“To promote, facilitate and support all our patients to achieve their optimal physical ability through excellence in clinical practice, collaboration, education, research and innovation”
Physiotherapy is a health profession concerned with helping to restore well-being to people with illness, pain or disability. The inclusion of physiotherapy-led rehabilitation within cancer pathways can optimise physical function and improve quality of life.
The Oncology Physiotherapy team provides both an inpatient and outpatient service to patients referred by their Consultant teams. The team includes a clinical specialist working in prehabilitation to prepare patients living with cancer for surgery. Both senior and staff grade physiotherapists work in cancer rehabilitation, helping patients to live during and after cancer treatment. This includes the assessment and treatment of breast care patients following their surgery. Senior physiotherapists also work with patients in the assessment and management of lymphoedema.
Prehabilitation is the concept of increasing an individual’s exercise capacity to physically prepare them for their upcoming surgery. The OpFit prehabilitation programme is the first pre-operative exercise programme for patients who are scheduled for cancer surgery in Ireland. We have based our programme on the current research on pre-operative rehabilitation, and also the Macmillan “Principles and Guidance for Prehabilitation within the Management and Support of People with Cancer” (2019).
All patients scheduled for cancer surgery in >2 weeks are referred to the programme by their surgical teams and invited to attend a daily exercise class in the physiotherapy department. The physiotherapist carries out an assessment of physical fitness, muscle strength, BMI, frailty, quality of life and mood, and gives advice and information on lifestyle factors such as smoking, alcohol intake and sleep where appropriate.
Patients are then enrolled in the programme and provided with a class timetable and exercise advice and information. During the exercise classes, patients are guided through a structured programme of resistance, aerobic and chest clearance exercises in the gym in the physiotherapy department.
Patients who are unable to attend the programme are invited to attend a 1:1 physiotherapy out-patient appointment where their fitness is assessed and an individualised home-based exercise programme is prescribed, with follow-up weekly telephone calls from the physiotherapist.
Since the Covid-19 pandemic in Ireland in March 2020, the programme has pivoted towards virtual care for cancer surgery patients at home. We are now running a level 1 and a level 2 physiotherapy led, high-intensity exercise class per day via the video conferencing app Zoom. The class consists of a warm up, aerobic and strength training, a cool down, and chest clearance exercises. If patients are unable to attend the class virtually, they complete an initial assessment and an individualised home based exercise programme is designed for them. They are contacted once weekly by the physiotherapist to further progress the programme. Patients are also given advice on exercising safely during Covid-19, and are directed to resources such as the Marie Keating Foundation and the HSE website which offer support for people with cancer during Covid-19.
Our work in setting up the first prehabilitation exercise programme for cancer surgery patients has been presented at the European Society of Thoracic Surgery (ESTS) conference November 2018, the St. James’ Hospital Grand Rounds in November 2018, and the Irish Association of Cancer Research (IACR) conference February 2020, where it won the prize of Best Proffered Talk. The project was shortlisted from 610 entries to the win highly commended in the category of “Excellence in Quality Care” at the HSE Health Service Excellence Awards this year.
For more information on the OpFit programme, please contact physiotherapist Sarah Moore (0874001157, email@example.com)
There is an inpatient physiotherapy service on both the Hollywood and Burkitt Wards. The physiotherapist will assess your functional capacity and treat any physical issues relating to your diagnosis and treatment. We also assess and treat breast care patients following their surgery on the wards with follow up in our outpatient department.
Your consultant will refer you to the physiotherapist as needed regardless of what ward your are admitted to. If you have any concerns regarding your mobility during your inpatient stay, please feel free to touch base with your team who will refer you to our service.
The physiotherapy in gynaecology oncology service is a new service aimed at preventing lymphoedema, monitoring and supporting patients throughout their recovery post gynaecology surgery. The physiotherapist in this service provides various self-management techniques and will sign-post patients to appropriate services as needed. Patients may be assessed pre-operatively and followed through to their post-operative recovery. The service plans to evolve to using Bio-impedance technology to predict lymphoedema amongst patients.
This service is available to both inpatients and outpatients using a blended care approach of 1:1 and Telehealth.
For further information you can contact Claire Murtagh on 085-1490785 or firstname.lastname@example.org
The Physiotherapy Department works in partnership with the trinity college exercise oncology research group to conduct research into the role of exercise in cancer care. The core value of this research programme is to conduct patient-centred, interprofessional, clinically pragmatic research that has the potential to positively benefit patient care. Further information can be found here https://www.tcd.ie/medicine/physiotherapy/research/exercise-oncology.php
The Physiotherapy Department, St James’s and Trinity College Physiotherapy are currently running the Pre-hiit trial (preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus), funded by the MRCG/HRB joint funding scheme 2018. This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and through evaluation of health economics, the impact of prehabilitation on hospital costs.
Patients are referred to the outpatient Lymphology clinic if they present with problems of oedema from lymphatic origin (Primary/Secondary lymphoedema), from vascular origin, from systemic origin or from complex combined origin. Diagnostic is essential for the patient and to determine the plan and course of treatment. In some complex situations, the gold standard tool for diagnostic of lymphatic function deficiency is the Lymphoscintigraphy.
Although there is no cure for lymphoedema , it can be managed through minimising the risk factors and triggers, and through patient education and advice.
These precautions are detailed and explained to the patient during their initial assessment
In relation to the extent of the problems and in agreement with the patient, the therapeutic treatment of lymphoedema consists globally in 2 phases: