MUSC students trailblazing a path for occupational therapists in oncology

It’s more than just feeling good again physically. Recovering from and getting back to a place where you feel like yourself after cancer treatment can be a struggle cognitively and emotionally as well.

There is someone who can help – but it’s a professional that not many people utilize or even know about. It’s a specialty often confused with physical therapy.

Occupational therapy, as described by the American Occupational Therapy Association (AOTA), uses everyday life activities to promote health, well-being, and the ability to participate in the important activities in your life. These activities include things like brushing your teeth and hair, getting dressed, cooking, writing, shopping – all the small but meaningful tasks that make you feel like yourself.

And occupational therapy is a career that MUSC College of Health Professions students Valerie Salmon, Julia Mabe and Maddie Gies are passionately pursuing. All three have noticed a gap in oncology care that occupational therapy can fill, and they’re trailblazing a path for students behind them.

“A lot of patients don’t realize that there are ways to manage their symptoms through occupational therapy. And they don’t know to ask for it,” said Gies.

“Occupations doesn’t always necessarily mean work. Occupations are activities of daily living. It’s making sure that cancer doesn’t disable the patient to the point where they cannot engage in those activities.”

Maddie Gies
OT student

What all three students found in their research is that not only do patients not know to ask, but many doctors themselves are unaware of the specific symptoms that should prompt a referral to an occupational therapist.

MUSC Hollings Cancer Center physical therapist, Katie Schmitt, DPT, who has worked with and mentored all three students, would agree.

“Depending on their symptoms, patients can be referred to the wrong specialist, and I think cognition gets overlooked. Something like 80% of patients will have chemotherapy-induced cognitive impairment, or brain fog,” said Schmitt, referring to the term commonly used to describe the memory issues patients deal with during and after treatment. “That’s something you could refer to OT.”

But often, these issues aren’t referred to an occupational therapist, and what Gies, Salmon and Mabe have found is that it comes down to a misconception about what occupational therapists do and how they differ from physical therapists.

“Occupations doesn’t always necessarily mean work,” said Gies. “Occupations are activities of daily living. It’s making sure that cancer doesn’t disable the patient to the point where they cannot engage in those activities.”

In addition to those daily activities and the expertise to work with patients’ cognition and memory, occupational therapists are also trained to help patients with body image.

“In a cancer setting, the sense of self and how you look at yourself again after breast cancer or head and neck surgery and how you deal with fatigue and anxiety is a huge part of it,” said Schmitt. “There’s a big overlap with what PT and OT can do, but then there are all of these other skills that OTs have that there’s a need for.”

So why is occupational therapy so underutilized? That’s a question that all three students have asked themselves and a major driver for their work this semester as they complete their capstone projects. These projects serve as a culmination of their academic journeys, demonstrating mastery of a chosen area of study. Students choose a topic of focus, create a needs assessment and then develop a program or project to investigate and highlight that research.

Gauging cancer-related fatigue in children

Gies discovered that fatigue is a big area that many overlook when it comes to treatment. In fact, it is one of the top three symptoms reported by cancer patients, along with pain and nausea, but it’s the least likely to be addressed or managed by health care providers.

That is where Gies has focused her work this semester. She found that this issue can be even bigger for children, as parents and health care providers often underestimate the levels of fatigue they experience.

So, she created a coloring book called Izzy’s Daily Bucket that helps children to understand cancer-related fatigue and plan their days to best utilize their energy. She’s currently running this program with patients at MUSC Shawn Jenkins Children’s Hospital and teaching staff OTs to continue implementing it with future patients.

 

“When I sit down with families to introduce the program, most caregivers say that they had never heard of cancer-related fatigue or that they do not know how to manage fatigue levels. That results in their child not being able to engage in their normal everyday activities,” said Gies. “Most parents are distressed by this but are unsure of where to start or even if there is a place to start. It feels good to have an evidence-based tool to help families to gain back some control in their lives.”

