Complementary Models of Cancer Rehabilitation Care

Video

This video covers the important concepts of the Prospective Surveillance Model and the Impairment Driven Model in cancer rehabilitation care. These models, though distinct, have significant overlap and are complementary. Watch the video to learn more about these models.

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Fast Track Cancer Rehabilitation Decreases Hospital Length of Stay

Julie Silver, MD

Multimodal “fast track” or “enhanced recovery after surgery” inpatient peri-operative studies have been demonstrating impressive results when it comes to getting patients out of the hospital faster and healthier.

Interventions for this fast track inpatient cancer rehabilitation may include such strategies as preoperative counseling, intraoperative fluid restriction, use of a laparoscopic approach, immediate initiation of clear fluids after surgery, early discontinuation of urinary catheters and early physical mobilization.

In a new study coming out of Canada that retrospectively evaluated 336 consecutive colorectal patients at seven hospitals, researchers found that in hospitals that had utilized enhanced recovery after surgery strategies found that of the strategies they studied, all were independently associated with shortened length of stay.[1]

As accountable care continues to be a key part of the healthcare dialogue and Medicare fines hospitals for high readmission rates, it’s important to pay close attention to the new studies that are coming out on fast track peri-operative cancer rehabilitation interventions.


[1]Aarts MA, Okrainec A, Glicksman A, Pearsall E, Victor JC, McLeod RS. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surgical endoscopy. 2012;26(2):442-50. Epub 2011/10/21. doi: 10.1007/s00464-011-1897-5. PubMed PMID: 22011937.

Review of Cancer Rehabilitation Shows it is Cost-Effective

Julie Silver, MD

The Oncologist recently published a systematic review of cancer rehabilitation and determined that it is cost-effective.[1] In this study that evaluated the current research and was titled “Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General”, there were 16 effectiveness and 6 cost-effectiveness studies—22 studies in all–that were reviewed. The individual studies were performed in many different countries, including the United States and Canada. The researchers noted that despite the fact that the individual studies assessed different rehabilitation interventions, they all showed favorable cost-effectiveness ratios. This is an exciting new evidence-based review of the current research that strongly supports cancer rehabilitation as cost-effective.


[1]Mewes JC, Steuten LM, Ijzerman MJ, van Harten WH. Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General: A Systematic Review. The oncologist. 2012. Epub 2012/09/18. doi: 10.1634/theoncologist.2012-0151. PubMed PMID: 22982580.

New Concerns About Safety in Cancer Rehabilitation

Julie Silver, MD

Cancer rehabilitation is offered in many different settings and by many different types of healthcare providers. Although cancer rehabilitation may include exercise programs recommended by trained fitness professionals, there is concern about the safety of referring patients directly to people who are not trained specifically in rehabilitation medicine. Recent articles are highlighting important safety concerns in cancer survivors. For example, a new article titled “Patient Safety in Cancer Rehabilitation” was published in May 2012 by Cristian and colleagues in the Physical Medicine and Rehabilitation Clinics of North America.[1]

In a recent study evaluating weightlifting in breast cancer survivors who had lymphedema or were at risk to develop it, researchers found that approximately 21% of the participants in the weightlifting group reported a problem—such as a new injury–that required them to see their doctors or other healthcare providers and this resulted in stopping or changing their exercise regimen.[2] In this study published in The Oncologist, Brown and colleagues stated, “Despite the demonstrated efficacy of weightlifting, musculoskeletal injuries and other health problems did occur. Therefore, for the successful translation of this rehabilitative intervention into clinical practice, health and fitness professionals working with breast cancer survivors need the knowledge, skills and abilities that clarify their scope of practice to address these needs.”

In order to clarify the scope of practice in rehabilitation medicine, it is important to identify those healthcare professionals who have completed the appropriate training in order to be able to identify and treat cancer survivors’ impairments. Only professionals who are licensed and/or board certified in rehabilitation medicine should be treating patients for physical impairments. These healthcare professionals include physicians (e.g., physiatrists), rehabilitation nurses and physical, occupational and speech therapists. The training of fitness professionals is not sufficient to qualify these individuals to treat survivors’ impairments. Therefore, this is beyond their scope of practice. Moreover, sending survivors to fitness professionals without first identifying and treating their impairments is dangerous. In the cancer care continuum, the goal must be to screen all survivors for physical impairments and then appropriately triage those with identified problems to licensed and/or board certified rehabilitation professionals prior to referring them to fitness professionals.


[1] Cristian A, Tran A, Patel K. Patient safety in cancer rehabilitation. Physical medicine and rehabilitation clinics of North America. 2012;23(2):441-56. Epub 2012/04/28. doi: 10.1016/j.pmr.2012.02.015. PubMed PMID: 22537705.

[2] Brown JC, Troxel AB, Schmitz KH. Safety of weightlifting among women with or at risk for breast cancer-related lymphedema: musculoskeletal injuries and health care use in a weightlifting rehabilitation trial. The oncologist. 2012;17(8):1120-8. Epub 2012/07/04. doi: 10.1634/theoncologist.2012-0035. PubMed PMID: 22752068; PubMed Central PMCID: PMC3425531.

Research Demonstrates that Multidisciplinary Cancer Rehabilitation is Effective

Julie Silver, MD

A recent systematic review of twenty-two studies on cancer rehabilitation that was published in the prestigious medical journal The Oncologist demonstrated that multidisciplinary cancer rehabilitation is effective.[1] In this review that evaluated the current research and was titled “Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General”, there were 16 effectiveness and 6 cost-effectiveness studies—22 studies in all–that were included. The individual studies were performed in many different countries, including the United States and Canada. The researchers noted that despite the fact that the individual studies assessed different rehabilitation interventions, they demonstrated statistically significant benefits for multidimensional rehabilitation over usual care. This is an important new evidence-based review of the current research that supports multidisciplinary cancer rehabilitation.


[1]Mewes JC, Steuten LM, Ijzerman MJ, van Harten WH. Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost-Effectiveness of Cancer Rehabilitation in General: A Systematic Review. The oncologist. 2012. Epub 2012/09/18. doi: 10.1634/theoncologist.2012-0151. PubMed PMID: 22982580.