Eva, 33, was recently discharged from the hospital to home following surgery to remove a bone cancer (osteosarcoma) at the proximal femur, and a portacath was installed in her chest for chemotherapy. At this time Eva is independent in eating, upper-body dressing. and basic grooming, although she needs some assistance with bathing and toileting. Since the start of chemotherapy, Eva has had little appetite and she fatigues easily.Eva and her husband live on a small farm. Her husband works as a bank manager and works a typical 40-hour week. She has two daughters, ages 6 and 9, who attend school during the day and help Eva in the mornings and evenings. Before her cancer developed, Eva was a very active equestrian. She enjoyed hunting, gardening, needlepointing, and taking care of her horses and dogs. Since her hospitalization, Eva’s daughters have taken over the feeding of the horses and the two family dogs. Her husband has hired a teenager from the community to perform the more strenuous animal care in the evenings.Eva takes a long time to complete most tasks, and continues to complain of pain in the left hip during activity. Eva is also experiencing “chemo brain.” Although her chemotherapy has been completed, she still sometimes finds she has trouble concentrating, a short attention span, and a tendency to “space out.” She takes a long time to finish most tasks due to disorganized, slower thinking and processing. During the day Eva is home alone except for her home health providers (including PT and OT). Her daughters get her set up in the recliner, with snacks and drinks before leaving for school. Eva often remains there until they return from school, even though she is safe to walk using a rolling walker. When asked, Eva always says that she “meant to” get up and do things. When the OT and PT put together a daily “to-do” list of physical activities that included walking out to get the mail and going outside to throw the ball for the dogs, Eva did not remember the list without someone reminding her to look at it. Even then, she needed someone with her to keep her on task during her therapy activities.Assessment of cognitive functions indicated deficits in working memory and in the executive functions of initiation, temporal sequencing, and persistence in task performance. Eva started a cognitive training program with her OT, and with the support of Eva’s family, her smartphone was programmed with alarms to prompt her in daily therapy activities. Eva’s daughters encouraged her, and left “surprises” for her in the mailbox and on the back porch to encourage her independent movements. It became a game for them to come home from school and see how many of their surprises she had found.As Eva began to move around more during the day, her strength quickly returned. Her “to-do” list was expanded to include a trip up and down the stairs and a trip out to the barn. Throughout the time she was receiving chemotherapy, Eva had periods of confusion and fatigue, but the cognitive therapy and the use of timers and alerts allowed her to keep up her activity level and regain her physical strength. Over time Eva was able to participate in activities at her daughters’ school and to begin riding her horse again.Eva’s chemotherapy extended over a period of six months, and after her cognitive problems were addressed, Eva was able to maintain a high enough physical activity level to allow her to do the things that were important to her. Some questions to consider:1. It is common to think of cognitive problems and problems of the elderly. Eva has survived a life-threatening illness but continues to have difficulty participating due to changes in her cognition. Can you think of other reasons that a young adult may have cognitive impairments that limit participation in daily occupations?2. Chemotherapy-induced cognitive impairments may be significant, but for many people they resolve over time. In the case of Eva, do you think that she would have been better off just waiting to see if it got better, or was it better to invest the time and money in treatment? Explain your reasoning.
Eva, 33, was recently discharged from the hospital to home following surgery to remove a bone cancer (osteosarcoma) at the proximal femur, and a portacath was installed in her chest for chemotherapy. At this time Eva is independent in eating, upper-body dressing. and basic grooming, although she needs some assistance with bathing and toileting. Since the start of chemotherapy, Eva has had little appetite and she fatigues easily.
Eva and her husband live on a small farm. Her husband works as a bank manager and works a typical 40-hour week. She has two daughters, ages 6 and 9, who attend school during the day and help Eva in the mornings and evenings. Before her cancer developed, Eva was a very active equestrian. She enjoyed hunting, gardening, needlepointing, and taking care of her horses and dogs. Since her hospitalization, Eva’s daughters have taken over the feeding of the horses and the two family dogs. Her husband has hired a teenager from the community to perform the more strenuous animal care in the evenings.
Eva takes a long time to complete most tasks, and continues to complain of pain in the left hip during activity. Eva is also experiencing “chemo brain.” Although her chemotherapy has been completed, she still sometimes finds she has trouble concentrating, a short attention span, and a tendency to “space out.” She takes a long time to finish most tasks due to disorganized, slower thinking and processing. During the day Eva is home alone except for her home health providers (including PT and OT). Her daughters get her set up in the recliner, with snacks and drinks before leaving for school. Eva often remains there until they return from school, even though she is safe to walk using a rolling walker. When asked, Eva always says that she “meant to” get up and do things. When the OT and PT put together a daily “to-do” list of physical activities that included walking out to get the mail and going outside to throw the ball for the dogs, Eva did not remember the list without someone reminding her to look at it. Even then, she needed someone with her to keep her on task during her therapy activities.
Assessment of cognitive functions indicated deficits in working memory and in the executive functions of initiation, temporal sequencing, and persistence in task performance. Eva started a cognitive training program with her OT, and with the support of Eva’s family, her smartphone was programmed with alarms to prompt her in daily therapy activities. Eva’s daughters encouraged her, and left “surprises” for her in the mailbox and on the back porch to encourage her independent movements. It became a game for them to come home from school and see how many of their surprises she had found.
As Eva began to move around more during the day, her strength quickly returned. Her “to-do” list was expanded to include a trip up and down the stairs and a trip out to the barn. Throughout the time she was receiving chemotherapy, Eva had periods of confusion and fatigue, but the cognitive therapy and the use of timers and alerts allowed her to keep up her activity level and regain her physical strength. Over time Eva was able to participate in activities at her daughters’ school and to begin riding her horse again.
Eva’s chemotherapy extended over a period of six months, and after her cognitive problems were addressed, Eva was able to maintain a high enough physical activity level to allow her to do the things that were important to her.
Some questions to consider:
1. It is common to think of cognitive problems and problems of the elderly. Eva has survived a life-threatening illness but continues to have difficulty participating due to changes in her cognition. Can you think of other reasons that a young adult may have cognitive impairments that limit participation in daily occupations?
2. Chemotherapy-induced cognitive impairments may be significant, but for many people they resolve over time. In the case of Eva, do you think that she would have been better off just waiting to see if it got better, or was it better to invest the time and money in treatment? Explain your reasoning.
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