 (16 hr)
Presenter: G. Stephen Morris,
PT, PhD, FACSM
o Explain the basic biology of exercise, cancer, and acute
and adaptive responses to exercise
o Understand how exercise training can improve functional
capacity, quality of life, and improve prognosis following
a cancer diagnosis
o Recognize and respond to adverse responses to exercise
training
o Appropriately modify exercise programs in response to
acute patient status
o Write exercise prescriptions for the oncology patient
o Identify and use appropriate outcome measures in the
oncology setting
o Discuss safety concerns associated with exercising this
patient population
o Discuss the use of exercise training across the cancer
spectrum
Describe the role of exercise in treating the cancer survivor
MSPT, CLT-LANA
approach
lymphedema
program development
25
cancer
Discuss the need for physical therapist and patient
a cancer diagnosis
training
oncology setting
patient population
spectrum
o Describe the role of exercise in treating the cancer
survivor
o Design and implement evidence based physical therapy
oncology management methods for individuals in
cancer survivorship across the continuum of care.
o Incorporate effective functional training, manual
techniques, lymphedema management, and aerobic
exercise throughout the continuum of care.
o Identify and manage symptoms and side effects of
cancer and its treatments across the continuum of care.
o Effectively communicate with multidisciplinary oncology
rehabilitation team members including patients and
caregivers, physicians, and nurses.
o
x
Exercise Training
for Cancer
Survivors:
Endurance,
Strength,
Flexibility, and
Adherence
Concord, New
Hampshire
October 1, 2011
(8 hr)
PT, PhD
x
Second Annual
Oncology
Rehabilitation
Symposium,
Oakland
University:
Rehabilitation
Across the
Continuum of
Care.
Rochester,
Michigan, August
Presenters: Deborah Doherty
PT, PhD, CEAS, Jacquelin Drouin
PT, PhD, Janet Seidell PT, Reyna
Colombo PT, MA, Marie-Eve
Pepin PT, DPT, OMPT, Adhil
Akhtar MD
26
x
x
x
23 and 25, 2011
(Online
presentations)
and August 27,
2011 (oncampus
laboratory
session, 17.5 hr
total)
Walk, Run, Jump,
and Thrive:
Physical Therapy
Assessment and
Intervention for
Children and
Adolescents with
Cancer
Minneapolis,
Minnesota May
13-14, 2011 (10
hr)
Breast Cancer
Rehabilitation,
Farmingdale,
New York April
2-3, 2011 (16 hr)
Breast Cancer
Rehabilitation,
Richland, WA,
October 1-2,
2011 (16 hr)
o
o
o
PhD, Lynn Tanner PT
Evaluate and integrate effective administration
practices across varied oncology settings.
Identify patient self-advocacy resources.
Critically appraise current evidence for practice.
o Describe the typical treatment regimen for children
with leukemia, lymphoma, and solid tumors, including
CNS tumors
o Describe the current literature on CIPN in children and
adolescents with non-CNS cancer
o Describe the current literature on physical impairments
and motor performance deficits in children with
leukemia, lymphoma, and solid tumors
o Discuss the pros and cons of different outcome
measurements to use in these populations
o Describe and demonstrate assessment and intervention
techniques to address common physical impairments
Participant Objectives: See same course above
27
x
Exercise Training
for Patients
Across the
Cancer
Spectrum:
Testing,
Prescription, and
Outcomes
Assessment
St. Joseph,
Michigan
January 16, 2011
(8 hr)
Courses in 2010:
x Breast Cancer
Rehabilitation
Exeter, New
Hampshire
November 13,
2010 (8 hr)
PT, PhD
Roberge PT, DPT, Med
o Describe cancer diagnoses, cancer treatments, and side
effects particularly as they relate to impairments
a cancer diagnosis
training
oncology setting
patient population
spectrum
survivor
approach
lymphedema
program development
28
cancer
Discuss the need for physical therapist and patient
advocacy in this population.
Participant Objectives: See same course above.
o
x
x
x
Exercise
Guidelines for
Individuals with
Cancer
Charlotte, North
Carolina
September 18,
2010 (7.5 hr)
Exercise
Guidelines for
Individuals with
Cancer, Concord,
NH, October 1,
2011 (7.5 hr)
First Annual
Rehabilitation
Symposium of
Oakland
University: Focus
on Breast Cancer
and Prostate
Cancer
Rochester,
Michigan,
August 26-28,
2010 (3 day
conference)
Courses in 2009:
Presenter: G. Stephen Morris
PT, PhD
PT, PhD
Presenters: Deborah
Doherty PT, PhD, CEAS,
Jacquelin Drouin PT, PhD,
Janet Seidell PT, Reyna
Colombo PT, MA, John
Maltese MD
o Evaluate and integrate effective administration
o Identify patient self-advocacy resources.
o Critically appraise current evidence for practice.
29
x
Interventions for
Cancer Patients
and Cancer
Survivors
Portland, Oregon
November 14-15,
2009 (11 hr)
PT, PhD, Andrea Leiserowitz
MPT, CLT
x
Breast Cancer
Rehabilitation:
Implications in
Physical Therapy
Atlanta, Georgia
April 4-5, 2009
(15.5 hr)
Presenters: Charles McGarvey
PT, DPT, MS, FAPTA, Nicole
Stout MPT, CLT-LANA
o
Explain the basic biology of exercise, cancer, and acute
a cancer diagnosis
training
o Write exercise prescriptions for the oncology patient and
survivor
oncology setting
patient population
spectrum
o Discuss exercise interventions in the context of
lymphedema and treatment-associated peripheral
edema
survivor
o Describe the basic cancer diagnosis, pathology and
staging
o Describe medical and surgical management commonly
used in treating breast cancer
o Choose and perform appropriate screening/systems
review and tests and measures
o Describe and choose interventions for common
impairments seen in individuals at various stages of the
disease process
30
o
o
Oncology Courses Sponsored by APTA Chapters
PA
x Courses
Washington
Projected for
DC
2013 (10-16 hr)
Presenter: Nicole Stout MPT,
CLT-LANA
x
Courses Offered
in 2012 (10-16
hr)
Alabama
South
Dakota
CLT-LANA
x
Courses Offered
in 2012 (8 hr)
Colorado
Presenter: Andrea Leiserowitz
MPT,CLT
Understand the need for
appropriate modality selection and use based on the
cancer history and/or treatment
Understand the importance of
physical therapy intervention in a palliative care setting
o Describe the cancer diagnosis, pathology, and staging
o Explain medical and surgical management of common
cancer diagnoses
o Choose and perform appropriate screening/ systems
o Design appropriate treatment interventions for
common impairments seen in individuals at various
stages of the disease process.
o Discuss the need for appropriate modality selection and
use based on the cancer history and/or treatment
o Order and describe precautions and contraindications
for exercise
cancer diagnoses
for exercise
31
o
Explain medical and surgical management of common
cancer diagnoses
Order and describe precautions and contraindications for
exercise
Private Continuing Education Courses Specific to Cancer Rehabilitation
x Cancer
CLT-LANA
Rehabilitation:
An EvidenceBased Course for
All Clinicians (20
hours,
intermediate
level course)
Offered by: Great
Seminars and
Books, Inc.
Frequency: The course is scheduled to be offered five times
in 2012, in Winston-Salem, Louisville, Green Bay, Nashville,
and Portland, Oregon. It was also offered five times in 2011,
in Palos Heights, Illinois, Oklahoma City, Dallas, Napa,
California, and Richmond Virginia.
Average attendance: 40-50, mostly physical therapists and
some PTAs. Assuming 40 physical therapists at each of five
courses, that would lead to a total attendance of 200 per
year.
cancer diagnoses
for exercise
32
Physical Therapy for
the Patient with
Breast Cancer (16)
Offered by programs,
a company founded
by the presenter to
offer evidence-based
programs for health
care professionals
and survivors of
cancer.
Presenter: Leslie Waltke PT
Advanced Oncology
Rehabilitation for
Successful Outcomes
(15-18 hours)
Offered by: North
American Seminars
Presenter: Julia Osborne, PT,
CMLDT
Frequency: Three times per year
Attendance: Ranges from 10 to 40, primarily physical
therapists for a total attendance of between 30 and 120 over
the course of a year.
o Describe basic cancer pathophysiology
o Describe cancer treatments including mechanisms of
action and side effects
o Perform a comprehensive evaluation of the cancer
patient
o Recognize and treat musculoskeletal dysfunctions of
surgery, radiation, and reconstruction
o Differentially diagnose and treat pain syndromes
o Set up a comprehensive post operative home exercise
program
o Develop a rehabilitation program to combat side effects
of chemotherapy and radiation
o
Teach infection and lymphedema
risk reduction techniques
Frequency: Course is scheduled for five offerings in 2012.
The course comes with an optional software program
designed for professionals who are starting a lymphedema
program.
Average attendance: 30, 80-90% physical therapists, for a
total yearly attendance of approximately 150.
o Describe cancer pathogenesis and how it is shaping
environmental awareness and changing cancer
management globally.
o Discuss the clinical management of breast cancer, head
and neck cancer, prostate cancer, ovarian cancer,
melanoma, leukemia, and lymphoma.
o Understand new advancements in cancer treatment:
chemotherapy, targeted therapy, radiation therapy,
33
immunotherapy and hormone therapy.
Discuss the clinical implications of myelosuppression,
cancer related fatigue, cardiotoxicity, hormone changes
and cognitive changes in patients undergoing cancer
treatment.
o Develop safe and appropriate oncology exercise
programs according to the guidelines, clinical tests and
screening systems presented in the course.
o Perform specialized manual therapy skills for the post
surgery and radiation management of patients with
cancer (upper extremities, trunk, and lower extremities).
o Utilize the appropriate modalities based on cancer
history and areas of treatment.
o Design appropriate inpatient and outpatient programs
with the consideration of program goals, referral and
intake processes and discharge criteria.
Frequency: Course is scheduled for six offerings in 2012.
o Understand the anatomy of breast cancer cells, their
functional capabilities, and how modern medicine is
responding in its design to treat breast cancer
effectively.
o Expand clinical knowledge about differential diagnoses,
treatment side effects, and physical sequelae of
chemotherapy, radiation therapy, and targeted hormone
therapies.
o Advance understanding of the biology and physiology of
the acute trauma that occurs to the lymphatic system
after surgery and radiation therapy, and how this affects
the normal healing processes in the body.
o Understand the difference between treating
“lymphedema” as a condition, and the advanced
o
Advanced
Management of
Breast Cancer
Rehabilitation (15
hours)
Offered by: North
American Seminars
CLT-LANA
34
o
o
o
o
o
Local Community Courses
UMDNJ, Newark, NJ
(16 hours)
2013
CLT-LANA
o
o
o
o
concepts of treating acute trauma of the “lymphatic
system” as it relates to other body systems in the healing
processes of surgery, radiation, and chemotherapy.
