We’d like to introduce Dr. Sasha E. Knowlton, Director of the UNC PM&R’s Cancer Rehabilitation program. She recently sat down with us for a Q&A session.
What is Cancer Rehabilitation?
Cancer rehabilitation is the unique subspecialty in PM&R that identifies and treats symptoms and functional impairments that occur before, during, and after a diagnosis of cancer. Cancer and cancer treatments such as systemic therapy (like chemotherapy and immunotherapy) along with radiation and surgery can result in pain, fatigue/deconditioning, weakness, impaired mobility, cognitive issues and neuropathy among other symptoms that we, as physiatrists, can uniquely identify and treat. I like to tell trainees that cancer rehab is like general PM&R but with a special “flavor” of cancer – some things are definitely unique, like aromatase-inhibitor induced arthralgia, dropped head syndrome and radiation fibrosis, but other impairments are treated very similarly to the non-cancer population.
How many years have you practiced cancer rehab?
I graduated from fellowship in 2017, so over 6 years! I am a recent transplant from the Boston area and could not be happier to be in NC with my family.
What do you like best about working patients at UNC?
The diversity! All of my patients here are unique and are inspirational to me, as I get to see a lot of different pathologies and am constantly learning to better serve the people of North Carolina. Being in a state medical system can have its challenges but the amount of support and interest from other medical specialties is exciting, both from a clinical and project perspective. In addition to my own research and QI projects, I am involved in a number of other oncology-initiated projects here at UNC, since so many of our colleagues are invested in improving patient care through multiple avenues.
What do we offer in our cancer rehab program at UNC?
Since starting here at UNC last year, we have exponentially grown the cancer rehabilitation services through a multi-disciplinary effort. I currently see outpatients at the NC Basnight Cancer Hospital/Lineberger Comprehensive Cancer Center at the main campus in Chapel Hill and also see inpatient cancer rehab consults at main campus. As part of my outpatient practice, I see both prehabilitation and survivorship patients, along with patients who may develop symptoms or functional impairments during treatment that I can help with. Outside of my clinical responsibilities, we now have a number of quality improvement initiatives that have been started within UNC in a collaborative effort with different services, including the therapy department and urology along with others. We have monthly program meetings between myself and the cancer rehabilitation therapists where we have case discussions, lectures, journal club and project “brainstorming”.
What are the department’s future plans and endeavors for the program?
In the next few years, I would love to be able to continue to expand the program clinically and developmentally. One of the critiques I often receive is that I am only at Chapel Hill; I’d love to have another physiatrist (or more!) join to offer services at Rex, for example, along with other locations like Hillsborough as we continue to grow. I want to hire more oncology therapists at UNC and expand the network of therapists across the state, since many patients live two or more hours away and cannot access a lymphedema or a pelvic floor therapist locally, which is a giant patient access barrier. I also want to continue to expand the research and quality improvement projects we are doing, as there is a lot of interest in collaboration from our oncology colleagues, in addition to the educational opportunities for trainees to learn more about cancer rehabilitation.