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Cancer of the Cervix - Occupational Therapy
Contents:
The role of occupational therapy is to enhance a patient's quality of life by facilitating maximum independence in the performance of activities of daily living. These activities include tasks in the areas of personal care, leisure and work. The major focus of any occupational therapy treatment will be on those activities identified by the patient as particularly important to them. For some patients, maintaining independence in self care tasks such as showering and dressing may be the most important, whereas for others, cooking the family meal may take priority.
The role of occupational therapy in cancer care is to address the effects of the cancer itself and/or its medical treatment, in so far as they impact upon a patient's ability to perform the activities of daily living. This ability can be affected in various ways. For instance, weakness, general fatigue and/or excessive stress levels may be limiting, as can
iatrogenic symptoms, which are the undesirable side effects of medical treatment, rather than of the actual cancer itself, and include nausea as a result of
chemotherapy, or
lymphoedema after surgery such as a
mastectomy,
vulvectomy or
hysterectomy.
After a comprehensive assessment, which may include assessment of a patient's physical abilities, social support, previous functional level, pattern of daily activities and environment (eg of the home, school or work place) intervention may include a variety of treatment
types.
During surgery such as mastectomy or
hysterectomy, lymph glands are often removed from the axilla or groin region to prevent the spread of cancer through the
lymphatic system. This affects the function of the lymphatic system, and swelling of the limb on the affected side is a common occurrence after such surgery.
Occupational therapy treatment for lymphoedema consists of a comprehensive regime, including skin care, exercise,
manual lymph
drainage and compression
bandaging.
Manual lymph drainage and compression bandaging generally are applied by a specialist practitioner 4-5 times a week. Treatment to reduce the swelling may take between 3 and 6 weeks depending on the severity of the condition. Once the size of the affected limb has been satisfactorily reduced, a compression garment (sleeve or stocking) is prescribed to maintain the reduction. Skin care, exercises and a modified massage technique for maintenance are ongoing after the initial treatment.
This involves educating the patient, and perhaps her carer, about protective measures to prevent injury or damage to the limb at risk in order to minimise the load on the compromised
lymphatic system. Advice on skin care, identification of potential risk factors (e.g. burns or insect bites) and an exercise regime may all be part of such education.
This may include advice on larger items such as wheelchairs, pressure care mattresses or shower seating, as well as small adaptive devices such as long handled aids. Sometimes commercially available equipment is recommended, but often adapted or individually tailored equipment may be necessary.
Energy conservation principles provide guidelines on how to best accommodate the reduced energy levels often associated with cancer and cancer treatments. Work/task simplification advice on how to modify the performance of desirable activities often forms part of occupational therapy intervention.
General energy conservation principles.
- Sit when possible. Activities such as showering, dressing, and meal preparation can all be performed while sitting. Make sure chairs and beds are of the correct height (about knee height) to make them easier to get in and out of.
- Avoid bending. Use long handled implements where possible.
- Avoid straining. Activities such as cutting with blunt knives or scissors, lifting and carrying heavy items, or opening tight jars should all be avoided. Seek dietary advice if you are constipated.
- Work as near to waist level as possible. Any activity above shoulder level requires more energy.
- Pace yourself and rest before you become exhausted. A few short rests are better than one long rest.
- Plan your time. Make sure not too many activities are performed in quick succession, and alternate light and heavy activities. Spread the load out over a day or many days.
- Avoid activity in extremes of temperature and humidity. Early mornings and nights are best.
- Avoid activity within an hour of a meal, as your body is busy digesting.
- Practise relaxation to recharge your batteries.
We experience stress when there is a mismatch between the demands being made on us and our ability to cope. Excess demand or pressure can make people feel tense, anxious, unhappy or uncomfortable.
When situations are recognised as stressful, our body changes to cope with them. This is called the "stress response". The stress response is the way our body mechanisms change to meet the demands required and it prepares the body for physical activity. It is also called the "fight or flight" response and is universal in all humans.
