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Introduction

This chapter gives an overview of the range of roles of allied health professionals (AHPs) and how they can support older people, their relatives and carers at different stages of their cancer journey. AHPs include: dietitians, lymphoedema therapists, occupational therapists, orthotists, physiotherapists, podiatrists, radiographers, and speech and language therapists.

AHPs working with cancer patients may specialize in the field of cancer care or remain generalists throughout their career, with intermittent contact with cancer patients. The aim of the specialist AHP role is to undertake holistic assessments, and from these assessments provide tailored advice and support to individuals affected by cancer and those closest to them. AHPs act as a referral point for others working in a variety of settings: from hospitals to the voluntary sector. They support people to adapt their lives to meet the challenges they face. Rehabilitation, to a greater or lesser extent, is a common theme. Effective rehabilitation requires different professionals to work as part of well-integrated teams to achieve the best outcomes. Good communication between these teams is essential.1 The support should always be person-centred and take account of the potential for additional sensory deficits that can impede communication: hearing loss, for example, can be improved by simple interventions such as ensuring that the AHP gains the patient's attention and faces the patient when speaking, and remains mindful of providing information in an accessible way.2 People may benefit from rehabilitation at diagnosis prior to any treatment, to optimize their condition, and throughout their treatment, to minimize symptom effects. Several studies have identified unmet needs of cancer patients in psychosocial, physical, sexual and occupational domains.3 AHPs are well placed to identify and support patients with their needs. Older patients may already be challenged by daily activities before a cancer diagnosis, and need additional support to make adjustments to regain or maintain a quality of life that is acceptable to them. AHPs contribute to a person's quality of life and work to improve outcomes, e.g. by improving nutritional support to preserve strength and reduce the hospital stay.4 It is not the responsibility of any one group of professionals to enable people to reach their potential despite having had a diagnosis of cancer, but rather a combination of the varied skills provided by AHPs at the right time.

What do the different AHP services offer?

The blurring of boundaries between professionals can cause confusion for the referrer. Different geographical areas will have different systems in place and it is important that referrers take time to familiarize themselves with the services in their location and be clear about what they wish to achieve from any referral. The National Cancer Action Team published care pathways for several cancer sites.5 Local cancer networks were then tasked with defining interventions for the AHP (Table 14.1). Reference to these pathways may aid a clinician to make appropriate referrals. Rehabilitation ...

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