Occupational Therapy in Oncology
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Direct answer
Cancer has become, for millions, a chronic disease lived through years of treatment and survivorship, and occupational therapy's mandate is to keep life running through it: managing cancer-related fatigue with graded activity rather than rest, maintaining function through chemotherapy-induced peripheral neuropathy, treating and preventing lymphoedema after breast cancer treatment with complete decongestive therapy, rebuilding shoulder function after neck dissection, and returning people to work, school and family roles. Assessment centres on what the disease and its treatment are taking from daily occupations, using the COPM to anchor goals the patient owns. India frames the caseload — global estimates put new cases well above a million a year, and the NPCDCS carries screening and referral — so most therapists meet oncology patients in general and palliative services, not dedicated units.
What you must remember
- Cancer-related fatigue: among the most frequently reported symptoms across cancers, characteristically not relieved by rest — and counterintuitively managed with graded activity and energy conservation, while deconditioning from bed rest worsens it.
- Chemotherapy-induced peripheral neuropathy: stocking-glove sensory loss from taxanes, platinum agents and vincristine (among others), costing falls, balance and fine motor skills such as buttoning — managed with sensory compensation, foot care, adaptive techniques and falls strategies rather than exercise promises.
- Lymphoedema staging (ISL): stage 0 subclinical, I reversible with pitting, II spontaneously irreversible with fibrotic change, III lymphostatic elephantiasis — the staging examiners ask.
- Complete decongestive therapy: intensive phase of manual lymph drainage, multilayer short-stretch bandaging, remedial exercise and meticulous skin care, followed by lifelong maintenance with compression garments and self-management.
- Traditional arm precautions after axillary dissection: no blood pressure cuffs, injections or cuts on the affected arm, gloves for gardening and dishwashing, immediate reporting of redness — long taught, now individualised per current guidance, still the safe exam answer.
- Axillary web syndrome (cording): taut fibrous bands under the arm after surgery, limiting abduction — treated with gentle stretching and graded activity.
- Head and neck cancer: neck dissection may injure the accessory nerve, dropping the shoulder — range, scapular control and ergonomics are the occupational therapy inputs; radiotherapy fibrosis and trismus add stretching goals.
- Bone involvement: when metastasis or radiotherapy weakens bone, heavy-load activity restrictions are set by the team and built into every plan.
- Survivorship is occupational territory: return to work graded, body-image adaptation after mastectomy or stoma, and meaning-making roles — the goals shift from survival to living.
After mastectomy: preventing and treating lymphoedema
A 48-year-old teacher, three weeks post-mastectomy with axillary dissection, arrives before problems begin. Education is the first procedure: skin care as prescription — moisturise daily, gloves for gardening and washing-up, no cuts or injections on that arm if avoidable, redness or fever reported the same day, because cellulitis in a lymphoedematous arm is an emergency. Baseline circumferential tapes are recorded at set points on both arms, because a two-centimetre change noticed early is treatable, while year-old elephantiasis is stage III. Shoulder mobility is progressed gently from pendulums to wall-climbing, the cording under her axilla stretched as it yields. Remedial exercises — slow rhythmic arm activation with deep abdominal breathing — are taught as daily routine to drive lymph flow. At four months a measurable swelling appears: stage I. She enters the intensive phase — daily manual lymph drainage, multilayer bandaging worn overnight, exercises with the bandage on — for three weeks, then steps down to a daytime compression sleeve and night bandaging, with self-massage learned properly rather than from a video. Her classroom goals run in parallel: chalkboard writing relearned ergonomically, the register delegated, a graded return to full timetables. Fatigue is managed on the graded-activity principle — movement as medicine, rest as dosage, never surrender.
Where students slip
The single most penalised answer in this area is the fatigue prescription: bed rest, the intuitively kind answer, is the wrong one — graded activity is evidence-based and rest-only deconditions. Lymphoedema staging and the CDT component list are the rote discriminators between candidates. The subtler viva skill is phase-matched goal setting: offering work hardening during radiotherapy or lymphoedema massage for stage 0 shows a mind that memorised components without reading the patient's phase.
Frequently asked questions
Why is exercise, not rest, the answer to cancer-related fatigue?
Because the fatigue is driven substantially by deconditioning and treatment effects that worsen with inactivity; graded activity improves it while bed rest deepens it.
What are the ISL stages of lymphoedema?
Stage 0 subclinical, stage I pitting and reversible, stage II non-pitting with fibrosis, stage III elephantine change of the limb.
What does complete decongestive therapy consist of?
An intensive phase of manual lymph drainage, multilayer short-stretch bandaging, remedial exercise and skin care, followed by maintenance with compression garments and self-management.
Which chemotherapy drugs classically cause peripheral neuropathy?
Taxanes, platinum compounds and vincristine among others, producing stocking-glove sensory loss with falls and fine-motor loss.
What is axillary web syndrome?
Taut fibrous cords under the arm after axillary surgery, limiting shoulder abduction and treated with gentle stretching and graded activity.