You are currently viewing Volume 2/Issue 6 – June 2022

Volume 2/Issue 6 – June 2022

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Ribbons Physical Therapy Launches Programs to Manage Cognitive Effects Resulting from Chemotherapy and Radiation Therapy

Radiation induced Cognitive Decline (RICD)

RICD is described as deficits with memory, attention, executive function, processing, and new learning post partial or whole brain radiation. As the survival rate for cancer patients increases, the need to understand neurocognitive deficits (NCDs) and how to provide treatment for your patients is becoming critical.

  • Early delayed effects (between 1-6 months post) have a higher chance of being reversible.
    • Recent study indicated improvement with verbal memory, attention, and mental fatigue 6 months post cognitive rehab compared to control group.
  • Late effects (6+ months post) are considered progressive.

Treatment Services for RICD and CICI

At Ribbon’s Therapy Clinic, we are dedicated to working with patients over the course of their treatment. Specifically, our Occupational Therapy staff at Ribbons will proactively monitor the cognitive skills of patients over the course of radiation treatment and will work with patients to provide training and compensatory techniques that will allow the patient to remain independent with functional skills.2,4 To do this successfully, we recommend scheduling a consultation prior to radiation treatment, which will determine the patient’s baseline skills, and a follow-up appointment every 6 months for 2 total years. This would allow the patient to be routinely assessed for early detection of cognitive deficits and for quick implementation of strategies to allow the patient to maximize the independence with daily activities and improve their quality of life. At Ribbons Physical Therapy, we will complete a cognitive evaluation to assess the patients’ strengths and limitations and how they affect their daily life. Based on evaluation results, the patient will participate in interventions focused on restorative (targeting the patient’s specific deficits with the goal of improving cognitive dysfunction) and compensatory techniques (implementing personalized aids to allow the patient to complete daily activities with maximum independence). We will assess factors such as pain and fatigue that can exacerbate cognitive deficits and provide treatment appropriately. To promote brain health, we will assist the patient in a customized home exercise program and will routinely update as needed. At Ribbons Physical Therapy, we are devoted to providing a client-centered approach to enable patients to live more fully in self-care, work, leisure, and community activities and enhancing their quality of life

Chemotherapy-Induced Cognitive Impairment (CICI)

Cognitive deficits most commonly occur after chemotherapy; however, they can also occur due to radiation therapy, endocrine therapy, and surgery. Deficits can be long-term or short-term and affect the patient’s ability to complete occupations. Patients with brain and head and neck cancers may experience longterm, adverse effects, including neurocognitive deficits (NCD).1-3 These deficits, which can be attributed to the tumor itself or from radiation treatment to the brain, may impact the quality-of-life of cancer survivors. For instance, cancer survivors with NCD are less likely to return to work, be involved in the community, and participate socially.1,4 As the survival rate for these cancers increases, the need to understand NCDs and how to provide treatment for patients with NCDs is becoming critical.

1) Zer A, Pond GR, Razak ARA, et al. Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2018;144(1):71–79. doi:10.1001/jamaoto.2017.2235

2) Dye NB, Gondi V, Mehta MP. Strategies for preservation of memory function in patients with brain metastases. Chin Clin Oncol. 2015 Jun;4(2):24. doi: 10.3978/j.issn.2304-3865.2015.05.05. PMID: 26112810.

3) Lawrie TA, Evans J, Gillespie D, et al. Long-term side effects of radiotherapy, with or without chemotherapy, for glioma. Cochrane Database Syst Rev. 2018;2018(6):CD013047. Published 2018 Jun 12. doi:10.1002/14651858.CD013047

4) Weyer-Jamora C, Brie MS, Luks TL, et al. Cognitive impact of lower-grade gliomas and strategies for rehabilitation. Neurooncol Pract. 2020;8(2):117-128. Published 2020 Nov 4. doi:10.1093/nop/npaa072

Melanoma and Lymphedema

Lower extremity lymphedema (LEL) is the one of the most frequent complications of both SLNB and inguinal lymph node dissection (ILND) in melanoma. Reported rates of LEL secondary to inguinal SLNB were from 7.6% to 35.1% and from 48.8% to 82.5% after ILND (16,19). The upper extremity lymphedema (UEL) rates after ALND (Axillary lymph node dissection) for melanoma were from 4.4% to 14.6% in the reported studies and from 4.1% to 21.4% after ALND for breast cancer (16-19,33-37). ALND directly affects the upper limb superficial lymph flows. No study compared lymphatic pattern before and after excision but the fact that these rates are similar is possibly due to the non-implication of wide local excision melanoma in UEL.

