So you made it to PT school. Congratulations! If you’re like me, upon entering your first year bright-eyed and bushy-tailed, you had well-intentioned plans in a particular field that, somewhere between clinical rotations, practical exams, late nights and bottomless coffee, may have wandered astray. Have no idea what setting you’d like to practice in when you graduate? Need a fresh, exciting, and challenging alternative? What about the new physical therapy oncology specialty?
Prior to beginning school, I had been an athlete all my life. I was sure sports physical therapy and outpatient orthopedics would be my calling. To be embarrassingly honest, I was only faintly aware that other fields in the realm of physical therapy even existed. Saying that I had a one track mind would be a glorious understatement.
However, two semesters into my pathology coursework, I found a new passion in critical care physical therapy. The subject matter challenged my perspective on the scope of physical therapy practice in new and exciting ways. I was enamored of scrutinizing patient charts and medical records. Decoding abnormal lab values, patient signs and symptoms and all of their nuances captivated my attention. I was hooked.
In particular, through various short-term clinical education experiences, I found particular interest in the therapeutic management of oncology patients. We all know this as fact: cancer is a nasty and persistent condition that affects the lives of so many people we love. Something about the stories of these individuals fascinated me. In many cases, these were people who, after living vibrant and healthy lives, had suddenly found themselves in a world of IVs, chemotherapy, radiation, round the clock care, and persistent and obliterating fatigue.
Physical therapy’s new specialty
For PTs like us, here’s the interesting part: according to the National Cancer Institute, “The number of people living beyond a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million by 2024.”1 In many cases, cancer wreaks havoc on multiple organ systems. The disease process coupled with its drug-induced side-effects can ravage the body, leaving substantial motor, sensory, and fatigue-related deficits even after the original cancer diagnosis has been treated.
This is a largely underserved population in terms of movement dysfunction. Are there physical therapists out there who specialize in this area? Absolutely, but how have they been recognized, and how do employers, or patients for that matter, find them to utilize their expertise? And what’s more, how will new graduates seek adequate training in this field?
Enter the physical therapy oncology specialty, the American Board of Physical Therapy Specialties’ (ABPTS) newest specialist certification. I became curious about the ins and outs of this specialty, so I enlisted the help of some seasoned therapists to provide me with more information. I had the pleasure of speaking with two members of the ABPTS Oncology Specialty Council, Dr. Amy Litterini PT, DPT, and Dr. Charles McGarvey PT, DPT, FAPTA about the new specialization, and what exactly it entails. With their help, it is my goal that this article provides you with a better overall picture of what to look for as this new certification makes its debut in the coming year.
What is the Oncology Specialty and why was it created?
According to Dr. McGarvey, a small group of therapists pursued this specialty a few years ago, but minimal interest and limited funds prevented the proceedings. However, with the advent of chemotherapy and radiation, things began to change. New research revealed the myriad of side effects associated with these interventions, including fatigue, muscle pain, neuropathies, balance deficits, and changes in cognition. It became apparent that there was an imminent need for cancer rehabilitation interventions, and cancer intervention specialists.
The APTA House of Delegates approved board certification in the oncology field in 2016. Dr. Litterini noted that the process of creating a new specialty isn’t an easy one — it involves several steps including surveying the APTA membership and creating a “Description of Oncology Specialty Practice.” According to Dr. Litterini, this process could take up to 10 years!
In name, the oncology specialty is much like the other specialties seen in the physical therapy world. Think orthopedic clinical specialist (OCS), pediatric clinical specialist (PCS), etc. A clinical specialist in oncology will have the knowledge base to treat patients based on their particular cancer diagnosis. Obviously, this casts a wide net, given the substantial number of possibilities within a cancer diagnosis. Since this information isn’t typically covered in detail within the entry-level DPT curriculum, advanced knowledge and additional training are necessary to become specialized.
How to become specialized
There are two ways to become specialized in oncological physical therapy:
OPTION 1: Acquire 2000 hours of patient care within the oncology population. This method exposes the therapist to a variety of treatment protocols for different types of cancer over an extended period of time. Following the 2000-hour experience, the applicant will then develop a personal reflections paper (a detailed comprehensive case report) about a patient the therapist followed during their experience.
OPTION 2: Complete a residency program in oncological physical therapy. Much like other physical therapy residency programs, this is the more “fast-tracked,” condensed option for certification. William Beaumont Hospital, located outside of Detroit, has just obtained conditional approval for the first residency program in the oncology field, and began accepting applications this September.
According to Drs. Litterini and McGarvey, other programs, namely comprehensive cancer centers such as MD Anderson Cancer Center, are not far behind in the residency process and can be expected to release a call for applicants in the near future. Baylor Institute for Rehabilitation, Duke University, and Memorial Sloan Kettering Cancer Center also have developing programs.
When is the physical therapy oncology specialization expected to “go live?”
The first applicants for the oncology specialization may apply for certification in 2018, and sit for the certification exam as early as Spring 2019.
What are the pros and cons of working with oncology patients?
Working in the field of cutting edge cancer rehabilitation is certainly exciting, but, according to professionals, has its drawbacks as well. Dr. McGarvey relates that one of the biggest things the new therapist should know before working with oncology patients is that you must have the internal fortitude to deal with death and the family relations surrounding it. He advises to take into consideration professional interests, driving passion, and the direction of your professional future before diving in head first with these patients.
On the other hand, both Drs. McGarvey and Litterini agreed that the benefits of the job far outweigh the difficulties. Their favorite parts of their job include becoming close to the patients and the family on a deeper level over several years of their treatment. They love that the job requires a certain resiliency and stamina, and they have enjoyed walking patients and family members through this process, teaching them and learning from them along the way.
According to these professionals, with the new specialty at the forefront, there couldn’t be a better time to start practicing!
How to get started
I was curious how an entry-level therapist could “get their foot in the door” with this specialty, since it does require additional training outside of the traditional DPT degree. I was offered these tips on ways to get started:
- Pursue a residency program like the ones listed above.
- Pursue a lymphedema certification to hone intervention skills in treating patients with cancer.
- During your clinical rotations, ask to treat patients in hospice or palliative care, who likely may have a cancer diagnosis, in order to accrue hours in the field.
- Ask to observe cancer related surgeries in your local OR.
- Join the Oncology Section of the APTA. This not only helps with networking toward other oncology specialized PTs, but gives you access to journals highlighting the newest treatment practices.
- Pursue a mentor with lots of experience in the field of oncology.
- Amplify your resume or CV so that potential employers or residency programs know you’re interested in the field! This includes things like volunteer work, oncology related continuing education courses, maintenance of professional memberships, attendance at regional and national conferences (like Combined Sections Meeting), and so on. Stay engaged and stay hungry for knowledge. Show them that you care!
If you’re looking for a field that seamlessly combines clinical challenges with outcomes that are both emotional and gratifying, that embodies personal growth and deep relationships, look no further. With hard work, perseverance and a little patience, this just might be the field for you.
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