Advance and integrate manual lymphatic drainage skills
with orthopedic manual therapy skills to include system
management of the musculoskeletal system, the nervous
system, the vascular system, the lymphatic system, and
the endocrine system during and post breast cancer
treatment.
Understand complex co-morbidities and adverse
treatment complications of breast cancer, how they
affect the healing capacity of patients, and how
treatment can be structured to minimize their effect.
Identify clearly the specific clinical goals of specialized
manual therapy skills and targeted exercise protocols for
patients undergoing advanced forms of breast surgery,
new chemotherapy treatments, and/or targeted
radiation therapy so as to achieve optimal function, as
well as sustainable treatment results.
Have increased knowledge about advances in breast
cancer diagnoses, advances in breast cancer
management, and advances in breast cancer research.
Gain and advance leadership skills in the continuum of
care and mulit-disciplined approach to the management
of patients with breast cancer.
Describe the cancer diagnosis, pathology, and staging
cancer diagnoses
Choose and perform appropriate screening/ systems
Design appropriate treatment interventions for
35
o
o
University of
Pittsburgh Medical
Center, Pittsburgh,
PA
12 hours
2013
CLT-LANA , G. Stephen Morris
PT, PhD, Elizabeth Hile PT, PhD
o
o
o
o
o
o
ST Barnabas Health
System, NJ
Rehabilitation (16
hours)
2012
CLT-LANA
o
o
o
o
o
Providence/ST. Peter
Hospital, Olympia,
WA
(16 hours)
2012
CLT-LANA
Discuss the need for appropriate modality selection and use
based on the cancer history and/or treatment
exercise
cancer diagnoses
exercise
cancer diagnoses
o Order and describe precautions and contraindications for
exercise
1. Explain the nature, risk factors, and course of
common adult cancers.
2. Discuss common toxicities and adverse events
related to cancer and its treatment in adults.
3. Apply the necessary diagnostic screening strategies
to manage patients during or after cancer treatment,
including acute, subacute, and late effects of
treatment on the various body systems.
4. Select treatment strategies to improve upper and
36
lower quadrant dysfunction and impairments and
mange symptom distress based on the evidence.
5. Describe the current outcome measurement tools
used in oncology rehabilitation.
Lymphedema Management Courses/ Training programs
Complete
Presenters: Steve Norton CLTFrequency: Course is scheduled for 20 offerings in 2012.
Decongestive
LANA, Andrea Cheville MD,
Average Attendance: 18-20 therapists
Therapy Certification
Nicole Stout MPT, CLT-LANA,
course (135 hr;
John Beckwith PT, CLT-LANA, Joy o Differentiate between a variety of peripheral edemas
participants receive a
Cohn, PT, CLT-LANA
o Understand the applications, medical indications, and
5 DVD set)
contraindications of MLD and CDT.
Offered by: Norton
o Establish a CDT treatment plan for individuals with
School of Lymphatic
primary or secondary lymphedema and perform the
Therapy
indicated treatment.
Perform the four components of
o
CDT (manual lymph drainage, compression therapy,
exercise, skin care)
e – Integrative
Presenters: Guenter Klose,
Frequency: The course is scheduled for 12 offerings in 2012.
Lymphedema
Kathleen Francis MD, Linda
Certification Course
Roherty PT, CLT-LANA, Jody
(135 hr, 45 hr of
Winicour PT, CLT-LANA, Jan
o Demonstrate four components of Complete
which is an internetWeiss PT, DHS, CLT-LANA, Julia
Decongestive Therapy.
based home study
Rodrick OTR/L, WCC, CLT-LANA, o Differentiate between a variety of peripheral edemas
course. Participants
Joanne McGillicuddy PT, CLTo Understand the application, medical indications and
receive DVDs,
LANA, Chris Cobb PT, CLT-LANA,
contra-indications for MLD and CDT.
software, and a
Leslyn Keith MS, OTR/L, CLTo Establish a CDT treatment plan for individuals with
manual.)
LANA, Heidi Miranda-Walsh
primary and secondary lymphedema and perform the
Offered by: Klose
OTR/L, CHT, CLT-LANA, Elizabeth
treatment for lymphedema accordingly.
Training and
Camp PT, MHS, CWS, CLT-LANA,
Consulting
Rene Janiece LMT, CLT, Ruth
Coopee, OTR, CLT.
Basic MLD
Presenters: Steve Norton CLTFrequency: 2012 schedule is not available on line at this time
Certification course
LANA, Andrea Cheville MD, John Average Attendance: 20-25 therapists
(48 hr; participants
Beckwith PT, CLT-LANA, Joy
37
receive a manual)
Offered by: Norton
School of Lymphatic
Therapy
Basic MLD
(45 hr)
Offered by: Klose
Training and
Consulting
Cohn, PT, CLT-LANA
o
Demonstrate an understanding of the anatomical
features and terminology of the functional lymphatic
system
o Demonstrate comprehension of information related to
normal lymphatic physiology and the differences
encountered in a diseased state
o Demonstrate an understanding of the proper clinical
applications of MLD (indications)
o Demonstrate an understanding of the improper clinical
applications of MLD (contraindications)
o Demonstrate an understanding of clinical applications
where caution should be exercised (precautions)
o Perform techniques consistent with proper Vodder-style
MLD and memorize the sequences for all body areas of
the intact lymphatic system
o Demonstrate the ability to customize treatment
strategies for various pathologies where MLD is indicated
o Demonstrate the ability to employ MLD on primary and
secondary lymphedema patients (medicallyuncomplicated, physician prescribed treatment)
o Demonstrate an understanding of the anatomy and the
Weiss PT, DHS, CLT-LANA, Julia
relevant scientific terminology related to the lymphatic
system
Rodrick OTR/L, WCC, CLT-LANA,
Joanne McGillicuddy PT, CLTo Demonstrate an understanding of the differentiation
LANA, Chris Cobb PT, CLT-LANA,
between the normal and diseased states of the
Leslyn Keith MS, OTR/L, CLTlymphatic system (physiology and pathophysiology of
the lymphatic system)
LANA, Heidi Miranda-Walsh
OTR/L, CHT, CLT-LANA, Elizabeth o Demonstrate an understanding of the indications and
contraindications related to the use of MLD
o Competently perform the techniques of MLD for all body
Coopee, OTR, CLT.
areas
38
o
Lymphedema
Management of the
Upper and Lower
Extremities (23 hr)
Offered by: North
American Seminars
Presenter: Elizabeth Augustine
PT, DPT or Julia Osborne PT,
CLT-LANA
Develop appropriate treatment strategies for indications
such as post-surgical edema, post-traumatic edema,
fibromyalgia, general detoxification and other conditions
o Competently perform MLD on clients after breast
surgery for cancer (clients at risk to develop
lymphedema)
o Competently perform MLD on clients with mild,
medically uncomplicated, primary or secondary
lymphedema
Frequency: This course is scheduled to be offered three
times in 2012.
Average attendance: 30, primarily physical therapists for a
total yearly attendance of 90.
o Demonstrate an understanding of the anatomy and
physiology of the lymph system
o Describe the pathophysiology of lymphedema and
pathogenesis of common upper extremity and lower
extremity lymphedema.
o Understand the common diagnostic procedures for
lymphedema.
o Recognize, assess, and treat the different classifications
of upper extremity and lower extremity lymphedema
o Perform proper massage techniques to enhance
lymphatic flow and explain the physiologic rationale for
lymph drainage massage.
o Correctly apply short stretch compression bandages in
the treatment of upper extremity and lower extremity
lymphedema.
o Perform limb measurements that provide acceptable
documentation of outcome measures.
o Instruct patients and health care professionals in
precautions and skin care.
o Choose the appropriate compression garments and
39
instruct patients in correct application.
Develop appropriate individualized treatment programs
for successful functional outcomes.
yearly total of 180.
o Understand the anatomy and physiology of the
lymphatic system and how to use the anatomy to its best
advantage in performing effective lymphatic drainage in
complex patients with aggressive and advanced
lymphedema, lipedema, and primary lymphedemas.
o Advance and integrate lymphatic drainage skills with
neuro-musculo-skeletal orthopedic skills to create
increased efficiency and greater success in treating
patients with UE complications, LE complications, head
and neck complications, groin and genital complications,
and abdominal and trunk complications.
o Demonstrate the ability to use the hands-on advanced
techniques taught in this seminar to treat patients with
co-morbidities such as chronic thrombosis, diabetes,
CHF, auto-immune diseases; and patients with
complications of lymphedema such as seromas,
hematomas, severe fibrosis, axillary web syndrome, and
Mondor’s syndrome.
o Have a more in-depth understanding of the acute
trauma that occurs to the lymphatic system after surgery
and radiation therapy so as to broaden treatment
protocols and implement early intervention.
o Have the knowledge and tools necessary to shift mindset
from treating “lymphedema” as a condition to treating
the “lymphatic system” as it relates to other body
systems during periods of acute trauma – a necessary
step towards progressive thinking in twentieth century
o
Advanced
Management of
Lymphedema (15 hr)
Offered by: North
American Seminars
CLT-LANA
40
o
o
o
On-Line Courses, Other Media-based Courses
Educata:
Foundation of
Oncology for Physical
Therapists (2.5 hr.
This is a beginner
level course designed
to provide a solid
foundation for
oncology practice.)
APTA Learning
Center:
CSM10: Medical
Screening for
Oncology Issues in
Author/Presenter: Marisa
Perdomo, PT, MSPT, DPT, CLTFoldi, CES
Author/Presenters: Mary Lou
Galantino, PT, PhD, MSCE, Laura
Gilchrist, PT, PhD, Victoria
Marchese, PT, PhD, G. Stephen
Morris, PT, PhD, Kirsten Ness,
medicine, and in the future development of evidencebased research.
Develop advanced critical thinking skills and clinical
decision-making skills in the management of patients
with lymphedema and all associated co-morbidities and
complications.
Expand knowledge base about bandaging, compression,
kinesiotape, and additional products on the market; and
know how and when to apply advanced management
products to patients.
care and multi-disciplined approach to the management
of complex patients
o Understand, define, discuss and educate others in the
scientific foundational principles regarding:
o The pathogenesis of cancer
o The diagnosis and prognosis of cancer
o The growth or spread of cancer
o Medical intervention strategies for the treatment of
cancer
Search medical Web sites regarding
o
specific cancer diagnoses and treatments to obtain the
specific information needed for a physical therapist to
perform an initial evaluation.
