In this course, we are going to review the nature of cancer itself, cancer treatments, and specific side effects that are pertinent to occupational therapy. Then we will cover the cancer care continuum so we can understand where our patients fall within that continuum and at which stages you may see them as an occupational therapist. Next, we will address the relevance of occupational therapy within the context geriatric oncology, specifically how older adults differ from younger adults with cancer, and also how they compare to same age peers with no cancer. We will discuss models of occupational therapy intervention, including evaluation and intervention strategies. We will take a look at occupational therapy and oncology research, past, present and future, along with future roles for OT. Lastly, we will review two case studies that exemplify different scenarios of older adults who have been diagnosed with cancer.
The lifetime risk for cancer is relatively high. One out of two men (1:2) and one out of three women (1:3) will have cancer within their lifetime. Not just within older adults, but cancer is common among all ages. The average age of a cancer diagnosis (across all different types of cancers and across different races and genders) is 66. By the year 2022, there will be 18 million adults who have survived cancer; 70% of them will be over the age of 65. The number of older adults in the United States will continue to grow, and as a result, the number surviving cancer is also going to increase in the next few years.
What is cancer? As defined by the National Cancer Institute, cancer is “a group of related diseases; the body being unable to stop cells from dividing and spreading” (National Cancer Institute, 2015). There are many different types of cancer (300+). Cancer types are typically named based on where they originate. The following types are the most common: breast, lung, prostate, colorectal, melanoma (skin cancer). Although cancer can metastasize, or spread, to other parts of the body (e.g., the brain, bone, etc.), the type of cancer it is called will remain as its point of origin.
Many different types of cancer treatments exist. We will discuss five of them: surgery, chemotherapy, radiation, endocrine and stem-cell transplant.
Typically, the first line of defense is surgery. The surgical procedure chosen depends on the type of cancer, where it is found, and how big it is. For example, within breast cancer, a lumpectomy is performed to remove a small lump; a mastectomy is the removal of the entire breast. A patient with ovarian cancer had not only her ovaries removed, but also her uterus (a total hysterectomy). Sometimes, these surgeries can be pretty invasive and people can be held in the hospital for recovery (average length of stay is about six days).
The next line of defense is usually chemotherapy. Chemotherapy is a drug treatment to kill or stop cells from over-dividing and spreading. It can be given as a primary treatment to kill the cancer itself, or it can be given in a maintenance treatment, which we will discuss a little bit more coming up, where it could be given on a long-term basis. It can be given intravenously or orally (in pill form). Oral chemotherapy is a newer technique that is gaining popularity as the drugs are developed.
The next type of treatment is radiation. Radiation is high energy x-rays to specifically destroy cancer cells. Although it is precise in targeting the cancer, it can destroy other cells around it, similar to chemotherapy.