Bone Marrow Transplant (BMT) and CAR T-cell therapy are evolving fast—are you keeping up?
In this episode of TheOncoPT Podcast, Dr. Adam Matichak returns to share the latest updates on these groundbreaking treatments and what they mean for your OncoPT practice.
You’ll learn how CAR T-cell therapy is expanding, why mobility strategies matter more than ever, and how to use vital signs to guide your treatment decisions.
Plus, we’ll explore how you can advocate for rehab’s role in oncology, prepare patients for complex treatments like BMT and CAR T, and find the resources you need to stay ahead in this rapidly changing field.
Whether you’re new to cancer rehab or a seasoned pro, this conversation will give you practical tools to treat your patients undergoing BMT and/or CAR T-cell therapy.
Listen now!
Listen to Adam’s previous episodes:
Ep. 204 – How to not feel lost with BMTs
Ep. 221 – Here’s How to Treat Patients Undergoing CAR T-Cell Therapy
Want to watch the episode instead?
Watch this week’s episode of TheOncoPT Podcast on our YouTube channel!
About Dr. Adam Matichak, PT
Adam Matichak is an acute care physical therapist at Stanford Healthcare in Palo Alto, CA working with Hematology/Oncology, Bone Marrow Transplant, and Immunotherapy/CAR-T Therapy patients. He is a Board-Certified Clinical Specialist in Oncologic Physical Therapy dedicated to providing the highest level of care to individuals navigating the challenges of cancer treatment. His passion for patient care, coupled with his dedication to education and advocacy, makes him a respected figure in the cancer rehab community.
Catch up with Dr. Adam Matichak on The Cancer Rehab Community or follow him on Instagram.
Email Adam at Amatichak@stanfordhealthcare.org.
Transcript
Elise Cantu (00:19)
Hey, Onco PT and welcome to this episode of TheOncoPT podcast. Now we here at TheOncoPT have surprisingly been doing episodes long enough that we need some update episodes from time to time. And today’s topic is absolutely one that I am so ecstatic to be bringing back to the podcast. Now way back in episodes 204 and 221, I know literally a hundred episodes ago.
We had speaker Dr. Adam Matichak on the podcast to talk about BMTs and CAR T cell therapy respectively. And since those episodes aired, there have actually been a lot of updates that are now more relevant than ever and more pertinent to cancer rehab and our involvement in these very special patient populations. So I have Dr. Adam Matichak back on the podcast today to talk about some of these updates.
And ultimately what this means for us, as you undoubtedly will see more of these patients in your own practice. So Adam, welcome back to TheOncoPT podcast.
Adam (01:23)
Good morning, Elise. Always fun to be back on the podcast with you. I think I’m going to set the record for most guest appearances on your podcast.
Elise Cantu (01:31)
I love it.
Adam (01:36)
so for those of you that haven’t listened to our recordings on BMT and CAR T, please go back and listen to those first. think it sets a good foundation for what we’re going to talk about today. for those of you that are new to the podcast and have not heard me yet, my name is Adam Matichak. am an inpatient, hematology, oncology, bone marrow transplant, and immunotherapy PT at Stanford healthcare in Palo Alto. I have been there almost a decade now, which is crazy to think about.
And over the course of my nine years there, we’ve seen a lot of advancements in bone marrow transplant and then the addition of CAR T cell therapy and then clinical trials and new therapies that we’ll get into a little bit today. And then I want to touch on like one of the really neat things is the advancements that we’ve made in preventing and treating Grapper’s Host disease for our allogeneic transplant patients.
Let’s get into it.
Elise Cantu (02:37)
Now that’s exciting stuff. Oh my gosh.
So again, as Adam mentioned, I have linked the episodes. So episode 204 on BMT and episode 221 on CAR-T in the show notes of your podcast player, excuse me. And also on our show notes page for TheOncoPT podcast. So I encourage you, if you have not already listened to those, go back and listen to those conversations before continuing with this, because what today is,
is we are using those prior episodes as a springboard to then talk about what has changed, what has advanced since those episodes aired back in, my gosh, 2022, which is insane, like three years ago, y’all. So let’s get into it real quick, real quick recap, just so we’re all on the same page. BMT and CAR-T cell therapy. Previously, were kind of reserved for…
patients with hematological malignancies. And some of that’s the same, some of that’s different. And CAR-T was this, I referred to it as like science fiction. It was like, it’s the future of cancer treatment. And that has largely held up. And what’s also exciting is that I think CAR-T has paved the way for a lot of new, exciting additional advancements and innovations within cancer treatment.
And what I love about this, and this was kind of what we expected to happen, but I think we’re there faster than what I thought we were going to be, is that BMT and CAR-T are being used in more patient populations. So not just those very specific patient populations we talked about way back in episodes 204, 221, but now in greater presence within oncology. And that ultimately means for us as OncoPTs
we’re going to be seeing these patients. So Adam, what have kind of been some of the updates, the innovations when it comes to BMT, CAR-T since 2022, three years ago?
Adam (04:37)
So starting with the BMT side, so not a whole lot has changed standard transplant wise. We’re still doing as a country about 10,000 transplants a year between allogeneic and autologous transplants. They’re still primarily used for blood-based cancers. So our leukemias, our lymphomas, our multiple myelomas One of the big advancements BMT wise that we’ve seen recently is the addition of
Elise Cantu (04:39)
Mm-hmm.