Utilize the scientific principles
o
regarding cancer to determine the role of physical
therapy for individuals with cancer.
disease
potential oncology 'red flags
41
Outpatient Physical
Therapy (2 hr)
PT, MA, MPH, PhD, Meredith
Wampler, PT, DPTSc
o
o
o
CSM11: Measuring
Outcomes in
Oncology
Authors/Presenters: Mary Lou
Marchese, PT, PhD, G Stephen
Wampler, PT, DPTSc
PT 2011: Manual
Therapy for the
Oncology Patient (3
hr)
Author/ Presenter: Lisa Massa,
PT, WCS, CLT-LANA
Describe the most common late-effects of cancer and its
treatment
Screen patients with a previous history of cancer for lateeffects of cancer and its treatment.
Determine appropriate referrals for
oncology-related issues in both patients with and
without a previous cancer diagnosis.
outcome measures.
rehabilitation.
o Review, discuss, and apply the proper indications and
contraindications for manual therapy for the patient
with cancer.
o Discuss the impact of surgery, chemotherapy, and
radiation treatments on the musculoskeletal and
lymphatic systems.
o Synthesize the relevant literature associated with
manual therapy and individuals with cancer, with
emphasis on mobilization/manipulation techniques and
therapeutic exercise of the musculoskeletal and
lymphatic systems.
42
o
o
PT10: Physical
Therapy
Management of
Children With Cancer
(3 hr)
Authors/ Presenters: Colleen
Coulter-O'Berry, PT, DPT, PhD,
MS, PCS, Kirsten Ness, PT, MA,
MPH, PhD, Durga Aman Shah,
PT, DPT, PCS, Claire F.
McCarthy, PT
CD-ROM: Audio-Plus
Home-Study Course:
Cancer
Rehabilitation:
Principles and
Practice
Author/ Presenter: Charles L.
McGarvey, PT, DPT, MS, FAPTA
Integrate relevant dysfunctional biomechanical and
neurophysiologic findings with appropriate manual
therapy interventions for patients with breast cancer
and/or head and neck cancer.
Identify oncologic emergencies that may initially appear
as musculoskeletal problems.
o Consider the process of screening and differential
diagnosis for children with signs and symptoms related
to brain tumors, leukemia, bone marrow transplants,
and solid bone tumors.
o Review the pathophysiology of selected diagnoses.
o Establish the patient/client management plan for various
pediatric diagnoses.
o Discuss practice management across the continuum of
care available in pediatric settings.
o Develop discharge plans and referrals to other practice
settings as appropriate.
o Define terminology associated with Cancer
o List statistics related to incidence, mortality, and
morbidity
o Identify basic metastatic process
o List primary antineoplastic strategies and their sequelae
o Identify general principles of cancer rehabilitation
o Describe the purpose of the physical therapy
impairment diagnosis
o Name the most common risk factors for cancer
o Identify the systems most often affected by cancer
metastasis
o
Describe the corresponding clinical
43
o
manifestations of each system affected by cancer
metastasis
List clinical signs and symptoms
corresponding to paraneoplastic syndromes
44
Criterion 7: Transmission of
Knowledge
ABPTS Feedback:
7.5 Describe methods of knowledge transmission through symposia, seminar, workshops, etc, and enclose representative programs concerning these
activities.
ABPTS requests that the petitioner separate information appropriately between sections 7.5 and 7.6, providing introductory and summary comments, to allow for
an easier review of relevant information by section.
7.6 Provides number of such events described in #5 above that occur annually and estimate the average and total attendance at such programs.
ABPTS requests that the petitioner separate information appropriately between sections 7.5 and 7.6, providing introductory and summary comments, to allow for
an easier review of relevant information by section. In addition, it was noted that attendance data was not consistently documented.
REVISED SECTIONS:
7.5 Describe methods of knowledge transmission through symposia, seminars, workshops, etc, and enclose representative programs
concerning these activities.
Multidisciplinary conferences
The availability of continuing education offerings in oncologic physical therapy has grown as the practice area itself has grown, initially
beginning with multidisciplinary conferences offered by the institutions that pioneered the area of practice. MD Anderson offered annual
conferences on cancer rehabilitation after beginning its oncology rehabilitation program. They published a proceedings document from the 1970
conference, (which was their fifteenth annual conference) on the topic of Rehabilitation of the Cancer Patient, bringing together physicians,
nurses, therapists, and other non-medical rehabilitation leaders in the country. Legacy Good Samaritan Hospital in Portland, Oregon, one of the
early NCI cancer rehabilitation grant recipients, also sponsored cancer rehabilitation conferences, incepted by John Stanwood. The conference
started in 1976 and was held every two years. Topics featuring the role of physical therapy in various types of cancer related disability were
prominent in every conference, although we do not have records of the titles, presenters and objectives from these historical events. According
to current Specialization Task Force members who attended these conferences, physical therapists typically made up the largest group in
attendance among multidisciplinary participants.
The James Cancer Center of Ohio State University School of Medicine conducted annual cancer rehabilitation conferences, offering basic
multidisciplinary information to a diverse audience, the majority of whom were physical therapists involved in cancer care. Attendance was
always strong as an increasing number of physical therapists became cognizant that a considerable percentage of the patient population they
were seeing in the general hospital setting were patients with cancer or cancer related disability. This conference was last held in 2006.
The most sustained of the continuing educational conferences in cancer rehabilitation began at the Virginia Commonwealth University’s
Medical College of Virginia under the directorship of Susan Mellette, MD, one of the early leaders in the cancer rehabilitation milieu. In the
1970’s she began crafting a novel and unique approach to the patient with cancer which emphasized, among other areas, physical
rehabilitation, hence involving the physical therapy profession from the very beginning. This biennial conference is still being held, sponsored by
the Department of Physical Medicine and Rehabilitation and the Massey Cancer Center of the university, and held in Richmond, Virginia. To
compliment the west coast Stanwood conference, it is generally held in the odd numbered years, though it was most recently held in 2010 and is
scheduled next for May 5, 2012. Physical therapists have typically made up 75% of the attendees at these conferences and topics relevant to
physical therapy have been prominent in the programming, titles, topics, presenters, hours, and objectives are found in Table 7.5-7.6 above.
In the 2007 MCV conference, Patricia Schmidt of the James Cancer Center at Ohio State University gave a visionary presentation
outlining the new models of cancer rehabilitation service delivery, stressing survivorship and involving partnerships and collaborations with
other disciplines. These models supported the concept of the multidisciplinary approach, but at the same time emphasized strongly that each of
2
the disciplines, e.g. physical therapy, develop their own expertise in treating the cancer problems they encounter. This in itself lends strong
support for the specialization in oncology physical therapy. Her predictions were prescient: survivorship issues drive much cancer care at the
present time; each discipline has its own course network. As physical therapists reached critical mass in knowledge and practice base, regional
courses specific to physical therapists grew in number.
Combined Sections Meeting (CSM): Oncology Section Sponsored Courses
Since its inauguration almost 30 years ago, the Oncology Section of the APTA has organized, sponsored and conducted extensive programming
at the Combined Sections Meeting. The number, variety, and quality of the courses have grown along with the growth of the specialty. The
Section, led by Program Chair Amy Litterini PT, DPT, makes an effort to provide courses at basic as well as intermediate or advanced levels in
order to provide offerings that serve the needs of the diversity of attendees at CSM. Courses offered at CSM over the last four years are listed
here. We do not have session by session attendance data, although all sessions were well-attended.
Regional Courses Sponsored by Oncology Section
The Oncology Section is responding to membership need for courses at the regional level that provide members an opportunity to receive
quality instruction and laboratory experiences where appropriate in order to develop knowledge and skills for oncologic physical therapy
practice. The Oncology Section maintains a Regional Course Chair (currently Mary Ann Calys PT, DPT) to organize and manage these selfsupporting courses in collaboration with the Section Executive. The Section began offering such courses in 2005, with one to two offerings per
year. In order to serve the educational needs of physical therapists the Section is engaged in continuing efforts to increase the number and
geographical distribution of these offerings. Section-sponsored regional courses have now grown in number to six per year. Because of the
3
expense of mounting regional course offerings it is necessary for these courses to focus on areas of high demand among physical therapists who
practice in a variety of settings. Currently there is reliable interest in courses dealing with physical therapy for the persons with breast cancer,
and for exercise guidelines for persons with cancer. The Section now also has a course in pediatric oncology that was first offered in 2011. The
Section has a special level of sponsorship for regional courses organized by section members who partner with the Section for some of the
course organization and implementation while contributing much of the effort of the organization themselves. The Section has so far sponsored
two such courses, the Oakland University Annual Symposia listed below in 2010 and 2011. We anticipate that with growth of the specialty and
educational outreach on the part of Section leaders, broader interest in other aspects of oncologic physical therapy will follow. Courses
scheduled for 2012, as well as courses offered in the past three years are described below. According to the Section Executive, the average
attendance for Section regional courses is 16-18 therapists, which at six courses per year would lead to a total attendance of 96-108.
Regional courses offered outside the sponsorship of the Oncology Section
Interest among physical therapists in acquiring the skills and knowledge necessary for practice in oncology has grown in proportion to the
growth of the practice area. In response to this growing demand, commercial continuing education providers offer courses relevant to this
practice area. All of the courses described below are offered multiple times per year in various locations in the United States. The number of
courses scheduled for 2012 is included in the descriptions; in each case the courses described have been offered at similar frequency for at least
three years, typically longer.
4
Lymphedema has a variety of causes not exclusive to cancer, but it is commonly seen in oncology rehabilitation since it can arise as a side-effect
of any cancer treated with removal of lymph nodes. Physical therapists who specialize in rehabilitation of the person with cancer encounter
lymphedema affecting the trunk, face, and any extremity among patients with breast cancer, melanoma, prostate cancer, head and neck
cancers, and other cancers. A wide array of training programs for the management of lymphedema has existed for many years, first in Europe
and then in the United States. These training programs sometimes lead to some form of certification but do not always, and vary in length from
15 to 135 hours. Section leaders have long held (consistent with the House of Delegates’ position on professional designations) that special
certification derived from a particular continuing education course is not necessary for a physical therapist. Physical therapists can build on their
entry-level foundation using self-study, colleague mentoring, and/or short courses to successfully add relevant understanding and skills and
multiple continuing education certifications introduce unnecessary confusion into the professional title. Self-evaluation of the adequacy of skills
and knowledge is a matter of professionalism. Factors that may influence training style choice may include previous exposure to the content and
the amount of focus that an individual may want to place on lymphedema management in his or her practice. Lymphedema is just one
impairment among many that affect persons with cancer, and focused lymphedema training is not, in and of itself, sufficient training for
management of the continuum of cancer care. However, it is important content in that it is a common and functionally limiting impairment for
patients, and a frequent source of referrals to physical therapy among persons with cancer. Exposure to lymphedema issues is also a relatively
frequent pathway through which therapists become interested in more comprehensive oncologic physical therapy. Hence, a brief description of
the most well-known courses in lymphedema management is included in the table listed in order of course duration beginning with the longest
courses.