Our body responds to stress by producing adrenaline which leads to:
 | increases in heart rate, blood pressure, breathing rate, blood sugar level, muscle tension, sweating and blood clotting ability. |
| decreases in blood supply to the skin, pain perception, activity of the digestive system and immune response. |
The stress response is useful in that it enables our body to deal with the stress. However, it becomes a problem when stress is prolonged or chronic. It may then start to cause wear and tear on our bodies. This may result in a number of physical and psychological symptoms over time. We also become more prone to diseases as the immune system's ability to fight off disease is decreased.
Some of the psychological effects of stress include loss of concentration, poor memory, confused thinking, depression, anxiety, frustration, anger outbursts and irritability.
Some physical effects are lack of sleep, sexual problems, constipation, headaches, rashes, palpitations, shortness of breath.
| Major events. Some obvious examples are: the death of someone close to you, divorce, moving house, job loss, serious illness or injury |
| Everyday life events. Examples of these are: disagreements, meeting new people, being late, diets, feeling bored, extremes of temperature, noise and clutter. |
Do not underestimate the cumulative effect of small stresses. In isolation they may seem insignificant but when they combine, the overall effect can be overwhelming. In managing your stress, it is often useful to start looking at the simple stresses that can possibly addressed so that the other stress factors become more manageable.
The role of your thoughts: is the cup half full or half empty. What you think will effect the amount of stress you experience. Many situations, depending on how we think about them, may make us feel pressured. Your reaction to stress is largely learned through life experiences and your personality and may cause you to respond quite differently from others.
Think about the reactions of the people below and what a difference their interpretation of the situation makes:
| Situation |
Reaction |
Emotion |
| The sight of a dog |
Bloody dogs always dig up my garden. |
Anger |
|
That reminds me of the dog that bit me |
Fear |
|
What a cute dog |
Pleasure |
Now in each of these cases the trigger was the same. But notice the consequences because of the message the people were giving themselves about the trigger. It was nothing the dog was doing to them, but what they were thinking that created the emotion.
Some people may have developed non-productive coping mechanisms to deal with stress. These often create more problems than they solve. Examples include: excessive drinking, smoking, using illegal substances, withdrawing from society, overeating and excessive use of tranquillisers and sedatives (the latter do however their place as a short term solution).
Step 1: Awareness. What situations are stressful for you (eg. traffic), what
symptoms do you experience? (eg. irritability, anger, pounding heart, shortness of breath)
Step 2: Can something be done about this stressor? Can the activity causing
the stress be changed, eliminated or delayed?
Step 3: Can I change the way I think about the activity or event?
Step 4: When all else fails: You can still be in control of the situation and reverse the stress response by using a relaxation technique to induce a relaxation response (which will be explained later)
An example of this approach is the following situation where frequent ringing of the telephone has become a source of stress.
| Avoiding or changing the stressor, for example by disconnecting the telephone, by letting someone else answer it or by turning on the answering machine and setting time aside to answer calls. |
| Changing the way you think about it, for example "Good, it may be a friend", or "They will ring back later if it is important". |
| By reversing the stress response, for example taking a walk or using relaxation
techniques |
From the following techniques for stress management, write down the ideas that appeal to you and place the sheet in a conspicuous spot to remind you of these new actions or attitudes.
In summary:, the ways we can deal with stress are
- Taking on the source of the stress
- Positive thinking
- Relieving the symptoms of stress
| Develop good time management. Get up earlier; plan your day, week, month, year and do not schedule too many things close together or at the same time |
| Prioritise. Get rid of the non-essentials, what would happen if it wasn't done? |
| Don't take on other people's problems; learn to say no |
| Improve your communication. Conflicts often arise because of unclear communication. Are you really clear in what you are trying to say and are you really listening to what other people are saying to you? What would it be like to be in the other person's shoes? Express your feelings honestly but calmly and precisely. Don't say "I have enough of this" but " You really make me feel.... when you......" |
| Avoid the situation. Walk away form potential arguments; avoid noisy, smoke filled places; avoid people that irritate you; take a break (an hour, a day, a holiday) |
| Change the situation. Join a car pool if traffic upsets you |
| Change your response. Take a few deep breaths, call a friend (don't bottle up your feelings) |
| Learn the art of setting goals. Write them down in SMART terms (specific, measurable, achievable, realistic and timely) and break them down in short term (eg. by next week I will....) and long term goals (eg. in 3 months I will....). Below is an example of this method of goal setting.
