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By uscbknpt

Reviving Hope

Three physical therapists providing treatment to a guy on a high-low table

USC’s Oncology Physical Therapy Residency program empowers survivors of cancer to reclaim their lives.


IN RESPONSE TO COMMUNITY NEED, USC recently launched a 12-month oncology physical therapy residency program that incorporates hands-on experience, dedicated mentoring, classroom instruction and opportunities for research. 

The program offers residents specialized skills to provide physical therapy for those at risk of cancer and cancer survivors who are currently undergoing treatment or have impairments related to cancer treatment. By the end of 2023, USC hopes to become the seventh such accredited program in the nation. 

“Cancer survivors has better outcomes if they receive rehabilitation prior to surgery or chemotherapy and radiation,” says Kimiko Yamada DPT ’06, associate professor of clinical physical therapy and director of the oncology physical therapy residency program. “We hired one specialist who graduated from an oncology residency, who went through a residency elsewhere and realized we needed to provide that option at USC.”


The first cohort of residents


The USC oncology physical therapy residency program officially began in November 2022 with two residents, Kristine Kivuls DPT ’22 and Lauren Vera DPT ’20, both of whom will graduate in early November 2023. Future cohorts will begin in the month of August.

Kivuls has a background in surgical oncology but always knew she wanted to pursue physical therapy versus being in the operating room. “I was interested in learning about what I can do to help a patient from a physical therapy standpoint post-surgery,” she says.

Vera was drawn to the specialization after shadowing a physical therapist at the USC Norris Comprehensive Cancer Center. “I decided to stay at the hospital and continue to treat that patient population,” she explains.


Specializing in healing


As opposed to traditional physical therapy, oncology physical therapy deals with patients who have received a cancer diagnosis. Residents learn about helping cancer survivors along the continuum of care from before, during and after cancer treatment. For example, residents learn about typical surgeries, including not only cancer removal, but also reconstruction and advanced procedures such as limb salvage or muscle and bone grafts. “Those are things you may not see in a typical physical therapy practice,” Yamada says.

Since chemotherapy is a component of oncology, residents also research the different types of treatments, along with the timeline for healing, their side effects  and how to work with them. “Some chemotherapies are very hard on the heart, kidneys, bones, joints, or muscles, so we are knowledgeable about those that might put other body systems at risk,” she continues. “We train our specialists about the unique treatments oncology patients receive.”

Most cancer patients must get worse before they can get better — through surgery, chemotherapy and/or radiation. Residents learn how to help patients in the multiple stages of recovery between their personalized treatments. “We need specialists to help patients manage the side effects and help them get back to the life they’ve fought so hard to keep,” Yamada says. 

Some of the side effects from treatments can develop into chronic issues. For example, radiation and chemotherapy may produce side effects for up to five or 10 years. “When a healthy individual has a total knee replacement, there is some kind of end to the rehabilitation — but if you’re a cancer survivor, you may always be experiencing some the effects of your treatment, and physical therapy can continue to help.”


A holistic approach


For Kivuls, a typical day in the residency program includes providing patient care in the hospital; on average, she sees eight to 10 patients a day. “Right now, I am shadowing a physician who primarily treats multiple myeloma,” she explains. “I see a lot of patients during their treatment and then treat those patients in outpatient three hours a day. I also review research and collaborate with other medical teams, whether that’s neuro, ortho or speech. It’s a busy day.”

Vera finds that most patients are experiencing issues with fatigue and building strength. “They want to get back to being able to walk a block or return to work,” she says. “Others are dealing with general pain and muscle tightness, especially after mastectomy surgery.”

Since starting the program in November, Kivuls says her skills have expanded exponentially. “I’ve learned how to integrate everything that is included with treating the oncology population, meaning: ‘How can I be an efficient and skilled clinician while integrating orthopedics, neurology, pediatrics, and all the side effects and impairments these patients encounter? How can I prioritize my treatment session? What can I do to integrate patient autonomy?’”


Experience, mentorship, and research


Vera says one of the program’s biggest strengths is that residents get to experience outpatient and inpatient training. “You get the whole journey of care, which is amazing.” She also offers praise for the mentorship provided. “The level of excellence at Keck is amazing, so that helps me as a physical therapist because I know I have to deliver the best of the best care for these patients, too.”

As far as research goes, Kivuls says residents get to choose the field that interests them. “For me, it’s pediatric oncology, so I’m currently sitting down and talking to other pediatric physical therapists and those involved in pediatric oncology to figure out what is important to me and what clinical questions I have.”

While some might consider oncology physical therapy to be depressing, Vera offers this insight: “There’s nothing that compares to when you have patients who thank you for helping them return to their prior level of function. I had a patient who was able to start interval training again, which was her favorite thing — and she never thought she would get there. You get to celebrate these huge successes with them.”

Kivuls says it’s important that oncology physical therapists get to know their population “and realize that it doesn’t stop at the medical, anatomy or physiology presentation,” she says. “These patients are human, and there are other things going on outside of their medical treatment that can affect who they are.”


Building a better future


Yamada is already looking to the future for the USC oncology physical therapy residency program. Her ultimate goal is to create more physical therapists who are specialized and knowledgeable about how to efficiently help the cancer-survivor population. “There are more and more cancer survivors in our communities, and their needs are not being met right now, especially in our underserved communities,” she says. “Oftentimes, our vulnerable populations are diagnosed later and have more drastic treatments for oncology and may therefore suffer more significant side effects. We want to ensure that USC is equipped with physical therapists who can effectively serve the local community.”