Adam (05:05)
targeted CAR T cells on top of an allogeneic transplant. So basically what we’re doing now is we’re getting donor stem cells and then we’re also collecting donor T cells. So from the same donor and those T cells are being sent off to be made into CARs and then patient comes into the hospital, goes through their conditioning chemo and then they get their transplant is basically split up.
over the course of anywhere between like four to six days, depending on, you know, other risk factors that the patient has, you know, protocols, things like that. So what they do is on day zero, they will get their T regulatory cells. On day plus two, they’ll get their T con cells. And then on like day plus four ish,
they will get these donor allogeneic CAR T cells, which is really cool. So now we’re seeing these T regulatory cells have had a chance to go into their bloodstream and search around and find all of these cancer cells. And then a couple of days later, we’re getting this influx of CAR T cells that are targeted with a surface antigen for their specific cancer.
Elise Cantu (06:13)
Mm-hmm.
Adam (06:23)
And now you have these T regulatory cells that have already gone out and done the searching. And now they’re telling these new car cells, like, this is where you’re going and this is what you’re doing. And so it’s making our allogeneic transplants more effective because now they’re way more targeted than they were before.
Elise Cantu (06:33)
my god.
Mm-hmm. Mm-hmm. Wow.
Adam (06:43)
So that’s been really neat to see.
So the downside of that is now we have these regular like allogeneic transplant patients that are now at risk for cytokine release syndrome and neurological changes because they’re getting these CARs. So now we add in those CAR T side effects on top of, right, with our allogeneic transplants, we have the regular chemotherapy side effects from their conditioning.
Elise Cantu (06:56)
Yeah. Okay.
Adam (07:11)
we still have that risk for acute and chronic graft-versus-sose disease afterward. And then we add in this risk for CRS and ICANs. it’s kind of, you know, roll the dice as far as what we’re gonna see and how they’re gonna present. But rehab-wise, not a whole lot changes. So for us on the inpatient side, when they’re going through conditioning, my goal is education. These patients are still coming in.
Elise Cantu (07:16)
Mm-hmm. Woof.
Adam (07:40)
Mostly independent, mostly doing well. So I am pushing them to take advantage of these first few days in the hospital when they’re feeling good to stay active, to kind of get into a routine in the hospital, to make sure that they’re out of bed for all their meals, that they’re getting their walks in, that they’re exercising, that they’re showering daily. Those little things that are keeping them moving throughout the day that they don’t really think about at home, right? When we have our regular routine at home.
And for a lot of these patients, it’s hard kind of losing a lot of their autonomy when they’re in the hospital. They’re on scheduled vital checks. They have these like windows of when they can order their meals from the kitchen. So helping them kind of get into a routine and kind of bring some normalcy to their day is my biggest goal on the inpatient side.
Elise Cantu (08:13)
and
my gosh. I just have to pause here because one of the things that we talk about in onco PT, and I feel like there’s more of an understanding now than there was like five years ago. You know, initially when we, know, when we started treating cancer kind of more structured in a structured format, you know, in the late 19 hundreds, I know crazy to say we.
you know, we did the best that we could as a, as a healthcare community, as a medical community between the best we could. And unfortunately, a lot of people had very significant side effects and some people did not live very long, maybe after they were diagnosed with cancer, if they went through cancer treatment. And now that we’re into the 21st century, we have a lot greater expectations for patients are going to live longer after they’ve been diagnosed with cancer. We’re better at treating.
people who have various diagnoses. You we expect a longer life expectancy and quality of life has really entered the conversation more. And that’s, you know, we could spend hours talking about that. And so all this to say, I bring this up because we have, you know, at the time it was like, well, people are living longer and now they’re experiencing these side effects that we didn’t expect. Like we didn’t know that they were going to experience because frankly, people weren’t living that long to get to the point where we say, we’re starting to see this.
So fast forward today, 2025, we know this, accept this, we expect this. And so now again, kind of what you alluded to, Adam, is we know that our role in rehab is to spend a lot of time educating patients on what to expect and whatnot. And I feel like these advancements, these updates are the latest iteration of that, of we’re getting better at treating these hematological malignancies with BMT and now the addition of CAR T cells. And that’s
awesome, that’s great. Okay, now we have to expect potentially these other side effects and then what can we do about them? So again, like this is exciting because we’re getting better at treating a person’s cancer. Now it means that we have additional things that we need to be aware of and preparing our patients for in the short term and in the long term.
Adam (10:46)
Yeah. And I think one of the other things that we’ve gotten better at is including rehab in this whole process, right? Like you think about, you know, when Stanford started doing their bone marrow transplants back in the 1980s, and they didn’t have a rehab team, right? Like these patients were thought to be like, they’re too neutropenic. You know, their platelet counts are terrible. Like they can’t do anything.
Elise Cantu (10:54)
Yes.
Mm-hmm.
Mm-hmm.
Mm-hmm.
Adam (11:14)
They’re
susceptible for infection. don’t need strenuous exercise. It’s not safe for them. Think about how far we’ve come now to where, especially with our team, we are a standard part of the order set for every patient that’s admitted for transplant. They get an eval upon admission. We have an education packet that we’ve built out over the years that every patient gets. We are involved from
Elise Cantu (11:23)
my God.
