File #1 Table of Contents Introduction Presenter’s Notes Oncology Rehabilitation: Web-based Learning for Physical Therapists Who Provide Rehabilitation to Patients with Breast Cancer

Oncology Rehabilitation: Web-based Learning for Physical Therapists Who Provide Rehabilitation to Patients with Breast Cancer Submitted by: Michael Coleman University of Maryland School of Medicine Department of Physical Therapy and Rehabilitation Sciences Department of Physical Therapy and Rehabilitation Sciences Doctor of Science in Physical Therapy Project approval by advisor, Frances E. Huber, EdD, PT, OCS And the Committee assigned to the Project

3 Table of Contents

4 Cover Sheet……………………….……File #1……..……………………………………………….02 Table of Contents……………………..……………………………………………………………….03 Program objectives…………………………..………………………………………………………..06 Presenter’s introduction…………………………..…………………………………………………..08 Pre / Post test…………………………………………..………………………………………….…..11 Presenter’s Notes…………………………………Use folder entitled DScPT Notes…………14-15 Basic Breast Cancer………………..….File #2…..…………..………………………………….…02 Statistics…………………………………………………………………..……………………………04 Cancer defined………………………………………………………………………………………..06 Tissue Evaluation……………………………………………………………………………………..12 Signs of cancer and risk factors…….……………………………………………..…………….…..20 Differential diagnosis…………………………………………………………………..………….…..24 Breast cancer diagnosis and protection…….…………………………………………..…………..26 Pathology and tumor staging……………………………………………………………….………..35 Survival…………………………………………………………………………………………………40 Time Out Test………………………………………………………………………………………….41 The Cancer Team………………………..File # 3……………………...……………………….….…02 Medical interventions……………………………………………………………………………… Chemotherapy…………………………………………………………………………………………09 Hormone Therapy…………………………………………………………………………………….16 Radiation…………………………………………………………….…………………………………19 Surgery……………………………………………………………………………………………… Time Out Test………………………………………………………………………………………….48 Bone Marrow Transplants……………………………………………………………………………49 Immunotherapy……………………………………………………………………………………..…57 Intervention side effects………………………………………………………………………………61 Clinical trials and Tumor Markers……………………………………………………………………73 Time Out Test………………………………………………………………………………………….83

5 Breast Cancer Rehabilitation…………………File #4……………....……………………………..…..……….02 Statistics………………………………………………………………………………………..………..04 Niche practice………………………………………………………………………………..………….08 Health Care Reform & ICD 9 Codes……………………………………………………..…………..13 Psychology and Support Issues…………………………………………………….…..……….… Pain……………………………………………………………………………….……..…..……..……29 Time Out Test………………………………………………………………………..…………………39 Quality Life through Rehabilitation…………………..…………………………..…….……………...40 Rehabilitation options…………………………………………….….…………..……………………..43 Evaluation scales…………………………………………………….….……..……………………….46 Lab Values…………………………………………………………………………………………….…51 General Breast Cancer Exercise Programs…………………….….…..…………………………….56 Documentation……………………………………………………………………………………..…...70 Post-Surgical Rehabilitation Examples……..…………………………….……………………….…74 Out-Patient example………………………………………………………………………….………...99 Research…………………………………………………………………………………………….…108 Modality contraindications………………………………………………………………………….…121 Oncologic Emergencies……………………………………………………………………………….129 Time Out Test………………………………………………………………………………………….135 Complications and Alternatives………………File #5…..…………………………………...…………….…...01 Lymphatic System……………………………………………………………………..….………… Nutrition………………………….………………………………………………………,,….…………..14 Holistic Alternatives…………….…………………….………………………..…………..……………24 Recurrence………………………..…………………….………………………..…………,,………….32 Presentation Conclusion……………………….File #6……………..………….…………..…………...……….02 Case studies………………………………………………….…………….………..……….…...……..03 Survival………………………………………………………………………….……..……………...….08 Physical therapy cancer education…………………………….…..………………..………..…….….11 Conclusion………………………………………………………….…..………………..………..……...16 Answers to Pre / Post Test………………………………………………………..……..……………….…..….…20 References……………………………File #7….Use folder entitled DScPT Reference List…..… 02

6 Program Directions Objectives & Introduction

7 How to complete this presentation This doctoral level presentation is designed to be “user friendly” as well as motivating to promote regular referrals to physical therapy for all patients diagnosed with breast cancer.This doctoral level presentation is designed to be “user friendly” as well as motivating to promote regular referrals to physical therapy for all patients diagnosed with breast cancer. This program has been divided into 7 files to make online learning beneficial.This program has been divided into 7 files to make online learning beneficial. File 1 IntroductionFile 1 Introduction File 2 Basic Breast Cancer InformationFile 2 Basic Breast Cancer Information File 3 The Cancer TeamFile 3 The Cancer Team File 4 Breast Cancer RehabilitationFile 4 Breast Cancer Rehabilitation File 5 Complications / AlternativesFile 5 Complications / Alternatives File 6 ConclusionFile 6 Conclusion File 7 ReferencesFile 7 References