5
The Oncology Section has just recently begun to develop offerings in on-line courses for oncologic physical therapy in recognition of the
likelihood that this learning method will grow in importance and demand in the future. Courses are offered or planned that are either fully online, or hybrid. In hybrid courses participants complete a portion of the course on-line to learn the background material and other information
that lends itself to that medium. Participants then take-part in a regional laboratory experience. The Section participates in both Educata and
the APTA Learning Center with on-line course offerings (both of which are new ventures in and of themselves) and plans to further develop online offering in the coming years. Currently available offerings that directly deal with oncologic physical therapy are shown in the table.
7.6 Provide the number of such events described in #5 above that occur annually and estimate the average and total attendance at such
programs.
Current available continuing education offerings are described below by category. Annual frequency of offerings and average attendance is
included with these descriptions, where known.
Methods of
knowledge
transmission
Multidisciplinary
conferences
ACMR (American
Congress of
Rehabilitation
Medicine) Cancer
Location
Year
established
Last Held
Conference
Organizer
*Frequency of Event
*Estimated Avg. Attendance
Varies
2013 is
90th
annual
conferenc
2012
ACMR
Annually
2012 (over 700 from 20 countries);
2013 (27 countries represented to
date)
6
Rehab. programming
at conference
MD Anderson Cancer
Center
James Cancer Center
of Ohio State
University School of
Medicine
Sloan Kettering
e
Houston,
TX
Columbus,
OH
1955?
NY, NY
2013
2013
Legacy Good
Samaritan Hospital
Portland,
Oregon
1976
Virginia
Commonwealth
University’s Medical
College of Virginia
Richmond,
VA
2011
(opposite
year of
VCU)
2012
(opposite
year of
Good
Samaritan)
Methods of
knowledge
transmission
Combined Sections
Meeting (CSM),
APTA including PreCon Courses
Location
CSM 2012
Preconference
course (1 day):
Evidence in Action: A
Varies with
CSM
?
2006
Year
established
30 years
ago
Topic: Management of
Balance Impairments
and Falls For Adult
MD
Anderson
Cancer
Center
Annually
100-120
Annually
200
Michael
Stubblefield
MD
Initially John
Stanwood
Biannual
80
Every other year
100-150
Initially
Susan
Mellette
Every other year
100-150
Last Held
Conference
Organizer
*Frequency of Event
*Estimated Avg. Attendance
2013
Oncology
Section
Sponsored
Courses
Annually
Since 2005, average
attendance at oncology preconference courses = 25
Average attendance at
conference symposia = 40150 topic dependent
Presenters: Jennifer
Blackwood, PT, MPT, GCS,
Min-Hui Huang, PT, PhD,
o Describe the unique and diverse local and systemic effects of
cancer that impact balance.
7
Comprehensive
Management of
Balance Impairments
and Falls For Adult
Cancer Survivors
Cancer Survivors
NCS, Lucinda Pfalzer, PT,
PhD, FAPTA, Amy Yorke,
PT, MPT, NCS
x
Exercise
Guidelines for
Patients with
Cancer: Where
Are We? Where
Would We Like
to Be? Where's
the Physical
Therapy? Part 1
(2 hr) and Part II
(1hr)
Morris, PT, PhD, Ann
Flores, PT, PhD, MS, MA,
CLT, Lucinda Pfalzer, PT,
PhD, FAPTA, Elizabeth Hile,
PT, PhD, NCS
x
Peripheral
Edema: Diagnosis
and Treatment
Strategies Across
All Patient
Populations, Part
I (2 hr) and Part II
(1 hr)
Presenters: Marisa
Perdomo, PT, DPT,
Antoinette P. Sander, PT,
DPT, MS, CPT-LANA, Kimiko
A. Yamada PT, DPT, OCS,
CSCS, ATC, Dawn
Franceschina, PT, DPT,
Michael Simpson, PT, DPT
x
Preventive
Rehabilitation: A
Novel Approach
to the
Presenters: Keren PalgiBornstein PT, DPT, Jean M.
Kotkiewicz PT, DPT
o
Describe the local and systemic effects of cancer treatment
that impact balance.
o Apply the appropriate screening tools with the ICF model to
manage balance impairment in a patient with cancer.
o Apply evidence based examination strategies to assess
o Apply evidence based intervention strategies to treat balance
dysfunction in a patient with cancer.
o Discuss acute and adaptive changes brought about in the
oncology population by participating in an exercise training
program.
o Explain why participation in an exercise training program
should be considered a treatment option for most oncology
patients.
o Describe common methods of exercise testing.
o Generally understand the basics of exercise prescriptions.
o Discuss currently available exercise guidelines available for
use in the oncology population.
o Apply these recommendations to an oncology patient
population.
o Utilize the pathophysiology of edema in the differential
diagnosis process to determine if physical therapy is
appropriate for the patient or if referral for medical consult is
warranted.
o Examine a variety of edema interventions that can be used
across patient populations.
o Select edema interventions based on the etiology of the
edema and best evidence available.
o Describe Memorial Sloan Kettering Cancer Center’s (MSKCC)
comprehensive post-operative pulmonary program for eligible
surgical patients and be familiar with the guidelines of care
8
Hospitalized
Oncology Patient
(2 hr)
x
Diagnosis Dialog
for Oncology
Physical
Therapists (2 hr)
and relevant supporting research.
o Discuss MSKCC’s wellness program for inpatients receiving
allogenic BMT and a typical treatment plan for this not-sotypical patient population.
o Educate PTs about MSKCC’s Early Mobility Program for
intubated ICU patients and the techniques and methods for
minimizing functional decline during this tenuous period.
o Explain MSKCC’s comprehensive treatment approach for
medically complicated lymphedema and edema patients and
discuss MSKCC’S lower extremity lymphedema prevention
group and its benefits to the targeted postoperative
population.
o Describe MSKCC’s breast surgery rehabilitation group for all
immediate post operative breast surgery patients, including
all reconstructive and non-reconstructive procedures.
o Describe MSKCC’s developing program targeting patients with
planned removal of large vessels and ways to most effectively
manage postoperative lymphedema and vascular
insufficiency.
o Apply this new prevention method using a pre-operative team
approach for compression garment fitting.
O’Toole PT, MPH
o Explain how the use of a common diagnostic scheme will
oncology patients.
of cancer.
9
Relate the history of diagnosis in PT, the diagnosis dialog
Discuss the need for widespread, consistent use of commonly
Explain how the use of a common diagnostic scheme will
oncology patients.
of cancer.
o Describe the process of screening and differential
diagnosis/red flags for children with signs and symptoms that
may indicate the presence of a hematological, nervous
system, or bone/soft tissue malignancy.
o Review the pathophysiology for selected cancer diagnoses
o Establish a medical and therapeutic management plan for
selected cancer diagnoses
o Discuss potential lifelong challenges and late effects of
treatment that face children who were treated for cancer.
o Ask questions about the cases and openly discuss issues
relating to the diagnosis, treatment, and long-term
management of children with cancer.
o Briefly describe the most common impairments of body
structure and activity limitations in individuals treated for
breast cancer.
o Describe the role of consistency in outcomes assessment to
monitor patient status and demonstrate intervention
effectiveness in both individuals and patient groups.
o Identify selected outcome measures that can appropriately
x
Diagnosis Dialog
for Oncology
Physical
Therapists (2 hr)
o
o
O’Toole PT, MPH
o
x
Cancer in
Children: A CaseBased Approach
Part 1 (2 hr) and
Part II (1hr)
Presenters: Lynn Tanner
PT, MPT, Colleen Coulter
PT, PhD, Shawn Israel PT,
DPT, Angela M. Corr PT,
DPT, Denise Cortes PT,
MBA, PCS
x
Oncology Section
Task Force on
Breast Cancer
Outcomes (2 hr)
Presenters: Pamela K.
Levangie PT, DSc, DPT,
FAPTA, Mary I Fisher PT,
MSPT, OCS, Marisa
Perdomo PT, DPT, Tiffany
Kendig PT, MSPT, MPH
10
x
Orthopedic
Manual Therapy
for the Individual
with Movement
Impairments
Resulting from
Radiation
Therapy (2 hr)
x
Oncology
Physiotherapists:
Preventing
Cancer and
Treating the
Metastatic
Sequel (1.5 hr)
x
Physical Therapy
Management of
Individuals with
HIV: An Overview
and Update (2 hr)
be used for individuals about to undergo treatment or who
have been treated for breast cancer.
o Discuss the relative merits of presented outcome tools based
on psychometric properties, administration issues, and
limitations.
Presenters: Marisa
Perdomo, PT, DPT, Chris A. o Select the appropriate examination tests and measures for
the shoulder complex and hip-pelvis complex which include:
Sebelski PT, DPT, OCS, CSCS
accessory mobility, muscle length, and assessment of end-feel
for the patient with complications from radiation therapy.
o Create a plan of care that integrates a progression of soft
tissue mobilizations and joint mobilizations (grade I-V) with
appropriate follow-up of therapeutic exercise.
o List the contraindications and indications for manual therapy
for tissues affected by radiation therapy.
Presenter: Oren Cheifetz
o Describe the strengths and weaknesses of the evidence
PT, MSc
supporting the role of physiotherapists In the prevention of
cancer.
o Describe strategies to engage patients with cancer in
exercise programs.
o State the indications for the use of exercise for patients with
cancer.
o Relate to the challenges of using exercise for patients with
cancer.
o Demonstrate an understanding of safety considerations
relevant to exercise for patients with cancer.
Presenters: David Kietrys
PT, MS, OCS, Mary Lou
o Describe the neuromusculoskeletal features of HIV and
Galantino PT, PhD, MSCE
discuss their effects on function.
o Design safe exercise programs based on the stage of the
disease for HIV-positive individuals.
o Describe the role of the PT or PTA in the management of
common impairments associated with HIV and its
11
x
comorbidities, and integrate physical therapy interventions
into a multidisciplinary model.
o Apply recommendations for social issues, such as working
with HIV-positive athletes and occupational exposure.
o Create a template for oncology rehab education for PT
generalists in a large health network.
o List disease-specific, PT-related impairments and
interventions according to primary cancer and side effects of
cancer intervention.
o Discuss assessment tools, including the use of electronic
learning modules to measure PT competency versus direct inservice with written competency.
