Special communicationToward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group
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.