Adam (11:44)
the time that they step foot in the hospital until the time that they discharge. So we’ve got, yeah, I think, you know, we think about the advancements in cancer care itself, but think about the advancements that we’ve made as a profession being involved in this whole continuum. And even outside of, you know, BMT from rehabs involvement in cancer prevention through survivorship and end of life, like there is so much more that we’re doing now from the rehab side.
Elise Cantu (12:13)
my gosh. This is so cool to be like reminiscing in that way. Cause again, I mean, and you know, it’s not perfect. We’re still working on this, but we have come a long way in cancer rehab over the last decade plus, which is so exciting. So we’ve talked a little bit about the updates in BMT. Let’s kind of shift to CAR-T in that realm because there’s a lot more that seems like has changed and updated in this realm.
than what we talked about with BMT already.
Adam (12:42)
Yes.
And I think the biggest advancement in CAR T has been just the number of diseases that we’re treating now. Right? If you think about when we, when we first started those first like Zuma 1 trials with YesCarta were strictly adult, diffuse large B cell lymphoma. Like that was it. That was the target. That’s what we treated. It was CD19, CD22 targeted CARs and that was it.
Elise Cantu (13:06)
Mm-hmm.
Adam (13:16)
Now we have cars for almost everything. We have cars for pediatric B-cell ALL. have the, yes, CARTA has been expanded to involve follicular lymphoma. We have cars for multiple myeloma now. And then that has started to expand into the solid tumor world. So.
Elise Cantu (13:40)
Mm-hmm.
Adam (13:41)
There’s trials right now for CAR T for ovarian cancer, which we’ve seen a handful of. There’s CARs for lung cancer, for breast cancer. And so we think about with CAR T cell therapy, right? We think about these modified T cells that have this single surface receptor that matches an antigen that’s on the patient’s specific tumor. And so…
Elise Cantu (14:06)
Mm-hmm.
Adam (14:08)
That’s where it gets tricky. I think we talked about this during our CAR T episode with like trying to make a car for solid tumors, solid tumors, especially like in the abdomen, they share a lot of surface receptors with all of the other stuff that makes up our insides, right? So it gets a little bit tricky to find a good target for these things. So I think we’re seeing a lot of like trial and error.
Elise Cantu (14:13)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Adam (14:34)
you know, we’ve had patients that have come in for a car for a solid tumor that have had like no response to treatment. Like it just did not work. So it does get a little bit tricky. But the other, and then the other big offshoot of the CAR T cell therapy is now being able to treat autoimmune disorders. So we have a CAR T for lupus. We have a new CAR trial for multiple my, not multiple, for multiple sclerosis.
Elise Cantu (14:41)
Yeah.
Ooh, that’s exciting.
Adam (15:04)
so like
these patients with relapsing remitting MS, the, like the goal of these cars is to, basically like down regulate their like B cell maturation, to prevent them from having these wild flare ups. so it’s, can’t cure MS yet. but what we’re seeing is just this like,
steady, easygoing progression of their disease instead of these massive spikes and then back to baseline. So it’s been really neat. Yeah. And then like you said, kind of the advancements in CAR-T have opened the door to all of these other new cellular therapy lines that we’re seeing. the two big ones that we’ve had trials for are
Elise Cantu (15:48)
Yeah.
Mm-hmm.
Adam (16:03)
which is tumor infiltrating lymphocyte therapy. So we are seeing patients with metastatic melanoma. And so what they do is they go into the site of their melanoma and they take out these lymphocytes that basically like they know how to find the tumor, like they are tumor infiltrating lymphocytes. They know how to find it, they know how to get into it, they know how to destroy it. So we’re taking these lymphocytes and we’re
Elise Cantu (16:24)
Mm-hmm.
Adam (16:33)
taking them to a lab and we’re letting them expand. And then we’re taking this like massive quantity of TILs and then re-infusing them and letting them go do their thing. They know where to go, right? Like that’s the big thing with targeted therapy. They know what they’re looking for. They know how to bind to it and they know how to destroy it. And so the cool thing is we have not seen a lot of side effects from TIL therapy.
The side effects come from what they do is so similar to a CAR-T. They get a couple of days of chemo before their cell infusion, and then they get their cell infusion on day zero. And then starting 12 to 24 hours after their cell infusion, they start getting doses of IL-2. So it’s an interleukin-2 cytokine that basically just helps keep that cell production up.
Elise Cantu (17:02)
We’ll see you next week.
Mm-hmm.
Mm-hmm.
Adam (17:30)
but we’re seeing a lot of side effects from the IL-2 infusions.
Elise Cantu (17:33)
Interesting. What kind of, I haven’t treated a lot of patients undergoing interleukin therapy. What kind of side effects are you seeing with that, Adam?
Adam (17:43)
So a lot of like fluid retention type things. So we’re seeing lymphedema, we’re seeing pulmonary edema, we’re seeing what’s called capillary leak syndrome. So it’s basically just like this like swelling in their like lymphatic system and their muscles in their blood vessels. And then the other thing that we’re seeing is renal disease. So from this like massive fluid retention, it’s just putting a lot of stress on their kidneys.
Elise Cantu (17:46)
Okay.
Adam (18:13)
Think about things that are more related to your body retaining fluid. Those are the kinds of side effects that we’re seeing from IL-2.
All right, and then the other big one is this new, like just FDA approved, either end, I think it was end of 2024 or right at the beginning of 2025. have, and so we have this new therapy called, and I don’t wanna screw it up.
Elise Cantu (18:36)
I’m, this is like breaking news. my God.
Adam (18:53)
So this is TCR, and I always say TRC, TCR. This is T cell receptor therapy. So this is very similar to CAR-T, where we’re taking out a patient’s T cells and we’re letting them expand in the lab. The difference is we’re not genetically modifying these T cells to have a surface receptor. These are natural T cells from the patient’s own immune system. They kind of have these.
already have these abilities to like go and find their cancer cells. So same thing, they’re coming in, they’re getting a couple of days of chemo, and then they’re getting the cell infusion. So I think we were talking before we started recording about the differences between CAR T cell therapy and T cell receptor therapy. And so the biggest one is that the T cell receptors,
rely on a major histocompatibility complex from the tumor cell itself to be able to go and bind. The cool thing is that these MHCs are on the inside and the outside of the tumor cells. So it gives these TCRs more of an opportunity to bind. But like we were talking about earlier, cancer is really smart, unfortunately.
Elise Cantu (20:04)
Mmm.
Adam (20:15)
And one of the ways that cancer tries to avoid, and this is how our normal immune system works, right? We have T cells that go out and find cancer cells and destroy them. And, you know, in patients that, you know, have these acute cancers, it’s because the tumor cells are just proliferating too fast and our T cells can’t keep up with them and they get overwhelmed. So with this T cell receptor, they rely on
Elise Cantu (20:40)
Mm-hmm.
Adam (20:45)
these MHCs to go find their tumors and destroy them. So cancer being the smart thing that it is, it can down regulate MHCs that it presents as targets for these T cells. So again, a little bit tricky, but I think, you know, we have some really smart people working on these things. So we’ll get there.
Elise Cantu (20:49)
Mm-hmm.
Yeah, man.
It’s, you know, again, I remember saying, like I said, when I first learned about Carti from my sister who was at an institution where they were doing like early work in that, I was like, oh my God, this is like science fiction. It’s so crazy. And now, you know, five years later, it’s like, oh man, that is so old school. Like look at what we’re doing now kind of thing. So it’s just, it’s, it’s new iterations of work that has been
Adam (21:27)
Right.
Elise Cantu (21:32)
building for many, years. And one of the things I, because I don’t, again, I don’t see a lot of patients who are undergoing this right now, but going back to CAR T, I believe it’s Yes, CARTA that we were talking about earlier. That’s one of the CAR T lines. They are now using that as second line therapy and not just third line. So a lot of CAR T, um,
across the country, it’s a third line treatment. So patients will have to go through and have two other lines of therapy fail them before they’re considered candidates. And CAR-T is even moving up in the ranks. So if you’re listening to this right now and you’re thinking, gosh, Adam is saying some cool things, this sounds awesome. I’m not gonna see these patients. They’re like, I’m not gonna see these patients in my practice. Friend, you are. And it’s only a matter of time because as we’re hearing about new treatments that Adam is covering,
as we’re hearing about treatments we’ve talked about previously that are now moving up in the ranks of, know, kind of a priority. And when we’re using them in cancer treatment, it’s only a matter of time before you start encountering these patients, basically no matter the diagnosis that we’re working with, which is really cool, but it might also be a little, maybe a little intimidating for someone who hasn’t had experience with this patient population yet, Adam. So what are some things like, what does this all mean?
for rehab and the rehab professional who’s like, okay, now I have to treat these patients. What the heck?
Adam (23:02)
So there’s two big things for the outpatient therapists. As CAR-T becomes more prevalent and it becomes safer because we have better ways of managing CRS and ICAMs, the patients that are going through it are gonna continue to get more complex. So when we first started doing CAR-Ts, I would say 60 to 70 % of our patients were in between
Elise Cantu (23:05)
Mm-hmm.
Yeah.
Adam (23:30)
20 and 35 years old. And now we have a pilot going on that we’re getting going in our cancer center where we’re doing pre-assessments for our geriatric CAR-Ts because about 30 % of our CAR-Ts now are over the age of 65. including like we just CAR-T’d an 84 year old like two weeks ago. Like they’re, yeah.
Elise Cantu (23:45)
my god!
Adam (23:57)
It’s becoming more prevalent. So patients are going to get older. They’re going to get more complex. The other thing that we’re seeing now is using CAR T to potentially bridge a patient to an aloe. So if we have a patient that is not responding to more traditional therapies to get them into remission, to get them to an aloe, we might see them bridge with a car to get to their donor transplant.
Elise Cantu (24:03)
Mm-hmm.
Adam (24:26)
And so these patients are gonna have these wider windows where they’re outside of the hospital but still have rehab needs so I think we’re gonna see a lot more patients for prehab I think with this like This like older a little bit more beat up from multiple rounds of treatment You know, they’re gonna need a little bit of work before they come in and the neat thing is like
Elise Cantu (24:34)
Mm-hmm.
That’s… Yes. my god.
Mm-hmm.
Mm-hmm.
Adam (24:56)
From the time that they aphorize their T cells, like it takes time to expand those cells, to make those receptors. So we have time from the time that they’re consented that they say, yes, I want to do this to the time that they’re ready to be admitted. Like we still have a three to four week window where we can make a little bit of a difference in how they’re moving. Even if it’s just like taking a really sedentary patient and getting them on a walking program to set that expectation for.
when you’re in the hospital, we’re gonna keep you moving. We know we’re not gonna see major gains in their fitness level from three to four weeks, but it’s enough time that we’re kind of setting those habits so that when they’re in the hospital, we’re not starting at this really low baseline.
Elise Cantu (25:40)
Absolutely.
Absolutely.
Adam (25:46)
And then
right like we talked about the other thing is on the back end those outpatient therapists like You need to know what the like warning signs of like recurrent CRS and ICANN’s are so Looking at things like making sure that you know It’s probably not something that you think about doing a lot as an outpatient therapist but checking vitals right like if your patient is hypoxic if your patient is hypotensive
Elise Cantu (25:52)
Mm-hmm.
Mm-hmm.
Absolutely.
Adam (26:15)
Like those are warning signs. You know, if your patient like they’re a little bit more fatigued, like, well, have you checked your temperature in the last 24 hours? Have you had a fever? Like those are things that we want to look out for. And then we look at the ICANN side of things. Like is your patient, you know, a little bit confused? Are they more forgetful? Are you know, when they’re going through their exercise program in your clinic, are they needing more queuing to do things? Like those are little things that you start to pick up on like.
Elise Cantu (26:28)
Mm-hmm.
Mm-hmm.
Adam (26:45)
Something’s not quite right here. Like maybe you should get your Docker call.
Elise Cantu (26:48)
Right.
Right. As far as a great, so first of all, great reminder on vitals are vital for a reason, including outpatient oncology, even for patients who might be, you know, on the other side of treatment. What about for someone who is maybe newer to a hospital system or a unit that’s on the inpatient, the acute care side that’s now encountering these patients? What kind of things should they be?
Adam (26:58)
you
Elise Cantu (27:17)
You you provided great recommendations for the outpatient. Now let’s flip it to inpatient side.
Adam (27:24)
Yeah, so the biggest thing that we do on the inpatient side is keep people moving. So again, it’s helping set those habits, set that routine, making sure that like, especially for our CAR T patients that are, you know, kind of on that like borderline, like CRS-1, ICANS-1, like those lower grade side effects, like making sure that they’re doing the little things, that they’re getting up into a chair for part of the day, that they’re going for short walks that…
Elise Cantu (27:29)
Mm-hmm.
Adam (27:54)
you know, we’re trying to maximize these windows that we have when they’re feeling well. and then on the patients that are, you know, maybe having the more significant side effects, kind of those like grade two into grade three CRS patients. it’s really about patient safety. right. These patients are going to be hypotensive. They’re going to be confused. They’re going to be high fall risk patients. So, yeah, really want to make sure that, you know, we’re utilizing.
an extra set of hands when we need to, especially if the patient’s more confused, aphasic, they’re not following commands 100 % of the time. So co-treating with your OT partners, using a rehab aid, pulling in a nurse, like making sure that we’re doing everything we can to keep patients safe when we’re trying to mobilize and keep them moving. Our patients that are getting into that like grade four CRS and ICAMs, like those are most likely gonna end up in the ICU.
Elise Cantu (28:42)
Yeah.
Adam (28:51)
So if you are a therapist that goes to the ICU like making sure that therapy is staying on board with these patients that You know, even if it’s bed level, you know range of motion anything we can do to maintain strength and function throughout their admission and then we get them back on the unit after their ICU stay or
These patients that are like that grade two CRS, grade two ICAMs that are staying on the unit with us, but maybe aren’t really appropriate for therapy. You know, when we pick those patients back up, they’re going to get a lot of steroids as part of the treatment for their CRS and their ICAMs. So making sure that, you know, we’re addressing things like steroid biopathy. So a lot of patient education, right? You might be a little bit weaker.
you you’re gonna fatigue quicker. So making sure that again, we’re keeping patients safe, that we know that they’re gonna be at risk for knee buckling. We know they’re gonna be at risk for dizziness, lightheadedness, things like that. So just adjusting your treatments as needed. One of the things that I always do with students and new grads is, you know, when we’re going in to see a patient that, you know, is now like day plus seven from their car,
Elise Cantu (29:47)
Mm-hmm.
Mm-hmm.
Adam (30:10)
They just have like two, three days of like grade two CRS. So high fevers, maybe hypotensive, haven’t been out of bed a whole lot. Like what’s your plan A, what’s your plan B and what’s your plan C? Like we need to have, you know, have an aggressive plan for getting this patient moving. But if that doesn’t go well, how are we pivoting during that session? Like what are we falling back to?
Elise Cantu (30:33)
Yeah.
my gosh. Okay. I did not prep you for this question whatsoever, but you queued some thoughts. So I was speaking with a different physical therapist earlier this week who is in a system that they’re like, okay, we recognize cancer rehab is important, but the bridge to like actually implementing it on a consistent basis is not there yet. But this physical therapist is in a position to like potentially build that up.
I know for sure this institution is doing BMT. I don’t know the status on like CAR-T and other therapies, but I would think it’s probably a matter of time. Just my hypothesizing. So what are some things that this, or you know, like a therapist who’s in a similar position, what are maybe some things that from a planning standpoint, from an organizational administrative standpoint, what maybe can this PT do to set up that relationship?
to really build out this BMT rehab program? Like what are some considerations?
Adam (31:41)
Yeah, I think there’s a lot of research that shows that the more involved PT is, the higher patient’s quality of life is, which I think should be at the top of the priority list, right? It’s not always for doctors, but it should be pretty close to the top for us. And so really it’s about finding a couple of attendings that are really pro mobility and planting the seeds with them.
Elise Cantu (31:51)
Absolutely. Absolutely.
Adam (32:11)
And then that’s, think that’s where it starts is you, find your docs that are on board with PT with OT, and you get them to plant those seeds. and then you go from there, you just keep, keep pushing, you know, cause it’s hard. It’s like organizationally, it can be really challenging. especially if, you know, you have a system that’s starting this new program, you know,
Elise Cantu (32:11)
Okay.
Mm-hmm.
Adam (32:40)
If they’ve never, like, I think that actually take that back. That’s probably a little bit easier. If they are starting a new program, like that’s when you can get your foot in the door early. And there’s a lot of research that shows that, you know, mobility through treatment is going to be effective for improving outcomes for improving patients’ quality of life. So I think that’s where it’s a little bit easier. If you are a new therapist in a healthcare system that already has this program and like,
Elise Cantu (32:50)
Mm-hmm.
Mm-hmm.
Adam (33:10)
rehab has not been a big part of it. Like now you’re trying to change the culture of the program, which is a little bit harder, right? Like, so like I said, you find your couple of docs that are really pro mobility and you latch onto them and kind of just keep, keep bugging people until you start to make a difference. think, like I said, the research is out there that shows that, you know, the more involved we are, the better patients do. So.
Elise Cantu (33:15)
Right.
Mm-hmm.
the squeaky wheel. think Nicole Stout has said that, again, somebody has said that. That’s really stuck with me of like, you have to be the squeaky wheel in this situation. And one of the things that as more systems and institutions are looking to become centers of excellence or have some kind of accreditation status, that requires some degree of rehab involvement. so again, it’s not like a, like
that’ll solve all the problems. But if you can leverage it to like, if you can connect it back to that, I think organizationally people are more inclined to be like, okay. So again, not a perfect fix. But if you can connect that, if you know, that’s a goal of this system or institution that can definitely help get things a little at least, you know, more standardized, more implemented consistently for patients across the system.
And I really like what you said about, you know, champions, right? Like finding those champions.
Adam (34:37)
Yeah, and.
And then little things too, right? Like pushing your way onto multidisciplinary rounds or tumor board or those kinds of things where you’re kind of, you know, find your seat at the table or make your seat at the table. Like we gotta, we gotta push our way into those multidisciplinary conversations cause it’s important. I think one of the things that we’re trying to do right now, is like,
Elise Cantu (34:48)
Yeah. Yeah.
Absolutely.
Adam (35:07)
So we go to inpatient team rounds, our rehab team on our units, we go three times a week. And so we’re very involved. Our docs know our team really well. So one of the ways that we’re trying to now kind of push a little bit further upstream is being more involved in what our docs call new patient meeting. And so this is a meeting that they have once a week where they talk about
like all of the patients that are, you know, kind of on the board to be consented for transplant and any concerns that they have. And so this is where we’re really trying to push for that, functional pre-assessment so that we can have a seat at that table. Like, Hey, if we can like this patient’s good to go, like they’re active at home, they’re moving like no concerns. But if we get those patients that are a little bit higher risk mobility wise.
Right? Are we now, do we now have the ability to sit at that table and say, Hey, like this patient needs, you know, a month of pre-hab before they come in for their transplant. you know, are we saying like, Hey, if this patient, you know, and it’s hard with the transplant world because we have patients that from initial diagnosis, you know, if they’re genetically like,
Elise Cantu (36:15)
Absolutely.
Adam (36:31)
Okay, like this, they’re going to be super high risk. We’re going to fast track them for BMT. Like that’s a little bit tricky. But if we have those patients that are a little bit lower risk and we can say to that medical team, like, Hey, if we can delay this for, you know, a month or six weeks or two months safely, you know, can we get them some rehab to get them stronger before they come in for their transplant? Because it’s going to make things easier on the back end.
Elise Cantu (36:36)
Okay.
Again, what a great opportunity for rehab to show up. you know, ultimately this helps the medical outcomes for this patient. Again, well established. Rehab is so beneficial here. And again, what a great opportunity for us to step into this as we continue to see these advancements. And there’s going to be more. I’m going to have Adam on the podcast again in three years, and we’re to talk about, my gosh, can you believe that that was the latest and greatest back then? Now talk about the new stuff we have here.
Adam (37:03)
them.
