Spotlight On: Physical Therapists in Oncology

September 23, 2014
Amber Bauer, ASCO staff

If you’ve been diagnosed with cancer, you will interact with a number of different members of the health care team at various times during treatment. When you walk into a doctor’s office, hospital, or cancer center, you may encounter nurses, physician assistants, social workers, doctors—the list goes on. In this series, we talk with some of these health care professionals to learn more about their jobs and the role they play in providing high-quality cancer care.

Advances in treatment have helped more people live longer after being diagnosed with cancer. However, many people experience a decrease in their quality of life both during and after treatment. Physical therapists play a unique role in the cancer care team because they are able to address the functional challenges that may develop as a result of cancer and cancer treatment. Physical therapists evaluate these issues throughout the cancer experience and provide effective treatment strategies to return a person to their previous level of physical function.

To better understand the role physical therapists play in the cancer care team, Sharlynn Tuohy, PT, DPT, MBA, Director of Rehabilitation at Memorial Sloan Kettering Cancer Center (MSKCC), and Jean Kotkiewicz, PT, DPT, CLT, Supervisor, Inpatient PT at MSKCC, graciously agreed to answer a few of my questions.

Q: What role do physical therapists play in the cancer care team? 

Sharlynn Tuohy (ST): Many people think of physical therapy as an intervention for sports-related activities or muscle/bone (musculoskeletal) injuries. However, physical therapists are adept at treating a variety of functional impairments related to issues with the heart and lungs (cardiovascular), nerves (neurological), skin (integumentary), pelvic floor, and inner ear (vestibular). We can provide a variety of individualized interventions to help people function better within their daily lives.

Physical therapists are underutilized, especially during the cancer journey, as we provide great value in a cost-effective manner. Surviving cancer requires attention to optimizing function and quality of life, and physical therapists are primed to do just that. We provide significant value to a patient’s experience through pre-habilitation (proactive management of anticipated side effects of treatments), as well as providing cost-effective interventions during cancer treatment to help individuals maintain their strength, decrease fatigue levels, minimize pain, and maximize function such as balance, walking, and overall mobility. We also provide value in end-of-life care through gentle but effective treatments.

Jean Kotkiewicz (JK): Physical therapists play a critical role as part of the cancer care team by intervening during all stages of care. Physical therapists provide not only detailed assessments and interventions, but apply functional training, strengthening, fatigue-combating interventions, complete decongestive therapy (CDT), and relaxation techniques to meet the specific goals of each patient. We provide a uniquely supportive position within this patient population. We facilitate a motivating, encouraging, and positive environment.

I think it is also important to note that physical therapists create a bridge in the lives of these patients. On one side we have the physician’s orders, medical treatments, and weight-bearing restrictions, while the other side represents the patient’s daily life before, during, and after diagnosis.  We provide a way to incorporate one side with the other in a way in which a patient understands, maintains, and is able to incorporate the important aspects of treatment safely.

Q: What are some of the most important things you do for patients on a daily basis?

JK: One of the most important things I inherently do for my patients is to read the situation I am walking into without them needing to explain. I tailor my treatments accordingly. I allow them to have control over their goals in a setting where their control over the situation is vastly limited. I listen, and I hear. I am creative. I ask what is important to them. I have respect.

ST: Physical therapists provide a healing touch. We also help an individual regain their confidence. Being diagnosed with cancer creates a vulnerability that may not have existed before, and it can really shake an individual’s confidence. Individuals benefit from achieving small successes through my positive and encouraging attitude.

Q: Why did you become a physical therapist, and how did you end up working in oncology? 

ST: I became a physical therapist because I wanted to help people and was drawn to this field. Because I was active in sports and loved working with children, this profession suited me well. Throughout my career, I was exposed to a variety of settings including acute care, outpatient, inpatient rehab, pediatrics, and home health care. I moved to New York City about 11 years ago and immediately applied to MSKCC as I had a friend who was a patient here and thought the care was phenomenal. During my time here, I have been truly inspired by the motivation of the patients and have been continually impressed by the skilled and compassionate care provided by the staff.

JK: I became a physical therapist because I was always active in sports and had a few encounters with physical therapists in my own life. I knew that I belonged in the medical field in some aspect, and sports drew me closer to this area. I began working in oncology as part of my first job within a hospital setting and grew to love the patients. After two years, I applied to MSKCC and have been here for the past seven years. I was drawn to the strength and resilience within this specific population.

Q: What are the best or most rewarding parts of your job?

ST: When I was treating full-time, my reward was from helping a patient feel better by achieving a goal, no matter how large or small, as long as it made a positive difference in their lives. It may be something as simple as breathing easier or being able to hug a family member, to walking across a city street, or running. Now that I am in administration, when one of the therapists receives an acknowledgement that their care made a difference in an individual’s quality of life, that makes my day. Being able to lead and support programs in which we can reach more patients is also very rewarding.

JK: The most rewarding part of my job is to be part of the lives of these patients while they are going through such a unique, challenging, and unknown part of their lives. During this time, their reactions and responses may require more TLC, and it is a challenge to provide that in a customized way. The best parts of my day are spent assisting patients in working toward and reaching their goals. It is also about being present in the moments of challenge and loss as well, but letting them know they are not alone in those moments.

Q: How can patients better communicate with their physical therapist or get access to physical therapy services? 

JK: I encourage patients to remain open and honest about their fears and limitations when working with their physical therapist. I encourage them to ask questions, discuss their limitations with their care providers, and ask for physical therapy referrals if they feel they are not able to return to their previous levels of function.

ST: Individuals should always communicate how they are feeling to their physical therapist. Sometimes a person may not respond favorably to a treatment, and we need to know that so we can modify the treatment accordingly. Patients can access physical therapists directly in most states without a physician referral initially. Although if you have a history of cancer, it is good for your physical therapist and oncologist or primary care physician to communicate about your treatment plan. There are online resources, such as Find a PT on the American Physical Therapy Association website, where you can locate a physical therapist in your area. Advocate for yourself and ask your physician for a referral as well. Do not feel guilty for asking for help to improve your function. 

Sharlynn Tuohy and Jean Kotkiewicz have more to say about the role of physical therapists in oncology. Learn more in the following podcast.