In 2002, Robert P. Cole and Salvatore J. Scialla published an article in the Annals of Oncology titled, “Does rehabilitation have a place in oncology management?” The authors acknowledged the physical and psychosocial side effects of cancer and its treatment. They asked the question of why rehabilitation had been underutilized as a cancer treatment. The authors identified limited quantitative research as the primary factor that rehabilitation was not valued at that time. They discussed the limitations of the few research studies that had explored the question. Interestingly, Cole and Scialla described the need for “physician-led” comprehensive, multidisciplinary programs.
Oh, how times have changed in a decade. Oncology rehabilitation research has grown exponentially. We have a multitude of researchers and clinicians whose work is changing the way we deliver oncology rehabilitation. As you read through the recent edition of the journal and reflect on past articles, I am sure you would agree that the depth and breadth of knowledge has increased significantly. We now have EDGE publications that advise us on the best outcomes and measurement tools. Our body of literature indicates that we are evolving from tertiary prevention into secondary and primary prevention. We are no longer viewed as physician extenders of the oncology care team, but we are autonomous practitioners who are valued. Our expertise as movement specialists has been shown to improve the health outcomes of cancer survivors. It is an exciting time to be a physical therapist or physical therapist assistant in cancer care.
We have answered the questions of if a cancer survivor should exercise. The new questions are how much and what type. We are now promoting exercise, physical activity, and rehabilitation throughout the cancer continuum. We have come a long way baby. As we think about where we have come from, let us be bold enough to envision what is next. We must move into comparative effectiveness research to determine what is best for our clients. We must move into health services research so that policy and reimbursement changes can occur. Drs. Nicole Stout and Charles McGarvey explained this need during their CSM 2015 presentation. We must now ask the hard questions of when to screen, how to reduce health costs, and how to transition care to other providers (medical and community based) to provide high quality, cost-effective care. We need to be change agents before change is forced upon us.
It is easy for us to think we should just enjoy our current improved status in the health care team. Do not be complacent. The fact that approximately 70% of cancer survivors will not receive a referral to a physical therapist due to access to care issues means there is still a lot to do. Policy must be changed to strongly support referral processes to attenuate or alleviate the side effects of cancer treatment. This will mandate that each of us become involved in the process. This means you must know your local, state, and federal legislators and cancer organizations. As our APTA President, Michael Bowers, stated at CSM 2015, “Vote for those who represent your interest.” If you don't know your representation, the Oncology Section and the APTA are here to help. The Oncology Section has a list of cancer organizations for each state. The APTA has resources that will link you directly to your state and federal legislators. Let people know that the body of literature concerning oncology rehabilitation no longer looks or reads like that of 2002. It is time for each of us to embrace our growth and prepare for the next phase in our own journey.