Elise Cantu (37:31)
this is only going to continue to happen. And it doesn’t matter if we’re talking inpatient, outpatient, acute care, and what diagnosis we’re talking about. We’re getting better at treating cancer in general. We’re trying new things with different diagnoses. We’re using the same things that we used to differently with different patient populations like we’ve already talked about in this episode. The onus is on us to make sure that we are not only keeping up with these changes,
but also thinking two steps ahead to make sure that as the medical side of treatment is advancing, we are also keeping up with that and making sure that patients are physiologically ready and able to undergo these very intensive treatments so that they can come out on the other side as best as they possibly can. And that excites me. Like that’s…
such a great place for us to be as we continue to propel cancer rehab forward, in my opinion.
Adam (38:34)
Yeah.
Yeah. Like you talked about earlier, like being able to get our hands on these patients as early as possible, right? Like for our team, that was making sure that they were getting a PTE vowel as part of their order set. So as soon as they were admitted, that order was in, like we didn’t have to ask for it. We didn’t have to wait for something to happen. and so now, right, it’s continuing to push that envelope, right? So how do we get further upstream?
Elise Cantu (38:42)
Mm-hmm.
Mm-hmm.
Adam (39:02)
How do we embed ourselves in cancer centers so that we’re getting these patients functional assessment prior to being screened for transplant or CAR T to make sure that, like you said, functionally they are ready to go through something like that. That’s what I tell every patient that comes in that I see is no two patients are gonna go through this process the same way.
Elise Cantu (39:25)
Totally,
totally.
Adam (39:28)
And so making sure that, you know, they’re coming in as strong as they can, as functional as they can, it’s going to give them a better chance to have a good outcome.
Elise Cantu (39:40)
Mm-hmm.
If you could go back in time, maybe not go back in time, but if you were speaking to you nine years ago when you first started and wide-eyed Adam is like, my gosh, all of these exciting things, what would you tell the physical therapist who’s starting today with patients who are undergoing BMT, CAR T cell therapy, and those other treatments that we’ve talked about, TIL, TCR, et cetera?
Adam (40:11)
I would say the biggest thing is don’t let either their treatment or their potential side effects of their treatment dictate what you do. So I think when I first started, especially because I started on our BMT unit as a student. so going from outpatient to like new acute care and then on top of that like.
Elise Cantu (40:30)
Thank
Adam (40:38)
cancer patients, like I have never worked with this patient population before, like these patients have got to be super sick and super frail and the treatments that they’re going through are really hard. And so I think, especially as a student, I probably under dosed my therapy for a lot of these patients. And so there’s no reason not to be aggressive with rehab as long as the patient can tolerate it and you can do it in a safe manner. So making sure that you’re taking all of the precautions that you can.
Elise Cantu (40:41)
Yeah.
Mm-hmm. Mm-hmm.
Mm-hmm.
Adam (41:06)
right with our new chip in patients that you’re doing more therapy like in their room, not in a rehab gym where we’re going to put them at risk for coming in contact with other patients, know, with our patients that are thrown beside a panic, making sure that, you know, we’re following precautions for resistive exercise and things like that. But there’s no reason that we can’t continue doing body weight exercise with them, that we can’t get them on a stationary bike, that we can’t make sure that they’re walking every day. So it’s like,
Elise Cantu (41:17)
Mm-hmm.
Adam (41:36)
I tell patients when they’re coming through the transplant process, Like your honeymoon phase is from the day that you’re admitted until like day plus two or three post-transplant, right? Like that is when you’re gonna feel your best and then you’re gonna be like day plus two or three post-transplant. And that’s when all of the chemo side effects, that’s when being in the hospital for a week, that’s when the post-transplant side, it’s like everything’s gonna hit you all at once.
But if we can just keep those patients moving through it, like, you know, it’s hard. And some days I have to be the bad guy where it’s like, if I saw that patient on Thursday, right? And I don’t see them again until Monday or Tuesday. It’s like, well, what have you done the last few days? And if you haven’t been out of bed a whole lot, I’m probably going to yell at you. So, but yeah, I think that’s, if I went back and told myself,
Elise Cantu (42:25)
Yeah.
Mm-hmm. Mm-hmm.
Adam (42:34)
what I know now. Keep your foot on the pedal. Patients can tolerate a lot more than you think they can.
Elise Cantu (42:42)
Mm-hmm.
Yep. I think in general, like we know how much we underdose patients, but I think especially in this patient population, it would be very tempting to slip into that. And we absolutely cannot. What resources would you recommend to someone who’s newer to the BMT, CAR-T world to learn some more? We already talked about our two episodes, episode 204, episodes 221.
But what else would you give or suggest to the person, the PT, who’s like, I need to know more about this world?
Adam (43:21)
Yeah, just email me and I’ll walk you through the whole thing. No, I think one of my favorite resources for people is the BMT InfoNet. A lot of great resources. I think the really neat thing about their platform is that they have it broken down like resources for healthcare providers. They have resources for patients and caregivers. And so what I recommend for people that are like new to transplant is go and go through
Elise Cantu (43:25)
love it
Yeah.
Adam (43:50)
some of that educational material for patients and caregivers first, because it gives you kind of that more simplified version of it, and then go back through the healthcare provider things, and it’s gonna fill in some of those knowledge gaps for you. But going through the patient side of things first is gonna give you kind of that real good simplified foundation of what the transplant process looks like.