Oncology PT
Intervention
Performed by a
Physical
Therapist
Generalist:
Educational
Strategies to
Improve Safety
and Outcomes
(1.5 hr)
CSM 2011
x Preconference
course (2 day):
Upper Extremity
Lymphdema: The
Art and Science
of Physical
Therapy
Interventions
Presenter: Linda McGrath
Boyle PT, DPT, OCS, CLTLANA
x
Measuring
Presenters: Elizabeth Augustine
PT, DPT, MS, Marisa Perdomo
PT, DPT, MS, Antoinette Sandler
PT, DPT, MS, CLT-LANA, Lisa
VanHoose PT, CLT-LANA, WCC
x Evaluate individuals with UE lymphedema, determine if
PT is appropriate or refer to another health care
provider for further differential diagnostic testing.
x Design an individualized intervention program that is
based on the anatomy and physiology of the lymphatic
system and is supported by best available evidence.
x Perform manual lymphatic drainage mobilizations (LD)
and modify the technique based on the quality and
nature of the edema.
x Apply appropriate UE compression short stretch
bandaging techniques and adapt the technique to
maximize therapeutic response from tissues with
fibrosis.
x Develop an appropriate physical therapy based
lymphedema home program
x Recommend the appropriate compression garment
12
x
x
Outcomes in
Physical Therapy
Note: This course
has been
implemented as a
repurposed online course in the
new APTA
Learning Center
(3 hr)
A Framework for
Treating Patients
with Oncological
Diagnoses Using
a Systems-Based
Approach (1.5 hr)
PT, PhD, Mary Lou Galantino PT,
PhD, MSCE, Kirsten Ness PT,
PhD, MA, MPH, Laura Gilchrist
PT, PhD, Meredith WamplerKuhn PT, DPTSc, Victoria
Marchese PT, PhD
Oncology
Exercise Issues in
Outpatient
Physical Therapy:
Beyond Range of
Motion and
Fitness
Prescription (2.75
hr)
Presenter: Mary Lou Galantino
PT, PhD. MSCE, Matthew Taylor
PT, PhD
Presenter: Stephanie Cramme
PT, DPT, Diane Heislein PT, DPT,
MS, OCS
o
Describe common impairments, limitations, and
outcome measures.
rehabilitation.
x Describe a comprehensive systems-based approach to
the physical therapy examination and treatment of
x Identify potential impairments and functional
limitations that may result as a direct consequence of
chemotherapy and/or radiation therapy treatment for
x Outline comprehensive evidence based interventions to
address integumentary issues in a patient with
leukemia, neuromuscular and cardiopulmonary issues
in a patient with metastatic lung cancer, and
musculoskeletal issues in a patient with metastatic
prostate cancer.
o Describe what is meant by full-spectrum movement
prescription contrasted with traditional therapeutic
o Describe how full-spectrum movement prescription
addresses the most common effects of cancer and its
treatment.
o Evaluate outpatients with oncological disease for fullspectrum movement prescriptions beyond traditional
13
o
x
Medical and
Physical Therapy
Management of
ChemotherapyInduced
Peripheral
Neuropathy
(CIPN)( 1.5 hr)
PhD, Kirsten Ness PT, PhD, MA,
MPH, Lynn Tanner PT
x
Improving the
Quality of Life of
Children with
Cancer: The Role
of Rehabilitation
(2.75 hr)
Presenter: Susan Miale PT, DPT,
PCS
x
Comfort Care
Only-Therapy
Presenters: Mary-Jean Paulitz
PT, MS, Jo-Ellen Thomson PT
Analyze a case report of an outpatient prescription for a
patient with oncological disease.
o Access resources for oncological patients within their
community as well develop niche programming within
their clinics.
o Describe the pathophysiology of CIPN.
o Describe medical management of CIPN, both for
prevention and symptom control.
o Describe the signs and symptoms of acute CIPN, and the
long-term structural and functional impairments and
associated performance limitations in individuals with
persistent CIPN.
o Develop an appropriate physical therapy management
plan for individuals with acute or chronic CIPN.
o Identify and describe the most common forms of
malignancy in childhood.
o Briefly describe the typical medical treatments for
childhood cancers.
o Identify the adverse effects of cancer and cancer
treatment that necessitate physical rehabilitation.
o Demonstrate a basic knowledge of how to effectively
screen patients to determine the need for occupational
and/or physical therapy services in the acute pediatric
oncology setting.
o Recognize the psychosocial issues that are common in
families of a child with cancer and determine strategies
to assist with coping
o Understand the benefits of physical therapy intervention
in children with cancer from an evidence-based
perspective.
o Identify the dilemma of comfort care in physical therapy.
14
o
o
Discontinued:
Can One Last Visit
Impact Quality of
Life? (1.5 hr)
x
Exercise and the
Athlete with
Cancer (2 hr)
Presenter: Alison DeLeo PT, DPT
x
to the
Identification and
Screening of
Balance for
Presenters: Min-Hui Huang PT,
PhD, Lucinda Pfalzer PT, PhD,
FACSM, FAPTA
Discuss the areas of focus for hospice physical therapy.
Identify the safety needs of patients who are
transitioning to hospice.
o Describe ways that a PT can impact a patient’s comfort.
o Discuss family and caregiver training opportunities that
could positively impact a patient’s quality of life at the
time of discharge.
o Define the “athlete cancer survivor”
o Describe current guidelines for exercise in athlete
o Identify the potential physiologic changes to exercise
response related to treatment modalities for cancer,
including surgery, chemotherapy, radiation therapy,
hormone therapy, immunotherapy and bone marrow
transplantation.
o Identify indications and contraindications for exercise in
an athlete patient with cancer.
o Apply and modify the general principles of exercise
prescription to meet the needs of physically active
o Formulate safe and effective exercise programs for
athlete cancer survivors before, during and after medical
management of cancer.
o Generate hypotheses regarding expected outcomes for
physically active patients with cancer participating in
exercise programs.
o Identify and respond to oncological emergencies.
x Describe the unique and diverse local and systemic
effects of cancer that impact balance.
x Describe the local and systemic effects of cancer
treatment that impact balance.
x Apply the appropriate screening tools with the ICF
15
x
x
x
Patients with
Cancer (1.5 hr)
to the
Examination and
Intervention of
Balance for
Patients with
Cancer (1.5 hr)
Successes and
Pitfalls:
Developing a
Sustainable
Comprehensive
Oncology
Treatment
Program (2.5 hr)
Breast Cancer
Physical
Restoration Using
the Pilates
Method (2.75 hr)
Presenters: Jennifer Blackwood
MPT, GCS, Amy Yorke MPT, NCS
Presenters: Teresa Fitzpatrick
PT, MBA, Mary Ann Calys PT,
DPT, MS, Andrea Leiserowitz
MPT,CLT, Kathie Hummel-Berry,
PT, PhD
Presenter: Suzanne Clements
Martin PT, DPT
model to manage a balance impairment in a patient
with cancer.
x Apply evidence based examination strategies to assess
x Apply evidence based intervention strategies to treat
balance dysfunction in a patient with cancer.
x Apply evidence based adaptation strategies for balance
dysfunction.
o Outline a plan for establishing a comprehensive oncology
clinical service within the community
o Describe at least two strategies for marketing the
practice to referral sources
o Explain the rationale for structure of the necessary
rehabilitation team.
o Describe a strategy for appropriate staff training
o Analyze the benefits of automatic referral protocols
o List at least three possible pitfalls that could impede
success in program development
o Explain the short and long-term physical and
psychosocial impacts of breast cancer.
o Compare and contrast the physical and psychosocial
impacts on pre-menopausal and post-menopausal
populations afflicted with breast cancer.
o Apply an evidence-based rationale for physical therapy
intervention in the rehabilitation and post-rehabilitation
phases for survivors.
o Perform a functional evaluation to identify core/trunk
strength as well as weight-bearing (pelvic and lower
extremity) movement dysfunctions.
o Define the Pilates Method; explain, and demonstrate the
16
x
x
Newer
Technologies
Advance the
Evaluation and
Treatment of
Peripheral Edema
and Lymphedema
(2.75 hr)
CSM 2010
Preconference
course (1 day):
End of Life Care:
Issues of Living
and Dying in
Clinical Practice
Presenters: Lesli Bell PT,
Elizabeth Campione PT, Marisa
Perdomo PT, DPT, Kathryn
Ryans PT, DPT
MA
qualitative benefits and differences between the popular
Classic conditioning Method and the therapeutic
application of the Method, focusing on the Upper Core.
o Identify contraindications for Pilates/ exercise and plan
appropriate treatments in the therapeutic application of
the Pilates Method.
o Set up a home well-being program for managing the
chronic condition of breast cancer survivorship.
o Upon completion of this course, you will be able to:
Understand and discuss the physiological rationale for
utilizing laser therapy, bioelectrical impedance and
compression pumps for individuals with lymphedema.
o Perform an evidence based decision making thought
process to determine if laser therapy, bioelectrical
impedance and compression pumps are appropriate for
individuals with lymphedema.
o Develop a PT intervention plan of care that includes laser
therapy and compression pumps for individuals with
lymphedema.
o Develop a PT intervention utilizing laser therapy for
those individuals who are at risk for developing
lymphedema.
o Understand the role of these modalities in the overall
plan of care for individuals with lymphedema and
determine when and how to optimize outcomes with the
use of these modalities.
o Identify signs and symptoms of terminal disease
processes.
o Problem-solve clinical issues of life limiting conditions.
o Identify common syndromes and barriers to adequate
pain relief at the end of life
17
x
Medical
Screening for
Oncology Issues
in Outpatient
Physical Therapy
(1.5 hr)
PT, PhD, MSCE, Laura Gilchrist
PT, PhD, Victoria Marchese PT,
PhD, G. Stephen Morris PT, PhD,
Kirsten Ness PT, PhD, MA, MPH,
Meredith Wampler PT, DPTSc
x
The Role of
Integrative
Medicine in
Physical Therapy
for the Oncology
Presenters: Carol M Davis DPT,
EdD, MS, FAPTA, Catherine
Goodman PT, MBA, CBP
o Discuss both pharmacological and non-pharmacological
approaches to symptom control.
o Differentiate 5 clinical practice patterns in palliative and
hospice care.
o Explain cultural differences in dying rituals and grief
responses.
o Identify normal pediatric response behaviors to death.
o Demonstrate the integration of spiritual care during the
end of life.
o Discuss legal, ethical and physiologic concerns around
palliative sedation, withdrawal of food and fluid, and
assisted suicide.
o Describe advanced directives and their related
components (power of attorney, living will, do not
resuscitate orders.
o Identify healthy personal and professional coping skills
useful while working with the terminally ill.
disease.
potential oncology “red flags”.
treatment.
cancer diagnosis.
o Give examples of body work, mind/body work, and
energy work used with cancer patients.
o Participants will gain an introductory understanding of
BodyTalk and how it is used with cancer patients.
