Meet Physical Therapist Scott Capozza
Scott Capozza, PT, MS has worked as a physical therapist in a multi-disciplinary survivorship clinic as well as an outpatient physical therapist dedicated to oncology rehabilitation. He received a Master of Physical Therapy degree from Ithaca College in 1999. Scott initially worked in pediatric physical therapy, including outpatient pediatrics, school-based physical therapy, and aquatic-based physical therapy, before making the transition to adult oncology rehabilitation.
Scott is among the first class of board-certified clinical specialists in oncologic physical therapy in the United States and serves as a SACE II Item Writer for the oncology certification exam through the American Board of Physical Therapy Specialists. He holds several leadership positions within the American Physical Therapy Association, including the APTA Media Corps and the Academy of Oncologic Physical Therapy.
Scott has taught as an adjunct professor in Oncology Physical Therapy for both Sacred Heart and Quinnipiac Universities in Connecticut and has delivered lectures to physical therapy programs around the country about the benefits of oncology rehabilitation. He has presented professionally on the local, state, and national level and has been a co-author on several peer-reviewed publications. He is also the co-author of the chapter ‘Young Adult Survivors’ in the new textbook Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians.
What is oncology physical therapist practice?
Oncology physical therapy is working with anyone with a diagnosis of cancer throughout the balance of their treatment trajectory. We can work with patients who are newly diagnosed in the Prehab phase of care to prepare them for the physical and emotional challenges of upcoming cancer treatment. We can work in the Supportive phase while someone is receiving active treatment for their cancer to minimize the impact of treatment on the body. During the Restorative/Long Term Survivorship phase of care, we can help patients return to their prior level of function. Finally, in the Palliative phase of care, we can offer our expertise and compassion to assist patients and their caregivers during this important time.
Why do you think this is a valuable practice area?
A cancer diagnosis comes with a multitude of emotions, including the loss of control. A person who is newly diagnosed with cancer may not feel that they have any control over their lives, as they now have multiple appointments to attend. We as PTs can offer people living with cancer some sense of control; we can educate on safe mobility, validate their concerns, and provide a consistent calm through the storm that is a cancer diagnosis.
For PTs practicing in the ED there are several ways we may encounter a patient with oncology related considerations. What are some general tips?
If you can, start in the patient’s chart. Develop an understanding of where in the treatment trajectory is this patient (2 weeks post-op? 5 weeks into radiation therapy?). This starts to help frame for us the questions we need to ask (post-surgical pain, skin integrity during radiation therapy, etc.). Then, take a really thorough subjective. What brought them to the ED? Did they come of their own accord, or did they contact their oncology team first with a concern and the oncologist said to go to the ED? If they came to the ED without first contacting their oncology providers, you may need to double back and check with the oncology team about the care the patient is currently receiving and any precautions to be aware of. Oncology treatment side effects are long and varied; dehydration/lack of energy due to nausea/vomiting and taste changes from chemotherapy are very common, but chemotherapy could also cause shortness of breath, tachycardia, or dizziness. Knowing where the patient is in their treatment phase is very important to understand why this patient is presenting to the ED.
When working with a patient with cancer related pain, what are some intervention strategies we should consider?
First, take a good history and try to identify the source of their pain. It’s important to know what the patient’s oncologic history is, and if the pain is a resultant of a recent surgery, medication interaction, or known metastatic disease. For someone in acute pain, beginning with simple diaphragmatic breathing may help lower their anxiety and stress levels which in turn could help decrease their pain. Offering therapeutic touch may also help diminish cancer related pain. Finally, having the patient perform safe mobility and exercises may further relieve some of their pain.
When evaluating a patient with existing or a history of cancer, what should we make sure to look at or ask in the ED?
You’ll want to know if they are currently receiving any active treatment, such as chemotherapy or radiation therapy. Chemotherapy can cause low platelets and weaken the immune system, and radiation can lead to skin damage. Many of the newer immunotherapies also have side effects which can present as auto-immune-type impairments (for example, scleroderma). If you’re not sure what a particular medication is, ask the physician or nursing staff.
When evaluating a patient without a known cancer history, what red flags are critical?
Any bruising that cannot be explained could be a sign of a blood cancer such as leukemia. Also, any unexplained pain, especially at the proximal joints or the spine, may be a sign of metastatic disease to the bone.
You have had a lot of loss and grief in your work in the oncology world. How do you suggest we have conversations with patients who might be making decisions about hospice or end of life care in our setting?
It’s so hard to predict the future, yet it’s human nature to want to know what’s coming next. First, I thank the patient for allowing me to be a part of their care and a part of their life. It is truly a privilege to be included in someone’s life, especially at the end of life. I would say that I will support them, and their family, however I can to make them comfortable and safe. And in that moment, when the patient is sitting in front of me, I would say ‘we’re here together right now, so let’s do something now.’
What safety considerations must we consider while balancing quality of life for our patients with cancer related diagnoses?
When appropriate, providing patients with an assistive device for ambulation could help offload a painful joint or help with energy conservation to allow the patient to be more mobile. For patients with known or suspected bone metastases, you may not want to perform traditional manual muscle testing, as the increased pressure on the extended limb could lead to a fracture.
Leave us with your final thoughts.
Working in oncology physical therapy is challenging but extremely rewarding. We can validate the patient’s concerns through reflective and emphatic listening, educate the patient on known and potential physical side effects of cancer treatment, and empower our patients through movement.
To Learn More
Listen here, watch here for all of the gems Scott shared in our recent interview. October is Breast Cancer awareness month. In memory of my friend Jessica Ishino, I invite you to learn more.