Specific: What do you want to do, eg not "I want to do more exercise", but "I want to walk more"
Measurable: How often are you going to walk how far will you go, how fast?
Achievable: if you haven't walked any distances, don't expect to be able to run the marathon in 3 weeks
Realistic : is it appropriate for your particular circumstances eg age, family situation, budget?
Timely: now is as good a time as any, don't wait for the first of January, it is just another day.
|
| Develop problem solving skills. Write things down (writing clarifies the situation), what worries you about the situation, what do you need to do/find out to make a difference, brainstorm possible solutions, talk it over with someone. |
Although one can never be happy all the time, try to minimise the negative times. Positive affirmations can condition your thoughts. Anyone can become a positive thinker with practice. Examples are: "I have plenty of energy", "I am going to enjoy all of today", "Today I will be able to... "(verbalise or picture yourself doing positive things)
| Think what you can do, not what you cannot do; concentrate on the possible, doing one thing at a time |
| Congratulate yourself when you act positively' |
| Cultivate a sense of humour |
| Look for ways to make others happy, it will rub off on you |
| Reduce anger towards others, tolerance and acceptance are good for your health |
| Do the best you can and then do not worry about it |
| Do not burden yourself with the past (you cannot change it), or the future (you don't know what it will bring), focus on the here and now |
| Enjoy each moment |
| Accept yourself, every person is unique and of value. |
| Develop a hobby |
| Go out and enjoy yourself: look at beautiful gardens, go for walk on the beach, have a picnic |
| Go and see a funny movie, read a funny book, laughter aids the immune system |
| Read inspirational books or articles |
| Get a massage |
| Use quick activities to reduce stress: do some gardening, listen to music |
| Develop a support system, for example choose a friend or counsellor to talk to or start a diary |
| Quick and easy stress reducers
 | have a pleasant sounding alarm |
| take a few deep breaths |
| slow down when you eat, talk or drive |
| eliminate habits that do not achieve a great deal, for example frenzied lane changing or beating the lights |
| take a break to stretch, raise your shoulders then drop them, relax your body |
| set aside a worry session: give yourself 5 minutes to concentrate on your problem, then firmly leave it behind |
|
Make sure you are in top physiological condition by having a healthy lifestyle, you can the handle stress better.
| Keep as fit and active as possible: exercise enables you to sleep well, feel less fatigued and more positive. Choose an activity you enjoy. Walking can be done at any time, does not cost anything and can be enjoyed in the company of others |
| Maintain a good balanced diet. Limit caffeine and salt, drink plenty of water. Limit alcohol intake and give up smoking. Remember, it is not the cigarette, the drink or the coffee that relaxes you but the situation, for example sitting down for a break or meeting friends at the pub! |
| Get plenty of sleep. The following may help you to get to sleep: a warm bath, a hot milk drink, listening to soothing music, relaxation techniques |
| Learn Relaxation Techniques. Although the stress response is universal to all human beings, the way we reverse it by relaxation is a personal choice and preference. What suits one person may not suit the other. |
Relaxation is a state of physical and mental calm that can help fight the effect of stress in our lives. The skills necessary to achieve relaxation can be learned.
Relaxation negates the "fight or flight" response and consequently results in decreases in oxygen consumption, heart rate, blood pressure and muscle tension.
Relaxation can:
| help us cope better with situations that are stressful to us |
| help avoid unnecessary fatigue |
| raise the threshold of tolerance to pain |
| enrich personal relationships because it easier to get on with people when you are relaxed |
Learning to relax is a healthy living skill for everyone, not just for those who are subjected to too much stress.