18
o
Patient (3.5 hr)
x
New
Opportunities in
Physical Therapy:
Creating a
Hospice Based
Physical Therapy
Practice (3 hr)
Presenters: Ilene Decker RN,
PhD, Karen Mueller PT, PhD, JoEllen Thomson BS
x
Movement
System
Impairment
Diagnoses
Applied to the
Breast Cancer
Patient (2 hr)
Presenter: Renee Ivens PT, DPT,
MHS
Participants will learn 4 basic BodyTalk techniques to
use with anyone.
o Participants will observe a BodyTalk session.
o Discuss current and emerging trends in hospice care.
o Discuss the interdisciplinary structure of a typical
hospice setting.
o Discuss the benefits of physical therapy participation in
the hospice interdisciplinary team.
o Discuss opportunities for physical therapy practice in a
hospice setting.
o Discuss and apply strategies for creating a physical
therapy based hospice practice.
o Describe the types of physical therapy interventions
that can benefit patients in a hospice setting.
o Discuss appropriate physical therapy outcome measure
for use in a hospice setting.
o Discuss evidence regarding physical utilization in a
hospice setting.
o Discuss research findings related to physical therapy
outcomes in a hospice setting
o Identify which tissues are involved in a patient’s
movement dysfunction: soft tissue (muscle or joint
capsule), neural structures, lymphatic system and how
this assists in optimizing treatment
o Discuss the Physical Stress Theory as related to postsurgical or radiated tissues
o Describe the most common impairments in the
movement patterns of the shoulder girdle in this
population
o Discuss the most common MSI Scapular and Humeral
Diagnoses affecting patients who have received
treatment for breast cancer
19
o
x
Multidisciplinary
Rehabilitation
Approach for the
Treatment of
Head and Neck
Cancer-Related
Impairments (3
hr)
CSM 2009
x Preconference
course (2 day):
Physical Therapy
Examination and
Intervention for
Breast Cancer
Survivors
Presenters: Melody OuYoung
MS, CCC-SLP, Marisa Perdomo
PT, DPT
Presenters: Jacquelin Drouin PT,
PhD, Charles McGarvey PT, DPT,
MS, FAPTA, Lucinda Pfalzer PT,
PhD, FACSM, FAPTA, Margaret
Rinehart-Ayres PT, PhD, Nicole
Stout MPT, CLT-LANA
Describe intervention strategies for MSI Diagnoses of
the scapula and humerus
o Understand the medical diagnostic process and
treatment of Head and neck cancers.
o Evaluate and treat the complex musculoskeletal
impairments and functional limitations most commonly
experienced by this population.
o Understand the musculoskeletal function of the head
and neck during speech and swallowing activities and
how PT interventions can compliment the speech and
swallowing therapy.
o Review and discuss appropriate orthopedic manual
therapy techniques for individuals recovering from
Head and Neck cancer.
o Develop a short-term and long -term comprehensive
multidisciplinary treatment approach for the individual
recovering from Head and neck cancer treatments.
o Develop and foster relationships with other
rehabilitative health care professionals in order to
optimize outcomes for individuals recovering from Head
and Neck Cancer.
o Educate and instruct the individual with Head and neck
cancer in an appropriate manual lymphatic drainage
home program for lymphedema.
Participant Objectives
o Describe sequelae of breast cancer treatment that may
lead to impairments and functional limitations.
o Assess patients for breast cancer specific impairments
including; lymphedema, shoulder dysfunction, postural
deviations, strength and ROM loss
o Develop a treatment plan specific to breast cancerrelated impairments with consideration for treatment
20
side effects.
Understand the indications, precautions and
contraindication related to physical therapy
interventions with patients who have a history of
cancer.
o Develop an understanding of the role of the physical
therapist in pre-operative assessment and ongoing
surveillance screening of patients with breast cancer in
the absence of impairment.
o Identify personal issues of loss related to end of life
care.
o Integrate issues of dignity and independence into their
practice with declining patients.
o Practice awareness of body sense, thoughts and
emotions during clinical interactions
o Describe three methods to enhance their growth while
caring for the dying.
o Recognize language of spiritual concerns voiced in
patient care.
o Describe and appreciate factors of prevention, screening,
treatment, and rehabilitation of prostate cancer
including differences across cultures.
o Learn, reflect, and discuss current evidence on the use of
exercise training in prevention and management of
prostate cancer.
o Evaluate and apply safe, effective exercise training
guidelines for individuals with or at risk for prostate
cancer.
o Demonstrate confidence in performing a literature
review on the computer including Hooked on Evidence
and Open Door APTA’s portal to Evidenced-Based
o
x
Being Present
with Suffering,
Loss, or Dying
(2hr)
MA
x
Physical Therapy
and Prostate
Cancer (2 hr)
Presenter: Jacquelyn Drouin, PT,
PhD
x
Guiding the
Clinical Physical
Therapist into a
New Role as
PT, PhD, MSCE, Loraine LovejoyEvans PT, DPT, CLT-Foldi,
Lucinda Pfalzer PT, PhD, FACSM,
21
Researcher (4 hr)
FAPTA, David Scalzitti PT, PhD,
OCS
x
Physical Therapy
Care Across the
Practice
Continuum for
Patients with
Colorectal Cancer
(2 hr)
Presenters: Meryl Roth Gersh
PT, Robert Gersh MD
x
State of the Art
Measurement
Methodology for
Evaluating
Lymphedema (3
hr)
PCS, Ellen Levy PT, BGS, OCS,
Nicole Stout MPT, CLT-LANA
x
Orthopedic
Presenter: Loraine Lovejoy-
Practice
Demonstrate improved confidence in reading the
literature using critical thinking
o Understand the basics of research design, data
collection, and analysis
o Maximize the ability to partner with an academic facility
in their local area to promote outstanding research in
the field of specialty in PT
o Identify possible sources to secure funding
o Review the current medical practice for the examination,
evaluation, and comprehensive treatment of patients
experiencing colo-rectal cancer.
o Identify methods of prevention, early detection, and
early medical management of colo-rectal cancer.
o Describe the implications that the medical management
of patients with colo-rectal cancer, including surgery,
chemotherapy, and radiation, have for physical therapy
care.
o Explore the application of comprehensive physical
therapy care across the practice continuum for a patient
diagnosed with colo-rectal cancer.
o Integrate the Guide to Physical Therapist Practice as one
considers the comprehensive management of this
patient.
o Demonstrate an understanding of the pathophysiology
of lymphedema.
o Understand and identify the methods available for
assessing lymphedema
o Recognize novel evaluation tools available including
perometry and bioelectrical spectroscopy as well as the
science behind these technologies
o
22
Rehabilitation:
Improving
Outcomes Using
Lymphatic
System
Treatments and
Home Program
Instruction (3 hr)
Evans PT, DPT, CLT-Foldi
x
Will I Be Able to
Wear Heels to
the Prom?
Physical Therapy
Assessment and
Rehabilitation of
Children with
Osteosarcoma (2
hr)
PCS, Michael Smith PT, MEd,
Kieu-Phuong Thi Vu PT
x
Hemophilia 101
for Physical
Therapists (1.5
hr)
Presenters: Alice Anderson PT,
MS, PCS, Sara Elizabeth Strawn
PT, MSPT, OCS
o
Understand the anatomy, physiology, and
pathophysiology of the lymphatic system
o Describe the relationship between the circulatory and
lymphatic system
o Identify varying types of edema disorders and establish a
treatment program to minimize swelling
o Understand the benefits of reducing swelling in
orthopedic disorders to enhance function and to
decrease pain
o Understand the philosophy and manual techniques of
Lymphatic Mobilization and the relationship to
improving function
o Identify when it is appropriate to utilize lymphatic
mobilization in the rehabilitation program
o Maximize treatment sessions by instructing patients in a
comprehensive self-care program.
o Participants will gain knowledge in the diagnostic
methods and medical management of children with
osteosarcoma.
o Participants will understand and identify the physical
therapy needs of this population.
o Participants will be exposed to assessments and
therapeutic strategies to maximize a child’s functional
outcome and quality of life.
o Participants will understand how to use the “Guide to
Physical Therapist Practice” when working with a child
with osteosarcoma.
o Define hemophilia and be knowledgeable of its
inheritance, incidence and hematological values.
o Describe the coagulation cascade in normal and
hemophilic patients.
o Know the red bleeding complications (red flags) of
23
x
linical Update
and
Interdisciplinary
Care:
Rehabilitation
Following Breast
Cancer Surgery (3
hr)
Presenters: Stephanie Caterson
PT, Roya Ghazinouri PT, MS,
Daniel Ovitt PT, Rebecca
Stephenson PT, DPT, MS,
Reginald Burns Wilcox III DPT,
MS, OCS
central nervous system, gastrointestinal system and
musculoskeletal system.
o Know the key factors to identify and treat acute,
subacute and chronic hemathrosis/hemarthropathy and
its sequelae.
o Know the in key factors to identify and treat muscle
bleeds and its complications.
o Be knowledgeable in the history and current hemophilic
factor replacement therapies.
o Understand the role of exercise, fitness, and sportsin the
hemophilic patient.
o Be knowledgeable in the radiologic assessment of the
Arnold-Hilgartner and Pettersson Classification of
Hemophilic Arthropathy.
o Describe the orthopedic surgical interventions for the
hemophilic population arthroscopic synovectomy,
radionuclide synovectomy, radial head resection and
total joint replacements) and their outcomes.
o Be knowledgeable of the comprehensive model of
treatment for hemophilic patients and hemophilic
treatment centers.
o Demonstrate an understanding of the medical and
surgical management for breast cancer treatment.
o Identify common dysfunction following breast cancer
surgery and adjuvant treatment.
o Articulate the efficacy for exercise and therapy following
breast cancer surgery.
o Appreciate the potentially complex patient presentation
following breast cancer surgery and the need for an
interdisciplinary postoperative rehabilitation plan.
o Illustrate why abnormal shoulder girdle mechanics occur
following surgery for breast cancer.
o Describe the rehabilitation principles for the shoulder
24
Regional Courses
Offered by Oncology
Section
Courses scheduled
for 2012
x Breast Cancer
Rehabilitation
(16 hr)
Scheduled for:
o March 31April 1, 2012
in Chapel Hill,
North
Carolina
o May 19-20,
2012 in Iron
Mountain,
Michigan
o September
29-30, 2012
in Edgewood,
Kentucky
x Exercise Training
Guidelines for
Individuals with
Cancer:
Endurance,
Strength,
Flexibility, and
Varies
2008
Oncology
Section
Sponsored
Courses
PT, PhD, FACSM
girdle following breast cancer surgery and treatment.
