An NCI-designated Comprehensive Cancer Center
By C. Pete Lee | August 23, 2019
lymphedema | City of Hope A therapist works on a patient with lymphedema.
Many are unfamiliar with the crucial role occupational therapists play in recovery for cancer patients.
Occupational therapists, according to City of Hope’s Mahjabeen Hashmi, O.T.R./L., C.L.T.-L.A.N.A., “enable people of all ages to live life to its fullest by helping them promote health, and prevent — or live better with — injury, illness or disability.”
While physical therapists’ main concern is helping patients regain mobility, occupational therapists assist patients with learning how to do everyday tasks again — everything from brushing their teeth to using a computer to driving a car.  
Hailing from Karachi, Pakistan, Hashmi said “the creativity and the holistic approach in treating the person as a whole” are what attracted her to occupational therapy. She has been working at City of Hope's Department of Rehabilitation Services for the last three years in outpatient care and sees about seven to eight patients every day.
In addition to occupational therapy, the department also offers both in- and outpatients such services as physical therapy, speech and language therapy, recreation therapy, and treatment for lymphedema and urinary incontience. The goal of such services is to ensure each patient maintains or regains the maximum degree of function, comfort and quality of life possible at any stage of the cancer journey. 
Hashmi works with her patients throughout their treatments, including before and after, especially when surgery is involved. She teams up with each patient’s medical team — physical therapists, doctors and nurses — to determine what support is needed to help them regain the ability to perform daily activities. If her patients can no longer move in a certain way due to surgery, chemotherapy or radiation, Hashmi discovers creative ways to support them so that they are able to participate in their daily activities in a whole new way, thus creating a new normal.

Going beyond mobility

“Occupational therapists work with physical therapists and go beyond mobility,” Hashmi explained. “We also address self-care, daily activities and everyday chores, functional cognition, psychosocial and emotional problems, fatigue and stress, sleep hygiene, intimacy and sexuality, and lifestyle management to support patients to be able to live at home and be fully independent.”
Hashmi is one of a few occupational therapists at City of Hope who specializes in lymphedema and edema management, which is swelling and inflammation due to improper lymphatic fluid drainage — common for patients going through cancer treatment. She has been a certified lymphedema therapist for over 20 years and has worked with a variety of patients.
“We have a very comprehensive and unique breast cancer program at City of Hope, and we see patients from presurgery to survivorship and beyond. Lymphedema is very common, and we work on it right away and support the patients faster,“ she said. Lymphedema is also common with cancers of the head and neck, gynecological cancers, bladder cancer and blood cancers, she said.

Challenges of Lymphedema

“These patients have fought, or in some cases are still fighting cancer, and now they have a new diagnosis of lymphedema, which is very challenging — physically, psychosocially and emotionally. A patient loses flexibility and function and needs full-time management, support and training,” she said.
Lymphedema treatment consists of manual lymphatic drainage, skin care, compression bandages and garments, exercises and engagement in activities.
Even though most of her work deals with patients with lymphedema, Hashmi also works with many other patients who are in different stages of their recovery, looking for guidance to return to a daily routine with balance and normalcy.
Hashmi sees occupational therapists as a key part of the cancer recovery team. “Rehabilitation is a very integral part of the multidisciplinary team for the treatment of cancer survivors, and we are ready to meet the challenges.”

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