Before embarking on any relaxation training, consult your doctor first. As noted above, physical changes occur during relaxation which may be harmful when suffering from certain conditions. For those with a psychiatric condition it may be advisable to stick to certain types of techniques only. Seek advice from your psychiatrist.
There are many methods of relaxation. Some concentrate on physical relaxation, some on mental relaxation. Whichever you choose to practice will result in the same benefits. The mind and body work together.
Some techniques have been introduced to Western society by Eastern cultures, for example Tai Chi, Yoga and various meditation techniques.
Scripts for progressive muscle
relaxation, breathing for relaxation and
guided imagery will be provided at the end of this section. Try each technique at least once to find out which one suits you best.
Relaxation can be learnt by anyone, but, like learning any new skill, it needs practice. It is not like taking a pill and sitting back and waiting for something to happen. Initially you may have to practice daily for two weeks before you notice any benefits.
Relaxation cannot cure conditions that require medical or surgical treatment, though it may well help you to recover or cope with your condition.
| Schedule a regular practice session of 15-20 minutes, 1-2 times a day |
| Wait at least 2 hours after meals |
| Practice in a quiet room, avoid any distraction, unplug the telephone, switch off the door bell, this is your time |
| Be warm and comfortable, wear loose clothing |
Be kind to yourself, don't worry if your mind tends to wander and you find it hard to concentrate. Just take your attention back to the relaxation technique when you become aware of it . Progress will come as you gradually learn to let go.
Music is often helpful. Chose relaxation music. For example "Rainforest Magic", "Mariner" or "Kakadu" by Tony O'Connor
It is important to allow for re-orientation after your relaxation session, regardless of which technique you have chosen.
When coming out of your relaxed state, don't move too quickly, re-orientate your thoughts to the room you are in, wriggle your fingers and toes, then your arms and legs, shrug your shoulders, have a stretch and a yawn, slowly open your eyes and when ready sit up slowly (if you were lying down).
Below are some suggested scripts for the various relaxation techniques. Preferably, have someone read them out to you for a few sessions until you become more proficient and have memorised the instructions.
The instructions should be read out slowly with pauses between. Allow at least 5 minutes for each script, then stay as long as desired in the relaxed state before re-orientating yourself. In the beginning this may not be more than 10 minutes, but slowly increase the time until you can mange approximately 20-30 minutes.
(Please note: this technique can be tried with or without tensing the muscle groups first before relaxing them)
- Sit or lie down quietly in a comfortable position.
- Close your eyes and become aware of your body as it is supported by the chair (or bed). Then start to listen to sounds around you.
- Take a few deep breaths and imagine that every time you breath out a little tension is carried out of your body.... You may like to say silently to yourself "relax" whenever you breath out.......
- Go back to your normal breathing pattern and direct your attention to the top of your head where you will start the relaxation......
- Let all the muscles of your face relax, .....the muscles of your forehead, around your eyes, mouth and jaw.......
- Let the muscle of your neck relax.......
- Let the muscles of your shoulders relax.......
- Let the muscles of your chest relax........
- Let the muscles of your arms relax, your hands and fingers.......
- Let the muscles of your back relax........
- Let the muscles of your stomach relax.......
- Let the muscles of your buttocks relax.......
- Let the muscles of your thighs relax, your calves, ankles, feet........
- Your whole body should now be fully relaxed. To make sure, just go over all those muscle groups again and check whether there is still any tension left: the muscles of your face....., neck....., shoulders......, chest....., arms and hands....., back......, stomach......, buttocks......, thighs, calves and feet........
- Stay in this relaxed state for as long as you can comfortably manage.
- Then, direct your attention to this relaxed feeling and memorise it so that you can recall it whenever you want to.......
- Very slowly, begin to wake your body from this state of relaxation.....
- Become aware of sounds around you.....
- Become aware of your body in contact with the chair (bed).....
- Move your fingers and toes, shrug your shoulders, move your head a little
- Take a deep breath and gently stretch.....
- Take another deep breath and become aware of your surroundings....and when you are ready open your eyes.......
Start practicing this technique by trying to stay focused for at least 5 minutes and then try to increase the time 5 minutes every few days until you can concentrate for 20-30 minutes.
