This chapter provides a description of the common functional limitations that children with cancer may experience as a result of cancer diagnoses and treatments. The epidimology of childhood cancer will be discussed, as will the potential limitations in body structure, function, and participation that can result from a cancer diagnosis and treatment.

This chapter provides a description of the current state of rehabilitation and occupational therapy services in oncology. Additionally, this chapter provides an introduction to the role of OT throughout the continuum of pediatric oncology care.

This chapter provides an overview of the basic precautions and specifics you need to know in order to safely provide occupational therapy services to children with a cancer diagnosis and receiving cancer-directed treatment. The learner will appreciate the importance of infection control and unique safety precautions in this population as well as demonstrate the ability to interpret clinically relevant lab values.

This chapter provides the learner with resources helpful in building an occupational therapy program in pediatric oncology. Topics addressed include review of web- and paper-based resources and logistic support, such as recommendations for obtaining OT referrals. This chapter will conclude with a look forward at the expanding role of occupational therapy in pediatric oncology.

This chapter provides a brief overview of the current state of rehabilitation and occupational therapy services in oncology. Additionally, this chapter provides an introduction to the role of OT throughout the continuum of pediatric oncology care.

This chapter provides an overview of the basic epidemiology, medical management, and resulting impairments in function for children with leukemia. Additionally, an evidenced-based overview of occupational therapy assessments and interventions specific to this population will be provided.

This chapter provides an overview of the basic epidemiology, medical management and resulting impairments in function for children who receive a stem cell transplant. Additionally an evidenced based overview of occupational therapy assessments and inteventions specific to this population will be provided.

This chapter will provide tips for increasing adherence and motivation when working with the oncology population in the inpatient setting and discuss equipment recommendations, programing recommendations, incentive programs, etc. The chapter will conclude with a summary of the strategies and recommendations provided in the interview, as well as resources helpful to the OT providing services to a child with cancer.

This chapter provides a brief overview of the current state of rehabilitation and occupational therapy services in oncology. Additionally, this chapter provides an introduction to the role of OT throughout the continuum of pediatric oncology care.

This chapter provides an overview of the basic epidemiology, medical management, and resulting impairments in function for children who are diagnosed with a brain tumor. Additionally, an evidence-based overview of occupational therapy assessments and interventions specific to this population will be provided.

This chapter provides an overview of the neurocognitive impairments children with cancer may experience and related occupational performance deficits. It also provides recommendations for assessment tools and intervention strategies for management of neurocognitive deficits in children with cancer.

This chapter provides an overview of long-term effects and related functional impairments survivors of childhood cancer may experience as a result of diagnosis and treatment. Common occupational performance deficits amenable to occupational therapy are identified, including return to school, fatigue, and education for survivors of childhood cancer. This chapter concludes with a brief discussion of helpful resources for the OT providing services to survivors of childhood cancer.

This chapter will identify the most common types and incidence of cancer seen in the pediatric population. The associated treatments for these cancers will also be reviewed.

In this engaging discussion, the potential short- and long-term side effects of oncology treatment in the pediatric population will be described. The negative effects on body structures and overall gross motor development of the child with cancer will be defined. Furthermore, the resultant impact that these side effects have on the physical function and overall well-being of the child will be expanded upon.

In this dynamic discussion, rehabilitation strategies that can be utilized to mitigate the short-term effects of oncology treatment in the pediatric population, in both the inpatient and outpatient settings, will be described. This discussion will also elaborate on the surveillance and management of late and long-term side effects of cancer treatment in the pediatric population.

It is important to correctly identify the adolescent and young adult (AYA) population to effectively address their unique needs. The AYA population will be defined, and the most common cancers seen in this group will be discussed.

The AYA population presents with unique challenges that set them apart from the pediatric population as well as the older adult population with cancer. The multiple life transitions associated with the AYA population will be reviewed. Additionally, some of the challenges of the AYA diagnosed with cancer, including loss of independence, financial toxicity, appointment burnout, social dissociation, and fertility preservation, will be defined.

It is important to define effective strategies to communicate with the AYA population about their needs and concerns. Healthcare providers need to identify when it is appropriate to make personalized referrals to help address the psychosocial needs of AYAs. Additionally, identifying strategies to maximize AYA engagement in rehab, including flexible scheduling, use of telehealth, and referral to free/low-cost community-based exercise programs, will be discussed.

It is essential to clearly define the AYA population so their unique needs can be addressed. This chapter will review AYA demographics and identify the most common cancers seen in the AYA population.

The AYA population can be diagnosed with cancers that are seen in the pediatric and older adult populations, including breast cancer and hematologic cancers. The short-term, late, and long-term side effects experienced by AYAs living with and beyond cancer will be identified. An engaging discussion will elaborate on the rehabilitation interventions required for AYAs to optimize function and return to prior level of function in both inpatient and outpatient settings.