Elise Cantu (43:55)
Mm-hmm.
Okay.
Right.
Adam (44:20)
Again, they have a lot of like patient testimonials and things like that. So you get to hear that patient voice out of it, which I think is great. BMP InfoNet also has a survivorship symposium, which is a week long of content. It’s free. You just have to sign up for it. You have to sign up for it ahead of time. That is the most important thing. I think all of the sessions are recorded and you have access to
Elise Cantu (44:45)
Okay.
Adam (44:49)
I could be wrong. think you have access to everything, but you have to sign up before the symposium. It’s in May. I will be speaking at that as well. So I’m actually really looking forward to that one. I’m doing a patient and caregiver kind of class on safe exercise and activity after Grapper’s Host Disease Diagnosis.
Elise Cantu (44:55)
you.
Very cool.
my gosh, amazing.
Adam (45:15)
We’re going to go into all of that
like steroid myopathy. How do we keep people moving when they’re fall risks? So that’ll be good. The GVHD Alliance is another great resource for those more complicated patients. Does a really good job of breaking down GVHD by body system and the treatments that are available. NCCN has a great like educational pamphlet on
Elise Cantu (45:36)
Mm-hmm.
Absolutely.
Adam (45:43)
the whole
bone marrow transplant process, the CAR T process. So yeah, there’s a lot of good resources out there. You can find a lot of them through the ASTCT website, which is the American Cellular Therapy and Stem Cell. Yeah, I can never remember what their acronym actually stands for.
Elise Cantu (46:01)
Quran, Quran.
I’ll find
it, don’t worry.
Yeah, I will be linking to all of those. Absolutely. Those are some really valuable resources you’ve mentioned. Keep going, Adam.
Adam (46:10)
But yeah, there you
Yeah. Yeah. The ASTCT is kind of the big one. It’s all of the stem cell and cellular therapy from across the country. The downside of that one is they have their conference the same week as CSM every year. and now…
Elise Cantu (46:33)
Ew, no! Dang it!
okay, that’s a big bummer. That’s a really big bummer. I’ll have to look into if they do any kind of like recordings or whatever to get make that connection.
Adam (46:49)
I think they do. think they have,
I think they have an on demand session like we do. Yeah.
Elise Cantu (46:53)
Okay.
I’ll have to look into that. man.
Just not enough time for all these amazing conferences. my gosh. With that said, Adam, now you are one of the things that I’ve so appreciated about you is that you’re so willing always to, you know, like you said earlier in the interview of like talk people through this and have these conversations because this is a very, you know, Adam has done a really good job of simplifying and making this information very concise. I feel like you could get really lost.
in this information. And so I will be including all of those resources like we’ve talked about in the show notes as well. But if people did want to connect with you and continue this conversation, Adam, what’s the best place for them to get in contact with you?
Adam (47:44)
I’m on LinkedIn. I’m on the cancer rehab community on circle. I am on blue sky. honestly, at least you can put my email, my work email in the show notes and people can email me and I will answer questions. anything that comes across like the oncology listserv that’s BMT and CAR-T related. I’m always quick to answer those questions. So lots of ways to reach out if you need anything.
Elise Cantu (47:54)
you
Mm-hmm.
Amazing. Definitely. We’ll be linking all
of that and very responsive to like as many places as Adam is present. He’s extremely quick to respond, which I so, appreciate. Adam, thank you so much for this conversation today. It was, you know, I went into this conversation very excited about the updates and I feel like I came out more invigorated and like charged to go out and do more stuff about this because like I mentioned previously, we’ve seen such crazy.
wonderful updates over even just the last three years. What else are we going to see happen and how much of a wonderful role that rehab has to play in all of this as more and more patients with different diagnoses get this amazing treatment and ultimately are going to have to, you know, go through that and then come out on the other side and eventually like we want them to get back to the things that they want to do and need to do with the people that they love as best as they possibly can.
and we are perfectly primed to do that. So thank you so, so much, Adam. Is there anything else that you’d like to leave my audience with today?
Adam (49:16)
if you have not already submitted your session and speaker application for the cancer rehab community conference, please do. if you are a loyal listener of this podcast, you know how much Elise and I push people like your voice needs to be heard. There is something that you are an expert in that we need to hear about. so please get involved.
Get involved on the cancer rehab community on circle Yeah, we need to hear from everyone that’s involved in cancer rehab everyone has their little niche that they are, you know exceptional at and Everyone needs to hear from you
Elise Cantu (49:44)
next.
that’s excellent because the deadline is also at the end of the week when your episode is releasing. So this is the best final pitch. Like you’ve heard it from Adam, you heard it from Kelly and me. We want to hear, and we need to hear your voice and perspective. Cancer rehab does not benefit from hearing the same people talking in echo chambers. We need you in your perspective. And I sincerely hope you will apply. I will also put that link in the show notes as well. so make sure that you do that. We cannot wait.
to read your application and see you at this year’s Cancer Rehab Community Conference. So Adam, thank you so much for that plug. You know I love a good conference plug. And with that, thank you so much again for coming on the episode. I’m so appreciative of your time and your expertise that you’ve shared. And until next time, this is Elise with TheOncoPT. And remember, you are exactly the physical therapist that your patients with cancer need. So let’s get to work.