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Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

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Abstract

The health care delivery system in the United States is challenged to meet the needs of a growing population of cancer survivors. A pressing need is to optimize overall function and reduce disability in these individuals. Functional impairments and disability affect most patients during and after disease treatment. Rehabilitation health care providers can diagnose and treat patients' physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population. However, few care delivery models integrate comprehensive cancer rehabilitation services into the oncology care continuum. The Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health with support from the National Cancer Institute and the National Center for Medical Rehabilitation Research convened a subject matter expert group to review current literature and practice patterns, identify opportunities and gaps regarding cancer rehabilitation and its support of oncology care, and make recommendations for future efforts that promote quality cancer rehabilitation care. The recommendations suggest stronger efforts toward integrating cancer rehabilitation care models into oncology care from the point of diagnosis, incorporating evidence-based rehabilitation clinical assessment tools, and including rehabilitation professionals in shared decision-making in order to provide comprehensive cancer care and maximize the functional capabilities of cancer survivors. These recommendations aim to enable future collaborations among a variety of stakeholders to improve the delivery of high-quality cancer care.

Section snippets

Methods

In 2014, an appointed dissemination taskforce of the Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health (NIH) was charged with identifying an emerging area of rehabilitation practice where the unique resources of the NIH Clinical Center could be leveraged to support practice development. The taskforce identified cancer rehabilitation as the primary area of need and recommended that the NIH Clinical Center Rehabilitation Medicine Department take on a

Postacute care

Postacute cancer rehabilitation is provided in inpatient rehabilitation facilities, skilled nursing facilities, long-term care hospitals, and hospice facilities. The rehabilitation service conducts a formal functional assessment to identify impairments and provides a range of services (eg, physiatry, physical therapy, occupational therapy, speech therapy, nutrition, psychology, nursing) to assist in optimizing an individual's function.42 Such programs demonstrate clinically effective care

Clinical measurement of function

Cancer treatment introduces risk for functional impairments that increase the potential for disability. In order to accurately screen for and manage functional impairments related to treatment toxicities, a battery of functional measurement tools must be identified. Robust evidence supports specific measures of functional impairment in the cancer population72, 73, 74, 75, 76; however, these individual measures fall short of comprehensively assessing function. Function is defined as “those

Patient-reported outcomes measures

A patient's perception of his or her own functionality is a critical clinical outcome. The current mandate to integrate the patient's voice into clinical decision-making in oncology has increased receptivity to the use of PROMs in both clinical and research settings.79 PROMs with strong validity and good clinical utility can be inexpensively administered, making them amenable to integration into busy oncology practice settings.

PROMs have a wide range of application and clinical relevance in

Clinical objective measures of function

High-level domains of clinical function are supported by a discrete evidence base; however, there are considerable gaps in the clinical utility of functional objective measures relevant to the cancer population.

Interdisciplinary clinical integration of rehabilitation

Integrated care models rely on a team of health care professionals that share patient care goals and interact on a care continuum. This includes individualized consultative, interventional, and integrative services.110 Integrated models are used in cancer care from the point of diagnosis through disease treatment and become particularly critical in transition from active disease treatment to survivorship.111 These models however conspicuously lack rehabilitation care providers.

Cancer

Summary and recommendations

The work of this SME group provides a sound rationale for the supportive capabilities that rehabilitation can offer to the oncology care continuum toward improving functional outcomes and quality of life for the cancer population. These recommendations are put forward to stimulate action among health care providers, policymaking bodies, research institutions, professional societies and associations, and patient advocacy organizations toward initiating advancements in the field.

Acknowledgments

We thank the following individuals who supported this effort at the NIH Clinical Center by bringing their knowledge and expertise to inform these findings: Stephen Pavletic, MD, Head of the Graft-Versus-Host and Autoimmunity Section of the Experimental Transplantation and Immunology Branch of the National Cancer Institute; Galen Joe, MD, Leora Comis, MPA, OTR/L, Maggie Glos, BS, of the Rehabilitation Medicine Department of the Clinical Center at NIH; Teresa Cruz, PhD, Mary Ellen Michel, PhD,

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  • Cited by (0)

    Presented to the Cancer Rehabilitation Symposium at the National Institutes of Health; June 8-9, 2015; Bethesda, MD.

    Supported by the Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health (NIH), the National Cancer Institute, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Center for Medical Rehabilitation Research at the NIH.

    The opinions expressed in this publication are not an official policy or position of the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government.

    Disclosures: none.

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