An article in OT's September 10 issue (“Call from NCI Survivor-ship Head for Increased Cancer Rehab”) highlighted critical issues that have led to a lack of evidence-based, multidisciplinary care for cancer survivors. The American College of Surgeons' Commission on Cancer (CoC) has recognized the need for cancer rehabilitation, but mandating that hospitals provide this hasn't led to well-coordinated services that are offered in a best practices model.
Why not? Probably the most critical issue is precisely what the Oncology Nursing Society's National Conference on Cancer Nursing Research's keynote speaker, Julia Rowland, PhD, mentioned in her speech—that the conference seemed to cover every facet of cancer patient care except one—cancer rehabilitation. In essence, she was saying that there is a disconnect between oncology and rehabilitation professionals, and they need to come together to solve the cancer rehabilitation problem.
This is the same thing that physiatrist Mary Vargo wrote about in the Journal of Clinical Oncology in 2008 in an editorial titled “The oncology-rehabilitation interface: better systems needed.”1
This gap is profound; filling it will solve the cancer rehabilitation problem. A few months ago, I published an editorial in Physical Medicine and Rehabilitation titled “Strategies to overcome cancer survivorship care barriers,”2 which addresses many of the barriers that have prevented the establishment of cancer rehabilitation as the standard of care for survivors and how to overcome the barriers. In it, I went into detail about many of the issues, but what I'll focus on here is the oncology–rehabilitation disconnect and how to quickly solve it.
Here are several simple solutions that will vastly improve cancer care:
* Define “rehabilitation specialist.” Every CoC-accredited hospital is required to have a “rehabilitation specialist” as a member of the cancer committee.This is an excellent recommendation, but it's important to define “rehabilitation specialist.” I would recommend that this individual be someone who is licensed and/or board certified in rehabilitation medicine. Candidates to fulfill this rehabilitation specialist criteria at CoC-accredited hospitals would then include: board certified physiatrists, licensed nurses who are certified in rehabilitation medicine, and licensed physical/occupational/speech therapists.
* Invite key rehabilitation medicine professional organizations to offer advice and direction for cancer rehabilitation care and initiatives. This means including representatives from the American Academy of Physical Medicine and Rehabilitation, American Physical Therapy Association, American Occupational Therapy Association, American Speech-Language-Hearing Association, and the Association of Rehabilitation Nurses. In every discussion about cancer rehabilitation, especially when formal national recommendations are being considered and distributed, rehabilitation medicine leadership should be included “at the table.”
* Include cancer rehabilitation topics, presented by rehabilitation medicine experts (as defined above), at every conference on cancer care.
* Enable the development of multidisciplinary teams that have been trained in evidence-based cancer rehabilitation. To date, there has been a lack of comprehensive cancer rehabilitation training for health care professionals in both oncology and rehabilitation medicine. Both oncology and rehabilitation medicine professionals should be trained in evidence-based, best practices, cancer rehabilitation.
Some allied health schools are beginning to offer cancer rehabilitation training for in their students, and there are a few cancer rehabilitation fellowships cropping up for physiatrists. There are also some conferences that include continuing education in cancer rehabilitation. But we need more education and training options.
Unfortunately, these solutions don't help practitioners—oncology and rehabilitation professionals—who are “in the trenches” treating survivors now. It is critical that they receive comprehensive training in evidence-based cancer rehabilitation care that can be implemented in a best practices model.
This is what led me to develop the STAR (Survivorship Training and Rehabilitation) Certifications for hospitals and cancer centers, which have been adopted by many institutions around the country. Regardless of the manner in which health care professionals undergo training in cancer rehabilitation—the simple fact is that in order to deliver evidence-based cancer rehabilitation, health care professionals must understand the large body of research that is developing in cancer rehabilitation, implement protocols, deliver multidisciplinary care, and track outcomes.
Vargo MM.The oncology-rehabilitation Interface: better systems needed. J Clin Oncol 2008;6:2610-2611.
Silver JK. Strategies to overcome cancer survivorship care barriers. PM R 2011;3:503-506.