Design a comprehensive rehabilitation program for a patient
following breast cancer surgery.
Frequency: Annually, often Average attendance: 16-18
more than once a year;
therapists per course, with
Typically average of six
six courses per year is
approximately 96-108
courses offered per year
therapists
approach
lymphedema
program development
cancer
Discuss the need for physical therapist and patient advocacy
in this population.
a cancer diagnosis
25
Adherence (8 hr)
Scheduled for:
o March 24,
2012 in
Jefferson
City, Missouri
o April 14,
2012 in
Rockford,
Illinois
o October 13,
2012 in
Tulsa,
Oklahoma
Courses in 2011:
x Breast Cancer
Rehabilitation
Richland,
Washington
October 1-2,
2011 (16 hr)
x
Exercise Training
for Cancer
Survivors:
Endurance,
training
Appropriately modify exercise programs in response to
oncology setting
patient population
spectrum
Describe the role of exercise in treating the cancer survivor
o
MSPT, CLT-LANA
PT, PhD
approach
lymphedema
program development
cancer
26
Strength,
Flexibility, and
Adherence
Concord, New
Hampshire
October 1, 2011
(8 hr)
x
Second Annual
Oncology
Rehabilitation
Symposium,
Oakland
University:
Rehabilitation
Across the
Continuum of
Care.
Rochester,
Michigan, August
23 and 25, 2011
(Online
presentations)
and August 27,
2011 (oncampus
laboratory
Presenters: Deborah Doherty
PT, PhD, CEAS, Jacquelin Drouin
PT, PhD, Janet Seidell PT, Reyna
Colombo PT, MA, Marie-Eve
Pepin PT, DPT, OMPT, Adhil
Akhtar MD
a cancer diagnosis
training
oncology setting
patient population
spectrum
survivor
27
x
x
x
x
session, 17.5 hr
total)
Walk, Run, Jump,
and Thrive:
Physical Therapy
Assessment and
Intervention for
Children and
Adolescents with
Cancer
Minneapolis,
Minnesota May
13-14, 2011 (10
hr)
Breast Cancer
Rehabilitation,
Farmingdale,
New York April
2-3, 2011 (16 hr)
Breast Cancer
Rehabilitation,
Richland, WA,
October 1-2,
2011 (16 hr)
Exercise Training
for Patients
Across the
Cancer
Spectrum:
Testing,
Prescription, and
PhD, Lynn Tanner PT
o Describe the typical treatment regimen for children
with leukemia, lymphoma, and solid tumors, including
CNS tumors
o Describe the current literature on CIPN in children and
adolescents with non-CNS cancer
o Describe the current literature on physical impairments
o Discuss the pros and cons of different outcome
measurements to use in these populations
o Describe and demonstrate assessment and intervention
techniques to address common physical impairments
PT, PhD
28
Outcomes
Assessment
St. Joseph,
Michigan
January 16, 2011
(8 hr)
Courses in 2010:
x Breast Cancer
Rehabilitation
Exeter, New
Hampshire
November 13,
2010 (8 hr)
Roberge PT, DPT, Med
x
PT, PhD
Exercise
Guidelines for
Individuals with
Cancer
a cancer diagnosis
Recognize and respond to adverse responses to exercise
training
oncology setting
patient population
spectrum
survivor
approach
lymphedema
program development
cancer
advocacy in this population.
o
29
x
x
Charlotte, North
Carolina
September 18,
2010 (7.5 hr)
Exercise
Guidelines for
Individuals with
Cancer, Concord,
NH, October 1,
2011 (7.5 hr)
First Annual
Rehabilitation
Symposium of
Oakland
University: Focus
on Breast Cancer
and Prostate
Cancer
Rochester,
Michigan,
August 26-28,
2010 (3 day
conference)
Courses in 2009:
x Interventions for
Cancer Patients
and Cancer
Survivors
Portland, Oregon
November 14-15,
2009 (11 hr)
PT, PhD
Presenters: Deborah
Doherty PT, PhD, CEAS,
Jacquelin Drouin PT, PhD,
Janet Seidell PT, Reyna
Colombo PT, MA, John
Maltese MD
PT, PhD, Andrea Leiserowitz
MPT, CLT
a cancer diagnosis
30
o
x
Breast Cancer
Rehabilitation:
Implications in
Physical Therapy
Atlanta, Georgia
April 4-5, 2009
(15.5 hr)
Oncology Courses Sponsored by APTA Chapters
PA
x Courses
DC
Projected for
Presenters: Charles McGarvey
PT, DPT, MS, FAPTA, Nicole
Stout MPT, CLT-LANA
CLT-LANA
Recognize and respond to adverse responses to exercise
training
o Write exercise prescriptions for the oncology patient and
survivor
oncology setting
patient population
spectrum
o Discuss exercise interventions in the context of
lymphedema and treatment-associated peripheral
edema
survivor
o Describe the basic cancer diagnosis, pathology and
staging
o Describe medical and surgical management commonly
used in treating breast cancer
o Choose and perform appropriate screening/systems
o Describe and choose interventions for common
impairments seen in individuals at various stages of the
disease process
o Understand the need for appropriate modality selection
and use based on the cancer history and/or treatment
o Understand the importance of physical therapy
intervention in a palliative care setting
31
o
2013 (10-16 hr)
x
Courses Offered
in 2012 (10-16
hr)
AL
SD
CLT-LANA
x
Courses Offered
in 2012 (10 hr)
Colorado
Presenter: Andrea Leiserowitz
MPT,CLT
cancer diagnoses
for exercise
Attendance average: 30
cancer diagnoses
for exercise
Attendance average: 40
cancer diagnoses
32
Discuss the need for appropriate modality selection and
exercise
o
Regional courses offered outside the sponsorship of the Oncology Section
x Cancer
CLT-LANA
Rehabilitation:
An EvidenceBased Course for
All Clinicians (20
hours,
intermediate
level course)
Offered by: Great
Seminars and
Books, Inc.
Physical Therapy for
the Patient with
Breast Cancer (16)
Offered by programs,
a company founded
by the presenter to
Presenter: Leslie Waltke PT
Frequency: The course was offered 5 times in 2012, in
Winston-Salem, Louisville, Green Bay, Nashville, and
Portland, Oregon. It was also offered 5 times in 2011, in
Palos Heights, Illinois, Oklahoma City, Dallas, Napa,
California, and Richmond Virginia.
Average attendance: 40-50, mostly physical therapists and
some PTAs. Assuming 40 physical therapists at each of five
courses, that would lead to a total attendance of 200 per
year.
cancer diagnoses
for exercise
Frequency: Three times per year
Attendance: Ranges from 10 to 40, primarily physical
therapists for a total attendance of between 30 and 120 over
the course of a year.
o Describe basic cancer pathophysiology
33
offer evidence-based
programs for health
care professionals
and survivors of
cancer.
Advanced Oncology
Rehabilitation for
Successful Outcomes
(15-18 hours)
Offered by: North
American Seminars
CMLDT
o Describe cancer treatments including mechanisms of
action and side effects
o Perform a comprehensive evaluation of the cancer
patient
o Recognize and treat musculoskeletal dysfunctions of
surgery, radiation, and reconstruction
o Differentially diagnose and treat pain syndromes
o Set up a comprehensive post operative home exercise
program
o Develop a rehabilitation program to combat side effects
of chemotherapy and radiation
o Teach infection and lymphedema risk reduction
techniques
Frequency: Course is scheduled for five offerings in 2012.
The course comes with an optional software program
designed for professionals who are starting a lymphedema
program.
o Describe cancer pathogenesis and how it is shaping
environmental awareness and changing cancer
management globally.
o Discuss the clinical management of breast cancer, head
and neck cancer, prostate cancer, ovarian cancer,
melanoma, leukemia, and lymphoma.
o Understand new advancements in cancer treatment:
chemotherapy, targeted therapy, radiation therapy,
immunotherapy and hormone therapy.
o Discuss the clinical implications of myelosuppression,
cancer related fatigue, cardiotoxicity, hormone changes
and cognitive changes in patients undergoing cancer
treatment.
o Develop safe and appropriate oncology exercise
34
Advanced
Management of
Breast Cancer
Rehabilitation (15
hours)
Offered by: North
American Seminars
CLT-LANA
programs according to the guidelines, clinical tests and
screening systems presented in the course.
o Perform specialized manual therapy skills for the post
surgery and radiation management of patients with
cancer (upper extremities, trunk, and lower extremities).
o Utilize the appropriate modalities based on cancer
history and areas of treatment.
o Design appropriate inpatient and outpatient programs
with the consideration of program goals, referral and
intake processes and discharge criteria.
o Understand the anatomy of breast cancer cells, their
functional capabilities, and how modern medicine is
responding in its design to treat breast cancer
effectively.
o Expand clinical knowledge about differential diagnoses,
treatment side effects, and physical sequelae of
chemotherapy, radiation therapy, and targeted hormone
therapies.
o Advance understanding of the biology and physiology of
the acute trauma that occurs to the lymphatic system
after surgery and radiation therapy, and how this affects
the normal healing processes in the body.
o Understand the difference between treating
“lymphedema” as a condition, and the advanced
concepts of treating acute trauma of the “lymphatic
system” as it relates to other body systems in the healing
processes of surgery, radiation, and chemotherapy.
o Advance and integrate manual lymphatic drainage skills
with orthopedic manual therapy skills to include system
management of the musculoskeletal system, the nervous
35
o
o
o
o
system, the vascular system, the lymphatic system, and
the endocrine system during and post breast cancer
treatment.
Understand complex co-morbidities and adverse
treatment complications of breast cancer, how they
affect the healing capacity of patients, and how
treatment can be structured to minimize their effect.
Identify clearly the specific clinical goals of specialized
manual therapy skills and targeted exercise protocols for
patients undergoing advanced forms of breast surgery,
new chemotherapy treatments, and/or targeted
radiation therapy so as to achieve optimal function, as
well as sustainable treatment results.
