1. ONCOLOGY REHABILITATION IN THE ACUTE CARE SETTING LORI BORIGHT, PT, DPT, CES

2. ACUTE CARE ONCOLOGY REHAB ST JOHN PROVIDENCE HEALTH SYSTEM Multidisciplinary – ONC REHAB Training and certification – System PTs and OTs – All levels of care Ambulation based cardiovascular training program for our hospital based Oncology Nursing Units Modeled after RMCRI – Phase 1 (During Treatment) Primary aim is to attenuate cancer related weakness and fatigue (CRF)

3. CANCER RELATED FATIGUE (CRF) Multifactorial Etiology – Disease process – Treatments Oncology patients demonstrate improvements in strength and cardiovascular status in response to goal specific exercise Optimal to begin program as cancer treatment commences and continue throughout UNCO – Acute and long-term cardio protective effects of exercise preconditioning

4. PLAN OF CARE Newly diagnosed cancer patients should receive information regarding cancer related weakness and fatigue – Signs and symptom recognition as well as management options across the continuum – Lymphedema risk reduction practices if appropriate – Role of exercise interventions – Precautions and contraindications Referral to the oncology rehab program upon hospital admission

5. TARGET POPULATION Patients who benefit include: Patients admitted for inpatient chemotherapy and or radiation treatment Oncology patients admitted due to a secondary diagnosis – Cardiopulmonary » CHF » Decreased O2 Saturation – Vascular » Blood Clot » Anemia – Weakness/Debility

6. BENEFITS OF PARTICIPATION Program participants demonstrate Increased – Functional mobility – Functional independence – Cardiovascular endurance – Extremity and core strength – Standing balance – Knowledge of disease and treatment process – Psychosocial wellbeing

7. INITIAL SESSION Standard Strength, Endurance and Mobility Assessment with ONC Emphasis – Lab Values – Vitals obtained Pre, During, Post Introduction to ONC Rehab Issue Folder/Ed Materials Conduct 6 MWT EX prescription Prescribe Mobility Program (currently in place at Macomb and SJH) if indicated Explain follow up plan of care

8. INITIAL SESSION PIC/FOLDER

9. FOLLOW UP SESSIONS Frequency 3X per week Session Time 25-30 minutes – 10-15 cardio – 10-15 strength and balance etc. Mobility Program utilized where indicated as supplement to program 6MWT Exercise Advancement – Seated/Standing – Balance – CV Ex – Walking Program

10. FOLLOW UP SESSION/BALANCE ADVANCEMENT

11. FUNCTIONAL MEASURE 6 MINUTE WALK TEST Evidence Based Functional Outcome Measure with Normative Data Available Sub-maximal measure of aerobic capacity – Prediction Formula for VO2Max – Peak VO2=0.03xdistance(m)+3.98 Goal to educate therapists across the continuum to utilize a consistent outcome measure

12. 6 MINUTE WALK

13. FUNCTIONAL MEASURE PERCEIVED EXERTION INDEX Subjective measure of exercise intensity 1-10 scale similar to VAS for Pain Patients advised to NOT Exceed 4 ("a little tired") for “Phase 1” training in Acute Care Setting

14. 1212 “Not Tired at All” 3434 “A Little Tired” 5656 “Tired” 7878 “Really Tired” 9 10 “So Tired, I Cannot Go Anymore” PERCEIVED EXERTION INDEX

15. EQUIPMENT/CART/CONTENTS

16. MEASURING WHEEL

17. ASSISTIVE DEVICES

18. LBE/PEDDLER

19. THERABAND ETC.

20. VHI SOFTWARE

21. OT INVOLVEMENT Education – Energy Conservation Lymphedema Support Adaptive Equipment to assist with ADLs

22. EDUCATION MATERIALS Folder Program overview Treatment side effects Benefits of exercise – Target HR, Exercise Prescription Perceived Exertion Index Home Exercise Program Map of SJPHS OP Therapy Locations Community Resources

23. SJPHS PROGRAM DEVELOPMENT PLANS Secure ONC Staff Representation at each site Continue staff education – Train additional staff for program support – Professional Staff Education – Grand Rounds – 2 nd System wide Oncology Symposium – Anticipated for rehab staff Fall 2015 Develop Standard Operating Procedures – Unify acute care processes across all hospital programs Grow program to include other hospital nursing units – IPR Improve transition to OP sites for seamless continuum of care

24. REFERENCES American Thoracic Society (2003). Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine. 166:1. 111-117. Hydock, David S., Lien, Chia-Ying, Jensen, Carol M., Hayward, Reid. Exerceise Preconditioning Provides Long-Term Protection Against Early Chronic Doxorubicin, Integrative Cancer Therapies 7 March 2011 10:47. Rocky Mountain Cancer Rehabilitation Institute, Workshop Manual, 2014.

25. REFERENCES Ross, Robert M., Murthy, Jayasimha N., Wollak, Istvan D., Jackson, Andrew S. The Six Minute Walk Test Accurately Estimates Mean Peak Oxygen Uptake. BMC Pulmonary Medicine 2010, 10:31. Wonders, Karen Hydock, David S., Schneider, Carol M., Hayward Reid. Acute Exercise Protects Against Doxorubicin Cardiotoxicity. Integrative Cancer Therapies 2008 7:147. RMCRI/UNCO http://www.unco.edu/rmcri/Recent_publications.ht ml