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Cancer Wellness: Supporting Patients Beyond the Treatment Cliff

presented by Megan Pfarr, DPT, CLT

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Financial— Megan Pfarr receives compensation from MedBridge for the production of this course. There are no other relevant financial relationships. Nonfinancial— No relevant nonfinancial relationship exists.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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When a person undergoes a harrowing diagnosis: cancer, heart disease, brain dysfunction; it can be an expansive showcase of services, phone calls, appointments and support. What happens upon treatment completion? Where do they go? Who will offer solace and emotional decompression? Often a source of significant anxiety and fear, the "treatment cliff" following the final day of treatment as a patient enters surveillance can be a time of reflection and fear, but also opportunity. Many times, care providers further task the patient with making healthy choices for fear of recurrence, with few resources. This session will discuss avenues to offer support and extend, but taper medical care into wellness that will support lifelong health forward decisions.

Meet Your Instructor

Megan Pfarr, DPT, CLT

Megan is a physical therapist and certified lymphedema therapist practicing in outpatient cancer care after graduating from Saint Louis University in 2005. She serves Health Sisters Hospital Systems (HSHS) Eastern Wisconsin Division as manager of Anew Cancer Survivorship and program development across a four hospital division. Anew Cancer Rehab successes include 57% referral rate within…

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1. The Have and Have-Nots: Contact Consistency in Treatment vs. Surveillance

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.

2. Life After: Discuss Contributing Factors to Anxiety at Treatment Change

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?

3. What Can You Use: Gap Analysis of Crucial Personnel

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.

4. Who Owns the Process: Community Referrals vs. Community Partners

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.

5. Logistics and Variables

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.

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