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From Cancer Patient to Cancer Survivor: Lost in Transition
lymphedema, pain, and fatigue. PT interventions for cancer survivors may include exercise, heat, therapeutic massage, gait training, and prosthetics to assist the patient in becoming as functional as possible (Mellette and Blunk, 1994). PTs focus on building lower body strength, dexterity, and flexibility. Nearly all hospital cancer programs provide PT services (see Chapter 4) and PT services may also be obtained through their independent practices. There were an estimated 37,000 PTs working in the United States as of 2002; however, the Oncology Section of the American Physical Therapy Association (APTA) has only about 600 members (Ries, 2004). Of the small number of physical therapists identified as specializing in oncology in the APTA database, most work in acute care hospitals and health systems, hospital-based outpatient facilities, private outpatient offices, or group practices (Personal communication, S. Miller, APTA, February 2, 2005).
The extent of coverage of cancer care in PT training programs is not well documented, but anecdotal evidence suggests that in many programs, oncology is integrated across the curriculum (Ries, 2004).11 A survey of physical therapy programs conducted in the late 1990s shows that most physical therapy programs cover topics in lymphedema management (Augustine et al., 1998), and previous National Physical Therapy Examinations have included questions on the treatment of cancer patients (Personal communication, M. Lane, Federation of State Boards of Physical Therapy, February 15, 2005).
Continuing education opportunities are offered through the APTA as in-person training sessions and online audio/video or text-based courses. Some courses are cancer specific, such as a session at the 2005 annual meeting entitled “Exercise Training Guidelines for Individuals with Cancer: Endurance, Strength, Flexibility & Adherence” (Oncology Section, 2005). One course, “Physical Therapy Treatment for the Breast Cancer Patient” addresses functional limitations associated with the late effects of treatment (R3 Programs, 2005). Other courses cover topics such as lymphedema, osteoporosis, and urinary incontinence, which, although not specific to cancer, may be relevant to cancer survivors (APTA, 2005b). The APTA publishes the journal Physical Therapy, which periodically publishes articles on cancer care. The comprehensive “Guide to Physical Therapist Practice,” published in Physical Therapy, includes a section on lymphedema diagnosis and management (APTA, 2001). The Oncology Section of the APTA publishes its own journal, Rehabilitation Oncology, and has also produced a series of monographs on developing oncology rehabilitation programs and training program curriculums.
In the United States, 80 training programs offer master’s degrees in physical therapy, and 125 programs offer doctoral physical therapy degrees (APTA, 2005a).