Stacey Morikawa OTD, OTR/L, CLT

Background. Chimeric antigen receptor (CAR) T-cell therapy is an immunotherapy with preliminary success in treating blood cancers, however, it is associated with adverse side effects that can impact patients’ functional statuses. There is a need to further explore side effects associated with CAR T-cell therapy and the role that occupational therapy may serve in addressing affected areas. The purpose of this study was to explore the functional and psychosocial effects patients experience while undergoing CAR T-cell therapy to better understand the rehabilitation needs from an occupational therapy perspective.

Methods. A retrospective chart review was completed to collect data from patients who underwent CAR T-cell therapy at a cancer hospital between February 2024 and July 2024. Patients were included if they received occupational therapy services throughout their inpatient stay, including completion of selected assessments prior to infusion, day +3 following infusion, day +6 following infusion, and day +9 following infusion.

Results. Trends between assessment scores prior to infusion and prior to discharge were explored with each patient. Although with varied results, this study found that CAR Tcell therapy may affect patients’ cognition, psychosocial wellbeing, grip strength, balance, and fatigue levels.

Discussion. Occupational therapy practitioners in acute care oncology can focus on the areas identified in this study to support evaluation and intervention planning for patients undergoing inpatient CAR T-cell therapy.

Keywords. acute care, cancer, CAR T-cell therapy, occupational therapy, oncology, rehabilitation

Importance. Occupational therapy practitioners play an important role in addressing the impairments, occupational performance, and participation needs of adults living with and beyond cancer.

Objective. These Practice Guidelines aim to assist occupational therapy practitioners, educators, and researchers in applying evidence and expert opinion to occupational therapy practice across the cancer continuum of care, including identifying gaps in care. Key focus areas include psychosocial function, fatigue, cognition, pain, sleep, and physical activity. These guidelines can serve as a reference for policymakers, health care professionals, health care managers, regulators, third-party payers, and managed care organizations to manage, reimburse, and set policy.

Method. We examined, synthesized, and integrated the results of systematic reviews, supporting literature, and expert opinion to develop and provide clinical recommendations for practice in the care of adults living with and beyond cancer.

Results. Sixteen systematic reviews with moderate to strong strength of evidence published between 2019 and 2022 served as the foundation for these Practice Guidelines.

Conclusions and Recommendations. To support symptom management for adults living with and beyond cancer, occupational therapy practitioners can consider using psychosocial interventions for anxiety, depression, posttraumatic growth, and overall psychological distress. Practitioners can consider using physical activity interventions for cancer-related fatigue, cognitive performance, and sleep. Practitioners could also consider using interventions for cognition, pain management, and self-management for the improvement of cancer-related symptoms.

AOTA Taxonomy. adults, cancer, client factors, evidence-based practice/knowledge translation, functional cognition deficits, groups and populations, habilitation and rehabilitation, home and community settings, hospitals, intervention approaches, intervention types, long-term care, occupations and everyday activity, older adults, outcomes, outpatient clinics, quality and value-based care, sleep deficits, telehealth and virtual services

Keywords. adult, cancer, occupational therapists, practice guidelines, fatigue, systematic reviews

The articles “Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation,” part 1 and part 2, examine the evidence of the effectiveness of occupational therapy interventions on adults with cancer. The systematic review highlights the importance of interventions including physical activity, symptom management, multidisciplinary rehabilitation programs, and interventions targeting psychosocial concerns, sexuality, and return to work. Strong evidence indicates that physical exercise is safe and beneficial for most cancer survivors, most notably to address cancer-related fatigue. Strong evidence supports the benefit of multidisciplinary rehabilitation for cancer survivors as well as the benefit of psychosocial intervention in reducing anxiety and depression. Moderate evidence supports the effectiveness of interventions on sexuality and return to work; however, further research in this area is needed. This systematic review provides support for occupational therapy intervention in addressing the activity and participation needs of adult cancer survivors.

Keywords. adult cancer rehabilitation, occupational therapy, oncology rehabilitation, activity, participation, exercise, psychosocial, physical activity