One out of Sixty-Four
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I always knew that I wanted to work in oncology physical therapy.
Out of my 64 classmates, I was the only one.
Most of them wanted orthopedics, with a few who had an interest in acute care or pediatrics. But oncology? No way!
"Why would you want to do that?" they asked me. I asked them the same question. "Why do you want ortho?" The same went for our spinal cord injury unit, which I hated. "Why don't you like it, Laura? Don't you think it's cool?" Sure, cool enough for someone else to do it.
I value my orthopedic and neurology skills, but practicing in outpatient orthopedics or at Craig Hospital in Denver? No thank you.
I was a "B" student in physical therapy school and I slogged my way through some of those courses. My true love was always oncology.
So when our cardiopulmonary tract rolled around, I got into it. My cardiopulmonary instructor used to say he probably still says it, actually"I've never treated a patient without a heart." The point being, even though most of my class stressed about orthopedics, every patient is going to have a heart and lungs to consider, so don't devalue what you learn through other coursework. I have carried that with me every day since he said it.
Physical therapy school, by design, prepares students for generalist practice. The task of specializing takes place after graduation with continuing education, mentorship, or residency. Oncology is no exception.
I landed at a clinic where the owner teaches her own certification course and provided mentorship for me when I started.
Much of specialization in oncology focuses on lymphedema. Sure, one can be a certified lymphedema therapist, but what about all those patients with cancer who don't have lymphedema? There are a lot of them out there.
That's where oncology rehab comes in; the clinic that has shaped (and continues to shape) my career.
Working in oncology allows you to work daily with those primary domains you learn in school: musculoskeletal, neuromuscular, and cardiopulmonary. Every patient who walks in the door has compromise to each of those systems.
The challenge of the job is prioritizing the one to address, which one your patient is struggling with, and where you can make the biggest difference. We learn about systems review in school; oncology is a setting where you must review all of them. Oncology is a specialty, but in a way, it's also the definition of generalist practice.
As much as I didn't love orthopedics, I stay sharp on those skills because my patients experience shoulder pain, neck pain, low back pain, hip pain, knee pain; the same as any other population.
A typical patient diagnosed with breast cancer may undergo surgery, chemotherapy, and radiation (or some combination thereof), depending on the stage and grade of cancer. An initial evaluation includes taking vitals, finding out if the chemotherapy the patient received, or will receive, has cardiotoxicity or neurotoxicity, learning if the patient has risk of developing lymphedema, determining if their shoulder pain is orthopedic or oncologic.
The same goes for peripheral neuropathyis it chemotherapy or was the hand tingling and numbness there before treatment? Maybe it's cervical radiculopathy instead. In one visit, you must use skills learned in orthopedics, neurology, and cardiopulmonary tracts.
That's not to say you should be intimidated by the field of oncology.
Yes, my patients have cancer, and yes, they are always medically complex. But what patient isn't complex to some extent?
Our job as physical therapists is to help our patients with their function and quality of life. Oncology is no different; you simply have a different set of circumstances to navigate.
I often get asked whether there are more contraindications to therapy in oncology, and I think this question comes from a place of fear. A patient with cancer is not a delicate flower to dance around. They are people, like you and me. Depending on their circumstances, there may be precautions, but not any more than you would see in a hospital, a skilled nursing facility, or outpatient orthopedics with a postoperative total knee replacement.
Oncology is challenging, but don't let that deter you if it piques your interest. It is a growing specialty, and there is a lot of work to be done. So why not join me?
Laura Vroman, PT, DPT