While the AYA population can be diagnosed with cancers that are seen in the pediatric and older adult populations, their unique needs during this critical life phase may impede their access to rehabilitation services. The barriers to oncology rehabilitation experienced by the AYA living with and beyond cancer, including financial and psychosocial concern, will be reviewed. Additionally, methods to address these concerns and implementation strategies to engage AYA engagement in oncology rehabilitation will be discussed.

This chapter takes an in depth look at the role that nutrition and exercise play, not only in preventive approaches to cancer, but in treatment as adjuncts to chemo, radiation and other traditional medical approaches. Nutrients that have been found to affect cancer cells will be presented; and exercise prescription, including its benefits and precautions, will be discussed.

This section of the Cancer discussion deals with exercise and nutrition. Specific information regarding observational studies and clinical trials are discussed, presenting evidence based information related to physical activity, specific nutrients and cancer. An exploration will also include weight control, growth hormone regulation, stress management, counteracting fatigue and improving the immune system.

As an individual ages, the risk of developing cancer increases. Older adults with cancer, however, experience the disease and the treatment side effects and outcomes differently due to the confluence of age-related factors and preexisting comorbidities alongside cancer treatments. This chapter will discuss the unique needs of older adults with cancer and will introduce the discipline of geriatric oncology and its comprehensive approach to cancer care for older adults.

Older adults with cancer require a comprehensive approach to assessing function and performance throughout the duration of cancer care delivery. The use of a comprehensive geriatric assessment for individuals with cancer has a large and growing evidence base with demonstrable improvement in outcomes through comprehensive assessment and morbidity management. This chapter will cover the domains of the geriatric assessment and will review guidelines for clinical use in older adults with cancer.

Cancer care occurs along a protracted timeline, with individuals in active treatment for one year or more. Side effects differ with each antineoplastic modality and often accumulate over time. This chapter will review the time course of cancer treatment, the common side effects associated with each phase of cancer care, and the impact on older adults’ function. Rehabilitation strategies and interventions will be discussed.

Late effects of cancer treatments occur months or years after cancer treatments are completed and can negatively impact various body systems. Late effects contribute to loss of function as an individual ages and may magnify age-related functional changes. This chapter covers common late effects of past cancer treatments, treatment toxicities, and consideration for adaptations to the rehabilitation plan of care.

Older adults have unique needs after cancer treatment and throughout the remaining lifespan. Aging introduces multisystem changes, comorbidities, and pharmacologic interventions that can be influenced by the late effects of cancer treatments. This chapter covers common age-related morbidity, how it is influenced by cancer treatments, and evidence-based interventions.

Cancer that was treated in the past may recur and become progressive over time. Recurrence of disease introduces new and often novel anticancer treatments that negatively influence function in older adults. This chapter covers common patterns of disease recurrence and special considerations for rehabilitation interventions with advanced or progressive disease, including mobility restrictions with bone disease, critical thresholds of blood markers, and cognitive adaptations with brain and central nervous system involvement.

In previous years, the cognitive dysfunction experienced by many cancer survivors was often dismissed as either related to the stress of cancer, or perhaps present before any oncology treatments. Previously referred to as chemo-brain, a growing body of research supports the long suspected concept that cognition may be impaired due to the cancer itself and /or cancer treatments. In this chapter Dr. Taylor explains our understanding of suspected physiological changes, premorbid conditions, and contributing factors to CRCD.

This chapter focuses on how CRCD impacts the cancer survivor's life on multiple levels from their sense of self and relationships through performance of everyday activities. Join Dr. Taylor as she highlights how the compounding effects of CRCD become significantly disruptive in both the cancer survivor's and their loved ones' lives.

Considering that upwards of 75% of cancer survivors experience changes in their cognitive functioning at some point between pre-diagnosis and through advanced disease, therapists should screen every client that has, or has had, cancer. At present there are no widely accepted measures to screen, assess, and evaluate CRCD, yet there are a multitude of options. Join Dr. Taylor as explains the current guidelines related to the identification and evaluation of CRCD.

Steady progress over the past decades has improved our understanding of cognitive impairments associated with cancer and cancer treatments. However, at present there are no clear guidelines for the management of CRCD. In this chapter Dr. Taylor emphasizes the need for therapists to utilize their clinical skills and knowledge to treat CRCD and improve functional abilities and quality of life for their clients. She explains how therapists can utilize a three-pronged approach of compensation, rehabilitation, and mitigation to best optimize cognitive performance.

