The COVID-19 pandemic has had a significant impact on the role of therapy services for patients with a thoracic oncology diagnosis. Here we look at how two facilities, an occupational therapy service in the United Kingdom and a physical therapy department in the United States, have adjusted to the new challenges and protocol, while continuing to meet the needs of patients.
The Experience at Guy’s Cancer Center, London
At Guy’s Cancer Center in London, allied health professionals, including occupational therapists (OTs), are positioned within the consultant-led outpatient clinics and play an integral role in providing proactive rehabilitation and symptom management for patients with thoracic cancer.
To reduce COVID-19 risk for both patients and clinicians, the outpatient cancer services had to determine new ways in which to work, while still providing a specialist and holistic service. To ensure that patients did not slip through the net and to prevent exacerbation of patients’ symptoms and deterioration of function, OTs quickly adapted to provide virtual consultations to patients, ensuring that their ongoing rehabilitation needs were met.
Despite the challenges of running virtual clinics, OTs have been able to provide an ongoing specialist service, for example, fatigue management interventions and assessment of functional needs. The use of advanced communication skills has been essential to build rapport and enhance assessment. Due to OTs not being physically present in the clinics, we have relied on strong communication with the wider multidisciplinary team to ensure that patients are not missing out on specialist lung cancer rehabilitation.
Their clinical experience in the management of thoracic oncology symptoms, predominantly fatigue and breathlessness, has allowed OTs to assist the wider services in their management of patients with COVID-19, who often present with comparable symptoms. In applying these transferrable skills, OTs at Guy’s Cancer Center have developed specialist training to optimize patient outcomes and increase occupational performance post-infection.
The Experience at UMMC, United States
In March of 2020, therapists at the University of Maryland Medical Center (UMMC) in the United States also began preparing for the COVID-19 surge. An initial action aimed to decrease the census in the hospital by postponing elective procedures and discharging inpatients. The Department of Rehabilitation Services, which encompasses physical therapy, occupational therapy, and speech language pathology, directed service staff to prepare patients for discharge by altering how each therapist prioritized patients. This initial phase led to a 60% to 80% reduction of patients admitted to the Thoracic Surgery Unit. Physical therapists (PTs) were reassigned to various units to prepare for the potential of discharging as many patients as possible. Staff were also fit-tested for N95 masks and trained in donning and doffing personal protective equipment (PPE) in preparation for the COVID-19 surge.
Once UMMC had accomplished this initiative, the second phase directed PTs to focus care on patients who were not initially discharged, many of whom experience anxiety that worsens with exertion, which commonly interferes with their rehabilitation. Most of the remaining patients in the Thoracic Surgery Unit had open tracheotomies, which initially required them to remain in their rooms to reduce potential risk to others from the aerosolized virus. Once permitted to leave the room, those patients who were treated without the Passy-Muir valve were required to wear a surgical mask over their mouth and nose and another over their open tracheostomy. The patients who could tolerate a speaking valve and those without an artificial airway often demonstrated severe levels of anxiety, which increased with the requirement to wear a mask. This reduced their capacity to participate in therapy, particularly walking and training on stairs.
PTs became more creative in providing interventions in patient rooms and incorporated breath-control training to help patients manage anxiety. UMMC, as other Maryland hospitals experienced, had difficulty discharging patients to post-acute rehabilitation facilities because of COVID-19 risks, leading the acute-care PTs to provide interventions that would more typically be delivered in rehabilitation facilities. PTs worked closely with OTs, speech language pathologists, and social workers to develop elaborate home-discharge plans for patients who, prior to the COVID-19 pandemic, would not have been released at this point in their therapy.
OTs, PTs, and other therapists working with patients during this COVID pandemic had to follow all the additional PPE and infection-prevention guidelines, which resulted in additional time needed to treat each patient. Therapists had to work in unexpected ways during these new and stressful times, adjusting their approach to rehabilitation to protect patients with lung cancer from COVID-19, while also, in some cases, maintaining a segregated team to address the needs of patients infected with COVID-19.