The Essential Role of Occupational Therapy to Address Functional Needs of Individuals Living with Advanced Chronic Cancers

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Abstract

Objective

Medical progress in cancer care has led to increased life expectancy outcomes across all stages of cancer, including in advanced cancers. People now living with advanced chronic cancers have unique, ongoing functional and quality-of-life needs. This article explores the functional considerations of individuals living with advanced chronic cancers in terms of managing chronic palliative care needs, assessing and intervening for functional issues, and consistently using occupational therapy in shared service provision together with medical and nursing teams. The unique and changing functional needs of these individuals may be effectively addressed through consideration of chronic palliative approaches to care; earlier access to occupational therapy services to facilitate continued engagement in everyday activities; and shared service provision with nursing to address both medical wellness and functional status.

Data Sources

These include key databases (Pubmed, CINAHL), international guidelines, and professional guidance documents.

Conclusion

Individuals living with advanced chronic cancer have ongoing and fluctuating functional needs that should be addressed in palliative care service provision. The inclusion of occupational therapy as part of inter- and multidisciplinary teams can facilitate maximization of function for individuals living with advanced chronic cancer.

Implications for Nursing Practice

Timely early referrals to occupational therapy can address functional issues as they arise, and can prepare individuals for future functional considerations.

Introduction

Medical advancements in cancer care have led to increased life expectancy outcomes across all stages of disease, including advanced or metastatic.1, 2, 3 Whereas in the past, cancer was considered either curable or palliative (with a shortened expected life span), there are now individuals living decades with a cancer diagnosis.4 Indeed, many cancer diagnoses are now considered chronic conditions, meaning that regardless of type or stage, the disease has a steady presentation.5 In the advanced chronic cancer population, the needs of these individuals vary greatly, depending on the type of cancer, their symptoms, and their functional and meaningful needs.6 For these individuals with life expectancies not considered palliative in the traditional sense (within 6 months of anticipated end of life), the health care approach to ongoing management has yet to be optimized.7, 8, 9, 10 Specifically, rehabilitation services, including occupational therapy, are not yet widely recognized or used in assessing and addressing the functional needs for this population.5,10, 11, 12

Occupational therapy is a person-centered rehabilitative specialty, aiming to maximize health and wellness through functional participation.13,14 Occupation refers to everything that occupies one's time, essentially, all forms of daily activities of living.13,14 Function refers to an individual's ability to perform or engage in activities and occupations.15 Aspects of functional (occupational) engagement may include basic activities of daily living (such as the self-care tasks of toileting, dressing, bathing, grooming, or eating), instrumental activities of daily living (such as the more complex daily engagements of grocery shopping, finances, medication, and appointment management), and may be categorized as productive tasks (such as working, schooling, or volunteering), leisure activities, or spiritual engagements.13 For individuals living with cancer, regardless of age, the need to address ongoing changes in activity engagement, functional status, or physical presentation is inherent.16,17

As individuals are living longer with advanced cancer, attending to the functional needs of this population is timely, particularly in light of the limited current research on this topic. This article will focus on functional considerations for individuals living with advanced cancers, specifically addressing questions regarding managing chronic care needs within a palliative care approach, assessing and intervening for functional issues, using and advocating for occupational therapy in a shared service model, and future directions in optimal advanced chronic cancer care.

Section snippets

Is Advanced Chronic Cancer Care the Same as Palliative Care?

Individuals living with advanced chronic cancer do not typically fit traditional criteria for palliative care support because their life expectancies are more than 6 months. They may experience relative symptom stability and have less acute medical needs but often require assistance with daily activities.18,19 For people living with advanced chronic cancer, they often do not require the resource-heavy nursing care that occurs at the end of life, but they do require additional support to live

What Issues Are Commonly Faced by People with Advanced Chronic Cancer?

An additional challenge is associated with functional fluctuations, and the uncertainty such changes cause.25 Chemotherapy, radiation therapy, targeted therapies, and their related sequelae impact daily routines and create changes to function despite goals of prolonging life and reducing symptoms.17,21 Cognitive impairment may alter thinking processes, independence, and resultant activity engagement.17,21 Fatigue and deconditioning can lead to fluctuations in capacity to participate in usual

Why Is Addressing Functional Ability for People Living with Advanced Chronic Cancer Important?

A systematic review by Neo et al26 reported that 50% to 75% of people living with advanced cancer have difficulty conducting instrumental activities, and 33% to 50% will have functional concerns with basic activities of daily living. Limited functional capacities are associated with increased hospitalizations and linked to decreased quality-of-life outcomes.17,30,31 Despite these issues, underuse of occupational therapy services and specific functional interventions remain.12,29 Addressing

How Is Early Access to Occupational Therapy Beneficial in the Care of People Living with Advanced Chronic Cancer?

Studies exploring occupational therapy services consistently found that people living with cancer who received occupational therapy experienced the following benefits: an increased understanding of and ability to access modifications and equipment earlier; receipt of comprehensive activity analysis that positively impacted functional outcomes; education regarding functional fatigue management; provision of cognitive assessment and interventions; functional and productive goal setting, including

When Should Occupational Therapy Be Involved in the Care of People with Advanced Chronic Cancer?

Historically, a medical approach to functional assessment has been used, through cursory screening or symptom review prior to any referrals to supportive care disciplines.35 Here, a physician performs an assessment and, in his or her opinion, determines what, if any, referrals or engagement of supportive disciplines will occur. Observation of a single functional impairment is unlikely to trigger an appropriate referral nor meaningfully address rehabilitation potential. Owing to the historically

How Does Occupational Therapy Enrich Holistic Care for the Advanced Chronic Cancer Patient?

Increasingly, health care best practice reflects the engagement of inter- or multidisciplinary teams understanding the role of different team members as an important and complementary aspect of supporting people living with cancer. A team could include a multitude of specialties including medicine, nursing, pharmacy, occupational therapy, physiotherapy, nutrition social work, psychology, spiritual care, or any other support that the individual feels are helpful and can offer personalized and

What Are Important Future Directions for Optimal Advanced Chronic Cancer Care, Including Occupational Therapy?

A reformed palliative approach could consider a new category of ‘chronic palliative care.’ This may seem a misnomer; however, for individuals living longer with a life-limiting illness, such as advanced chronic cancer, the ability to connect with services and address needs of everyday life in a timely manner offers not only a more effective use of services but also offers the potential for greater benefit from their use.19,38 Similarly, when earlier access to rehabilitation occurs, measurably

Conclusion

The increasing number of people living with advanced chronic cancers reflect the medical advancements in cancer care. The challenge in meeting these patients’ needs presents an exceptional opportunity to rethink provision of palliative care services. Supporting individuals living with advanced chronic cancer care requires functional needs to be addressed as early as possible and throughout the disease trajectory to maximize engagement in everyday activities and promote meaningful participation.

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  • Declarations of interest: none.

    Statement of authorship: The authors (N. Dolgoy, A. Driga, J. Brose) shared in the conceptualization, data curation, writing, reviewing, and editing of this manuscript. Author N. Dolgoy completed the original draft preparation.

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