For those patients with a curative intent (those that will enter a remission or surveillance stage) many times, the treatment portion of their care involves daily or every-other-day contact with nurses, lab, etc. On the “off weeks” from chemotherapy, patients commonly are meeting with the rest of the supportive care team: the dietitian, physical therapy, psychosocial support when needed. The cancer centers that provide this cohesive care well highlight in even more stark contrast the difference in support when treatment is completed. For many cancers, the next follow up for lab work is in three months. Those twelve long weeks before they are seen or talked to equate to 30-40 LESS touches than they have been used to.

Large bodies of research have been produced in the past few years outlining the role that environmental factors and lifestyle choices play in cancer care. The front runner across most bodies of research is the role of obesity. Many times, when the treatment team is discussing minute percentage alterations from one treatment course to another, the comment is made, “the best thing this patient could do would be to maintain a normal BMI.” Given the amount of effort the patient has put forth to complete treatment, have we equipped them with the tools necessary to make a lifestyle change? There are patients who use their diagnosis of cancer as a pinnacle moment, a shift in lifestyle. How can we capture these patients, extend our cancer services outside the walls of our centers, and support their ongoing quest for wellness?

This can be a tricky topic to traverse. Should the wellness program be an extension of medical care as an outpatient service? Should we refer to an outside vendor? Should clinical personnel be involved? These topics can be used to align program goals and meet expectations. Items to discuss in this section include nutrition information versus weight loss information, gym/center-based exercise versus an active lifestyle, and medically supervised programs versus voluntary and community-based programs. This chapter also discusses professional recommendations of ACSM CES training, as well as collaborating with community partners and philanthropy, to meet the needs of the patient and medical team.

This can be a passionate topic and for the purpose of wellness, it proves appropriate to define the overlap and unique attributes of physical activity and nutritional selection. When we exercise, various benefits abound, including our synovial fluid which serves for lubrication, endorphin release, GI and gut motility is encouraged, our skin and sweat glands cleanse, and our heart and lungs are challenged, supporting improved active and rest cycles. Many times, nutrition gets the focus in cancer care because one could argue that selecting a Greek yogurt instead of ice cream is an easier choice than walking for 15 minutes. This is likely true! This section will recognize the intricate link that nutrition and physical activity play, while outlining the separate and distinct need for both areas to receive attention.

Unfortunately, this topic can be the forgotten section, the unspoken challenge. After facing cancer, and many times, no matter how it is framed, after one has contemplated the end of their life it can be difficult to then “move on”. The lens is forever shifted after spending time (minutes, hours, days) thinking that life may end sooner than previously thought. Some don’t struggle to understand this, and flourish in the new respect they have for the people around them. For others, the focus of their life swiftly revolves around the diagnosis of cancer and they are unable to refocus. Using the resources available through a wellness initiative can offer the right mix of “normal” life through a group of peers, as well as offer a platform for psychosocial experts to normalize fear and anxiety.

It is a myth that all older adults are at increased risk of depression. Risk factors for geriatric depression and common treatment options are explored in this chapter, along with the effects of depression on cognitive abilities.

Motivation is highly correlated with ultimate therapeutic outcomes. We will explore one of the most useful theories of motivation and introduce how therapists and other professionals can use it to develop short-term motivation strategies that help to improve clients’ beliefs that they can do the necessary work. The idea that clients need to be aware of the benefits of doing specific therapeutic exercises is introduced. One of the best predictors of a client’s success is their self-efficacy, or their belief that they can do something and attain a desired outcome. We will discuss the concept of self-efficacy and ways to improve a client’s self-efficacy for therapy.

Whether or not someone is willing to do some behavior is, in part, determined by their knowledge of the benefits of doing that behavior. We will discuss how to connect the therapy exercises to functional goals and outcomes that the client wants. Strategies for how therapists and other professionals can better explain why exercises are being prescribed are provided. There are other tools that professionals can use to maximize motivation. They can point out the consequences for not engaging in therapy. Practitioners can also benefit from asking clients to report the frequency and duration of home exercises. Caregivers can also be used to maximize motivation and therapeutic outcomes.

Unfortunately, people with dementia and traumatic brain injuries often engage in behaviors that can negatively affect their quality of life. Caregivers and staff members are often unsure how to handle unwanted and challenging behaviors. In this chapter, we will look at how executive functioning mediates behavior and use that to develop intervention strategies so people can better inhibit unwanted behavior.

Often times people with more advanced cognitive impairment will be living in the past and have even lost more recent memories. We will discuss these phenomena and how this process usually abides by the principles of retrogenesis. We will then discuss interventions designed to redirect attention by taking advantage of what the person remembers and comprehends. The goal will be to reduce unwanted behavior and the need for pharmaceutical interventions.