Have increased knowledge about advances in breast
cancer diagnoses, advances in breast cancer
management, and advances in breast cancer research.
care and mulit-disciplined approach to the management
of patients with breast cancer.
Complete
Presenters: Steve Norton CLTFrequency: Course is scheduled for 20 offerings in 2012.
Decongestive
LANA, Andrea Cheville MD,
Therapy Certification
Nicole Stout MPT, CLT-LANA,
John Beckwith PT, CLT-LANA, Joy o Differentiate between a variety of peripheral edemas
course (135 hr;
Cohn, PT, CLT-LANA
o Understand the applications, medical indications, and
participants receive a
contraindications of MLD and CDT.
5 DVD set)
Offered by: Norton
o Establish a CDT treatment plan for individuals with
School of Lymphatic
primary or secondary lymphedema and perform the
Therapy
indicated treatment.
o Perform the four components of CDT (manual lymph
drainage, compression therapy, exercise, skin care)
e – Integrative
Lymphedema
Certification Course
36
(135 hr, 45 hr of
which is an internetbased home study
course. Participants
receive DVDs,
software, and a
manual.)
Offered by: Klose
Training and
Consulting
Basic MLD
(48 hr; participants
receive a manual)
Offered by: Norton
School of Lymphatic
Therapy
Joanne McGillicuddy PT, CLTLANA, Chris Cobb PT, CLT-LANA,
Leslyn Keith MS, OTR/L, CLTLANA, Heidi Miranda-Walsh
Coopee, OTR, CLT.
Presenters: Steve Norton CLTLANA, Andrea Cheville MD, John
Beckwith PT, CLT-LANA, Joy
Cohn, PT, CLT-LANA
o
o
o
o
Demonstrate four components of Complete
Decongestive Therapy.
Differentiate between a variety of peripheral edemas
Understand the application, medical indications and
contra-indications for MLD and CDT.
Establish a CDT treatment plan for individuals with
primary and secondary lymphedema and perform the
treatment for lymphedema accordingly.
Frequency: 2012 schedule is not available on line at this time
Average Attendance:
o Demonstrate an understanding of the anatomical
features and terminology of the functional lymphatic
system
o Demonstrate comprehension of information related to
normal lymphatic physiology and the differences
encountered in a diseased state
o Demonstrate an understanding of the proper clinical
applications of MLD (indications)
o Demonstrate an understanding of the improper clinical
applications of MLD (contraindications)
o Demonstrate an understanding of clinical applications
where caution should be exercised (precautions)
o Perform techniques consistent with proper Vodder-style
MLD and memorize the sequences for all body areas of
the intact lymphatic system
o Demonstrate the ability to customize treatment
strategies for various pathologies where MLD is indicated
o Demonstrate the ability to employ MLD on primary and
secondary lymphedema patients (medicallyuncomplicated, physician prescribed treatment)
37
Basic MLD
(45 hr)
Offered by: Klose
Training and
Consulting
Joanne McGillicuddy PT, CLTLANA, Chris Cobb PT, CLT-LANA,
Leslyn Keith MS, OTR/L, CLTLANA, Heidi Miranda-Walsh
Coopee, OTR, CLT.
Lymphedema
Management of the
Upper and Lower
Extremities (23 hr)
Offered by: North
American Seminars
Presenter: Elizabeth Augustine
PT, DPT or Julia Osborne PT,
CLT-LANA
o Demonstrate an understanding of the anatomy and the
relevant scientific terminology related to the lymphatic
system
o Demonstrate an understanding of the differentiation
between the normal and diseased states of the
lymphatic system (physiology and pathophysiology of
the lymphatic system)
o Demonstrate an understanding of the indications and
contraindications related to the use of MLD
o Competently perform the techniques of MLD for all body
areas
o Develop appropriate treatment strategies for indications
such as post-surgical edema, post-traumatic edema,
fibromyalgia, general detoxification and other conditions
o Competently perform MLD on clients after breast
surgery for cancer (clients at risk to develop
lymphedema)
o Competently perform MLD on clients with mild,
medically uncomplicated, primary or secondary
lymphedema
Frequency: This course is scheduled to be offered three
times in 2012.
Average attendance: 30, primarily physical therapists for a
total yearly attendance of 90.
o Demonstrate an understanding of the anatomy and
physiology of the lymph system
o Describe the pathophysiology of lymphedema and
pathogenesis of common upper extremity and lower
extremity lymphedema.
o Understand the common diagnostic procedures for
38
lymphedema.
Recognize, assess, and treat the different classifications
of upper extremity and lower extremity lymphedema
o Perform proper massage techniques to enhance
lymphatic flow and explain the physiologic rationale for
lymph drainage massage.
o Correctly apply short stretch compression bandages in
the treatment of upper extremity and lower extremity
lymphedema.
o Perform limb measurements that provide acceptable
documentation of outcome measures.
o Instruct patients and health care professionals in
precautions and skin care.
o Choose the appropriate compression garments and
instruct patients in correct application.
o Develop appropriate individualized treatment programs
for successful functional outcomes.
yearly total of 180.
o Understand the anatomy and physiology of the
lymphatic system and how to use the anatomy to its best
advantage in performing effective lymphatic drainage in
complex patients with aggressive and advanced
lymphedema, lipedema, and primary lymphedemas.
o Advance and integrate lymphatic drainage skills with
neuro-musculo-skeletal orthopedic skills to create
increased efficiency and greater success in treating
patients with UE complications, LE complications, head
and neck complications, groin and genital complications,
and abdominal and trunk complications.
o Demonstrate the ability to use the hands-on advanced
techniques taught in this seminar to treat patients with
o
Advanced
Management of
Lymphedema (15 hr)
Offered by: North
American Seminars
CLT-LANA
39
o
o
o
o
o
Educata:
Foundation of
Oncology for Physical
Therapists (2.5 hr.
This is a beginner
level course designed
Author/Presenter: Marisa
Perdomo, PT, MSPT, DPT, CLTFoldi, CES
co-morbidities such as chronic thrombosis, diabetes,
CHF, auto-immune diseases; and patients with
complications of lymphedema such as seromas,
hematomas, severe fibrosis, axillary web syndrome, and
Mondor’s syndrome.
Have a more in-depth understanding of the acute
trauma that occurs to the lymphatic system after surgery
and radiation therapy so as to broaden treatment
protocols and implement early intervention.
Have the knowledge and tools necessary to shift mindset
from treating “lymphedema” as a condition to treating
the “lymphatic system” as it relates to other body
systems during periods of acute trauma – a necessary
step towards progressive thinking in twentieth century
medicine, and in the future development of evidencebased research.
Develop advanced critical thinking skills and clinical
decision-making skills in the management of patients
with lymphedema and all associated co-morbidities and
complications.
Expand knowledge base about bandaging, compression,
kinesiotape, and additional products on the market; and
know how and when to apply advanced management
products to patients.
care and multi-disciplined approach to the management
of complex patients
Attendance: Over 180 Individual users since inception
o Understand, define, discuss and educate others in the
scientific foundational principles regarding:
o The pathogenesis of cancer
o The diagnosis and prognosis of cancer
40
o
o
to provide a solid
foundation for
oncology practice.)
APTA Learning
Center:
x CSM10: Medical
Screening for
Oncology Issues
in Outpatient
Physical Therapy
(2 hr)
Author/Presenters: Mary Lou
Marchese, PT, PhD, G. Stephen
Wampler, PT, DPTSc
CSM11: Measuring
Outcomes in
Oncology
Authors/Presenters: Mary Lou
Marchese, PT, PhD, G Stephen
Wampler, PT, DPTSc
The growth or spread of cancer
Medical intervention strategies for the treatment of
cancer
o Search medical Web sites regarding specific cancer
diagnoses and treatments to obtain the specific
information needed for a physical therapist to perform
an initial evaluation.
o Utilize the scientific principles regarding cancer to
determine the role of physical therapy for individuals
with cancer.
Attendance: Over 60 individual users since inception
disease
potential oncology 'red flags
treatment
cancer diagnosis.
Attendance: Over 80 individual users since inception
outcome measures.
41
PT 2011: Manual
Therapy for the
Oncology Patient (3
hr)
Author/ Presenter: Lisa Massa,
PT, WCS, CLT-LANA
PT10: Physical
Therapy
Management of
Children With Cancer
(3 hr)
Authors/ Presenters: Colleen
Coulter-O'Berry, PT, DPT, PhD,
MS, PCS, Kirsten Ness, PT, MA,
MPH, PhD, Durga Aman Shah,
PT, DPT, PCS, Claire F.
McCarthy, PT
rehabilitation.
Attendance: Over 30 individual users
o Review, discuss, and apply the proper indications and
contraindications for manual therapy for the patient
with cancer.
o Discuss the impact of surgery, chemotherapy, and
radiation treatments on the musculoskeletal and
lymphatic systems.
o Synthesize the relevant literature associated with
manual therapy and individuals with cancer, with
emphasis on mobilization/manipulation techniques and
therapeutic exercise of the musculoskeletal and
lymphatic systems.
o Integrate relevant dysfunctional biomechanical and
neurophysiologic findings with appropriate manual
therapy interventions for patients with breast cancer
and/or head and neck cancer.
o Identify oncologic emergencies that may initially appear
as musculoskeletal problems.
Attendence: Over 40 individual users
o Consider the process of screening and differential
diagnosis for children with signs and symptoms related
to brain tumors, leukemia, bone marrow transplants,
and solid bone tumors.
o Review the pathophysiology of selected diagnoses.
o Establish the patient/client management plan for various
pediatric diagnoses.
o Discuss practice management across the continuum of
care available in pediatric settings.
o Develop discharge plans and referrals to other practice
settings as appropriate.
42
CD-ROM: Audio-Plus
Home-Study Course:
Cancer
Rehabilitation:
Principles and
Practice
Author/ Presenter: Charles L.
McGarvey, PT, DPT, MS, FAPTA
Average Attendance: over 150 individual users since
inception
o Define terminology associated with Cancer
o List statistics related to incidence, mortality, and
morbidity
o Identify basic metastatic process
o List primary antineoplastic strategies and their sequelae
o Identify general principles of cancer rehabilitation
o Describe the purpose of the physical therapy
impairment diagnosis
o Name the most common risk factors for cancer
o Identify the systems most often affected by cancer
metastasis
o Describe the corresponding clinical manifestations of
each system affected by cancer metastasis
o List clinical signs and symptoms corresponding to
paraneoplastic syndromes
43

Oncology Specialization

Transcription

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