8 Program Objectives Upon completion the therapist will be able to: demonstrate an in-depth understanding of breast cancer. demonstrate an in-depth understanding of breast cancer. understand medical interventions and side effects of cancer care. understand medical interventions and side effects of cancer care. have an awareness of the emotional aspects of a breast cancer diagnosis. have an awareness of the emotional aspects of a breast cancer diagnosis. gain knowledge to establish treatment goals for breast cancer. gain knowledge to establish treatment goals for breast cancer. understand how the lymphatic system can influence breast care. understand how the lymphatic system can influence breast care. understand how survivorship leads to rehabilitation. understand how survivorship leads to rehabilitation. explore opportunities in breast cancer rehabilitation. explore opportunities in breast cancer rehabilitation.

9Introduction: I would like to welcome you to a self study program for physical therapists who provide or would like to provide rehabilitation to patients diagnosed with breast cancer. With over 30 years experience as a physical therapist, I have found that many patients have not received quality rehabilitation after the cancer diagnosis. I would like to welcome you to a self study program for physical therapists who provide or would like to provide rehabilitation to patients diagnosed with breast cancer. With over 30 years experience as a physical therapist, I have found that many patients have not received quality rehabilitation after the cancer diagnosis. I believe the physical therapist plays a vital role in promoting a higher quality life for the breast cancer patient. Due to early detection, diagnostic techniques, treatment plans and increased exercise research, we are able to promote realistic goals for the increased number of cancer survivors. I believe the physical therapist plays a vital role in promoting a higher quality life for the breast cancer patient. Due to early detection, diagnostic techniques, treatment plans and increased exercise research, we are able to promote realistic goals for the increased number of cancer survivors. This program has been designed to promote confidence and expertise in the treatment of breast cancer. I personally feel that anyone that treats breast cancer patients, must have a complete understanding of cancer. This program has been designed to promote confidence and expertise in the treatment of breast cancer. I personally feel that anyone that treats breast cancer patients, must have a complete understanding of cancer.

10 Again, I welcome you to this program. I hope it will be a stimulating experience and will motivate you in a very rewarding specialty of rehabilitation for the patient diagnosed with breast cancer. Again, I welcome you to this program. I hope it will be a stimulating experience and will motivate you in a very rewarding specialty of rehabilitation for the patient diagnosed with breast cancer. Thank you. Thank you. Michael S. Coleman, PT

11 Pre / Post Test

12 PRE / POST STUDY TEST (Answer on a separate sheet of paper) Oncology / Breast Cancer Review 1.Define cancer: ______________________________________________________________________ 2.List the seven warning signs of cancer. C_____________________________________________________________________ A_____________________________________________________________________ U_____________________________________________________________________ T_____________________________________________________________________ I______________________________________________________________________ O_____________________________________________________________________ N_____________________________________________________________________ 3.List 5 risk factors of breast cancer. ______________________________________________________________________ 4.What does TNM mean in the diagnosis of breast cancer? ______________________________________________________________________ 5.List the professionals that make up the Cancer Team.______________________________________________________________________ 6.Where would you go for update physical therapy information concerning breast cancer? ______________________________________________________________________ 7.Why should physical therapy be involved with breast cancer patients?

13 8.Where is the best location to treat a breast cancer patient? A. Hospital B. Out-patient facility C. Home care D. All facilities listed 9.List five benefits of exercise after medical interventions for breast cancer. _______________________________________________________________ 10.Describe the types of surgery completed for cancer. Diagnostic_______________________________________________________ Curative________________________________________________________ Palliative________________________________________________________ Prophylactic_____________________________________________________ 11.What medical intervention might follow a lumpectomy? _______________________________________________________________ 12.What modalities would you choose to treat lymphedema? _______________________________________________________________ 13.Where are two of the three major lymph node regions? _______________________________________________________________ 14.List five contraindications of exercise following breast cancer. _______________________________________________________________ 15.How would you market breast cancer rehabilitation to physicians and the general public? _______________________________________________________________ Comments: _____________________________________ (Answers: File #6) SUPPORT THE ONCOLOGY SECTION of the A.P.T.A.

14 Presenter’s Notes

15 DScPT Presenters Notes Open folder entitled DScPT Notes Open folder entitled DScPT Notes Each file corresponds with presentation slides according to file and slide numbers. Each file corresponds with presentation slides according to file and slide numbers. Copy each set of notes to follow along with slide show presentation. Copy each set of notes to follow along with slide show presentation.