A personal connection

Salmon has an equally passionate pull to occupational therapy for oncology, but hers comes from a personal connection to cancer. Both of her parents died – her dad from pancreatic cancer and her mom from ovarian cancer – before her 23rd birthday.

“So, I was caretaker for both and saw their short and long-term symptoms,” said Salmon. “It’s not like I’m trying to save my parents, but it’s cool that I can use that experience to help other people.”

Salmon’s capstone project is centered around making other occupational therapists and students aware of the need for and benefits of OT in oncology. She noticed that there were very few lectures and very little information that focused on caring for cancer patients in her coursework.

“I thought it would be a really great opportunity to show students and current occupational therapists where they can really use their skill set to treat patients with cancer,” said Salmon.

 

She works closely with Schmitt and hopes to show others that OT and PT can work in tandem to give patients the best care possible.

“So, for instance, we see a lot of breast cancer patients and their surgery can cause lymphedema,” said Salmon, referring to the swelling that happens when there is a buildup of fluid in the body. This swelling can cause tightness and a loss in range of motion.

“Dr. Schmitt does strengthening and stretching exercises, but then an OT could come in and work with them on cancer-related fatigue, daily planning and body image. It would be more holistic – treating the whole person along with the exercises. These are short sessions. It'd be great if they could have both.”

Salmon works with Schmitt, seeing nearly two dozen patients a week and said it’s given her a broader understanding of the cancer experience from those who are living with the disease.

“I think I can get so laser-focused on my parent’s experiences,” said Salmon. “And I don’t ever want to forget that so many other people experience cancer. It’s been good for me to see people living with cancer and going to their appointments and going about their daily lives – just how strong they are with everything they’re going through."

Fitness and cancer

Mabe experiences this strength with breast cancer survivors in her capstone project, at the MUSC Wellness Center. 

“We're all kind of battling our own things,” said Mabe. “And these women have been through a lot – they're still going through a lot. They’ve shown me how important it is to have a support group and to just be open-minded to whatever comes your way.”

She chose her project after hearing about the Survivors' Fit Club, a 10-week program dedicated to exercise, nutrition and behavior modification. The program aims to improve fitness levels, build body strength, address depression, and boost self-esteem. The program includes a two-month membership to the Wellness Center and classes twice a week.

Mabe, a fitness enthusiast, works with women four days a week – split between the Fit Club and a new program, called Fight Back. This program is a continuation of the Survivors’ Fit Club and aims to provide women with a safe and supportive environment to maintain the strength and physical stamina they have gained through the Fit Club. The women work through circuit training two days a week with the program leader and Mabe’s mentor, Cindi Day. Mabe brings her occupational therapy knowledge to the mix to help women with the mental health side of survivorship.

 

“I think about how we as OTs can help with the activities of daily living,” said Mabe. “Coming and doing strength training is great but how can we help with cancer-related fatigue? A lot of women experience that, and a lot of women experience body image issues.”

As members of Fight Back, women go through assessments for things like their body mass index, body fat percentage and muscle mass, but Mabe takes it a step further and adds in an assessment of their functional movement. This means testing their ability to move from sitting to standing or picking themselves back up after a fall.

“A lot of these women are struggling with upper body strength,” said Mabe. “So, if they do fall, how can they get up on their own? We’re going to see how you are at the start of the three months – how you're doing getting off the floor and then at the end to see the improvement there, which is cool.”

The value of occupational therapy

After discovering that many of the patients they have worked with have spent time with a physical therapist but almost none have worked with an occupational therapist, the three students are hoping that the work they’re doing on their capstone projects shows others the value.

Schmitt, for one, is convinced.

“You come into having cancer usually relatively healthy, but with chemo, radiation and surgery, it will knock you down to zero on purpose to fix the cancer,” said Schmitt.

“But then how do we build you back up? Having an OT counterpoint to help patients deal with who they are after cancer is a huge gap in care that we need to be providing our patients.”

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