- Sit or lie down in a comfortable position.
- Close your eyes.
- Start listening to your breathing..... Don't force it in any way just observe your normal breathing pattern........
- Put your hands around the area of your navel.......
- Feel the slow, peaceful rise and fall of your chest as the breath moves slowly in and slowly out of your body.......
- Become aware of this steady process of your breathing.......
- Notice the brief pause after one breath and before the next breath begins.....
- Just observe your breathing....... To help you to stay focused on your breathing you may like to say to yourself silently "rising" when the chest rises, "falling" when the chest falls.......
- Imagine that every time you breath out, you breath out tension, every time you breath in, you breath in peace and relaxation.........
- Try and keep your attention on the rising and falling movements...........
- Usually the mind wanders quickly and it may take some time before you notice that you are no longer paying attention to your breathing..... As soon as you become aware that you are no longer concentrating, acknowledge this and take your attention back to the rising and falling movements...............
- It does not matter how often your mind wanders and in the beginning it will wander a lot, just acknowledge that this is happening without judgment and take your focus back again to the rising and falling...............
- Allow sounds or thoughts to arise and pass away without becoming involved with them...... Simply note them and go back to your focus......
- Rising and falling, rising and falling.........
- Stay in this relaxed state for as long as you can manage.....
- Now, direct your attention to this relaxed feeling and store this feeling in your memory so that you can relax whenever you want to.........
- Become aware of your body and sounds around you.......
- Move your fingers and toes, shrug your shoulders......
- Take a deep breath and stretch......
- Take another deep breath and when you are ready, open your eyes.
The example of a garden is provided here, but of course the place where one may feel relaxed is different for everyone of use. For some it may be the beach, for others, the bush or the mountains. Just make sure when you create your image or mental picture that you tap into all the sensations that are part of that place: the things you see, hear, smell and feel. Music is often helpful in this technique. Choose appropriate music whenever possible. For example, rainforest music when creating the image of the bush, sounds of the ocean when imagining that you are on the beach, etc. Again try to practice this technique until you can manage 20-30 minutes of it.
- Start by making yourself comfortable, sitting or lying down.
- Close your eyes and concentrate briefly on your normal breathing pattern....
- Now imagine that your are in a garden......
- A garden with grass, trees, flowers and a fountain...........
- You are lying on the grass and you can feel the grass against your skin,..... a light breeze flows very gently over your face......
- ..And while you lie there, you listen to the wind in the trees and you can hear the birds......far away you can hear the trickling sound of the water of the fountain......
- You smell the flowers in that garden and there is this wonderful fresh air all around you........
- You are feeling very warm and content in this special place....
Stay in your special place for as long as you like.
Carers are often an important part of the occupational therapy management of
gynaecological cancer. Although the main focus in occupational therapy is to
help people help themselves, often patients will need the assistance of their
carer(s) in the early stages. For instance, where appropriate, carers of
patients with lymphoedema
can be taught the principles of manual
lymph drainage and compression
bandaging where it is not possible for patients to attend a clinic on a
daily basis. This training is provided and supervised by the occupational
therapist in question.
Carers can further assist patients with the practice of relaxation
techniques. This can involve providing instructions to the patient by means
of a script provided by the therapist.
In relation to work simplification advice, elements of tasks may have been
identified by the occupational therapist that need to be carried out by carers
in order for the patient to complete the remainder of the task independently.
Carers can also be provided with advice on how to best handle or move patients
where this type of physical assistance is required.
Further Information
To contact a practitioner it is advisable to ring the Occupational Therapy department of your local hospital. In remote areas, information on your nearest Occupational Therapist specializing in cancer care can be found in the database attached to this site. Alternatively, it is recommended to contact OT Australia-Qld to obtain details of the nearest practising Occupational Therapist.
OT AUSTRALIA-Qld
388 Cavendish Road
Coorparoo Qld 4151
Ph (07) 3397-6744
To obtain details of a local lymphoedema practitioner click
here:
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