May is Melanoma Skin Cancer Awareness Month. How Can Ribbons PT Help?

Melanoma is a cancer that begins in the melanocytes. Other names for this cancer include malignant melanoma and cutaneous melanoma. Most melanoma cells still make melanin, so melanoma tumors are usually brown or black. But some melanomas do not make melanin and can appear pink, tan, or even white. Melanomas can develop anywhere on the skin, but they are more likely to start on the trunk (chest and back) in men and on the legs in women. The neck and face are other common sites. Having darkly pigmented skin lowers your risk of melanoma at these more common sites, but anyone can get melanoma on the palms of the hands, soles of the feet, or under the nails. Melanomas can also form in other parts of your body, such as the eyes, mouth, genitals, and anal area, but these are much less common than melanoma of the skin. Melanoma is much less common than some other types of skin cancer. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught and treated early.

Decongestive Therapy

Physiotherapeutic management of lymphedema has been reported to be effective. Treatment of lymphedema with complete decongestive physiotherapy (CDT), which combines manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, and skin care, can achieve a 45-70% reduction in limb volume (48-50). Phase 1 of CDT consists of skin care, manual lymphatic drainage, exercise, and adjustable
compression garments that the patient undergoes on an outpatient basis. Phase 2 is a continuation of phase 1 where the patient continues a home program to manage lymphedema independently.1

Intervention with Lymphedema Surveillance Programs

When it comes to lymphatic swelling, the earlier we can treat the problem improves outcome. Once the swelling stays in one spot for too long, the proteins present in the fluid can form a network and cause the swelling to become firm. Once this stage is reached, it becomes much more difficult to treat and adverse effects may become irreversible. Initiating treatment early can mean the difference of utilizing a compression garment all the time versus on an as needed basis, thus improving your patient’s quality of life. Our surveillance programs follow NCCN guidelines for pre-operative/pre-radiation assessment and baseline measurements with follow up after procedure and quarterly thereafter for a year. This allows us to note changes in the area early and provide interventional treatment. We want to help your patients dealing with lymphedema whether it is related to a cancer diagnosis, a defect in the lymphatic system, or related to chronic venous insufficiency. We employ experienced certified lymphedema therapists with 135 hours of specific training in lymphedema treatment. We provide-one on-one individualized care in private rooms, which helps create an environment for healing where the patient does not have to worry about his/her appearance and can focus on healing.

National Cancer Survivors Day

National Cancer Survivors Day® is an annual, treasured Celebration of Life that is held in hundreds of communities nationwide, and around the world, on the first Sunday in June. On National Cancer Survivors Day®, thousands gather across the globe to honor cancer survivors and to show the world that life after a cancer diagnosis can still be fruitful, rewarding, and even inspiring. NCSD offers an opportunity for all people living with a history of cancer- including America’s 17 million cancer survivors—to connect with each other, celebrate milestones, and recognize those who have supported them along the way. It is also a day to draw attention to the ongoing challenges of cancer survivorship in order to promote more resources, research, and survivor-friendly legislation to improve cancer survivors’ quality of life.

How can we help your patients?

  • Call to schedule an in-service to help identify patients with the potential for developing lymphedema who need to be screened or treated by our Certified Lymphedema Therapists
  • Refer patients to our lymphedema monitoring program starting pre-procedure to establish baseline assessment and measurements, followed up one month after surgery/treatment, then quarterly for a year
  • Do you want our lymphedema or cancer rehabilitation rack cards in your clinic to help patients understand why you are recommending us for treatment?
  • If you have navigators, do you want patient handouts explaining our monitoring program and why you’re sending them to us?

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