Cancer care rehabilitation is game changer for patients

By Vishwa S. Raj, M.D., associate medical director of Carolinas Rehabilitation in Charlotte, North Carolina, and director of cancer rehabilitation

When evaluating the spectrum of care for cancer patients, providers are asked to understand the needs of individuals from the time of diagnosis through the end of life. For years, the role of medical oncologists had been to supervise care and meet the various needs of patients, including medical, functional, and psychosocial. This model offered a great deal of stability for patients because it provided an oncological home that could help with any concerns that would arise after diagnosis.

However, as increased resources have been devoted to cancer care, significant advances have been made in the areas of medical care delivery and patient care related to research, treatment protocols, and applications of technology. Although this exponential growth of knowledge provides unique opportunities for providers to deliver the most effective and safest interventions for their patients, it also requires them to spend more time and resources on areas such as chemotherapeutic intervention, radiation therapy, and surgical procedures. This in turn allows less time to focus on equally important areas such as functional and cognitive deficits before, during, and after treatment. Recognizing the need for a more patient-centered approach, the Commission on Cancer (COC) of the American College of Surgeons has placed a significant emphasis on survivorship care plans. In collaboration with several advocacy groups, such as the American Cancer Society, the Cancer Support Community, the National Coalition for Cancer Survivorship, and LIVESTRONG™, the COC developed cancer program standards in 2012 to help ensure that accredited cancer centers use a more multidisciplinary treatment team to provide patient-centered care for individuals living with cancer.

CARF cancer rehabilitation standards
With a renewed focus on both survivorship and quality of life, the medical community now recognizes that rehabilitation can serve an important role in improving care for the more than 14 million people currently living with cancer. Rehabilitation specialists can provide specialized services, including preventive, restorative, supportive, and palliative, that address both functional and cognitive deficits. This renewed focus allows for new opportunities of growth and clinical development in which the skills and tools commonly used for more traditional rehabilitation populations are now being applied to underserved individuals with significant needs.

CARF International recognized the importance of developing standards for cancer rehabilitation services, both nationally and internationally for this new environment. Under the facilitation of CARF Medical Rehabilitation staff and CARF’s manager of standards, a group of experts convened at CARF headquarters in Tucson, Arizona, to develop standards that would provide a structure for current and future oncology rehabilitation programs to develop service lines that meet the clinical, educational, and administrative needs of their patients. In June 2013, this multidisciplinary group, which included physiatrists; therapists; surveyors; and, most importantly, cancer survivors, developed the preliminary framework by which all cancer rehabilitation programs can be evaluated and compared. These standards, after comprehensive field review, were officially released in CARF’s 2014 Medical Rehabilitation Standards Manual. They allow rehabilitation providers to develop specialized cancer rehabilitation services in a standardized and organized fashion.

Benefits of specialized cancer rehabilitation programs
Although the creation of CARF standards for cancer rehabilitation has greatly advanced program development, several legislative and regulatory initiatives have also furthered growth in oncology rehabilitation. As federal legislation evolves, there is an increasing emphasis on providing efficient care with improved outcomes. However, this creates challenges for complex patient populations such as persons with cancer.

Rehabilitation is uniquely positioned to serve as a resource for healthcare providers and payer sources to provide access to efficient and cost-effective care. For many patients, cancer care requires extended acute care hospital stays and time-intensive chemotherapeutic protocols. For acute care providers, these extended stays and possible readmissions after discharge due to medical co-morbidity may negatively impact both reimbursement and outcomes measures. Inpatient and outpatient rehabilitation programs can help to provide an additional post-acute care resource, which can yield better acute care measures on outcomes and access to care.

When an inpatient rehabilitation program is well integrated with an acute care referral source, patients can transition to the rehabilitation setting more quickly than if they remain in an acute care setting until they are medically cleared for discharge to the home. Thus, patients with significant medical complexities can benefit from intensive rehabilitation therapies while receiving consistent physician and clinical care. This allows individuals to improve their physical functioning, which would likely decrease future potential co-morbidity and improve their functional status for future interventions. The functional status may also improve quality of life, depending on patient goals, and could decrease 30-day hospital readmission rates by mitigating the negative effects from medical co-morbidities. Similar considerations could also be made with coordinated outpatient therapy programs. Individuals who participate in such programs may still be able to receive concurrent chemotherapeutic or radiation interventions, which could allow them to maintain or improve functional status while receiving life-altering treatments and may also allow patients to remain in the home setting so as to decrease hospital utilization rates.

Conclusion
The opportunities for growth and development within cancer rehabilitation are tremendous. The cancer patient population has been underserved regarding rehabilitation options. But, as access is improved, acute oncological and rehabilitation providers are learning the value of collaboration as it relates to patient care and outcomes. Now, due to renewed clinical focus, legislative initiatives, and development of international accreditation standards, opportunities to improve access abound. The field of cancer rehabilitation will continue to be a major focus of the rehabilitation and oncological communities for years to come.

About Carolinas Rehabilitation’s Oncology Rehabilitation Program

Vishwa S. Raj, M.D., associate medical director of Carolinas Rehabilitation and director of cancer rehabilitation, co-authored the CARF standards of care guidelines, which were published in early January 2014.

The oncology rehabilitation program at Carolinas HealthCare System’s Carolinas Rehabilitation received the world’s first accreditation from CARF International, demonstrating the system’s commitment to providing comprehensive, high-quality care for cancer patients throughout their cancer journey.

The partnership between Carolinas Rehabilitation and Levine Cancer Institute brings cancer patients increased access to specialized cancer rehabilitation therapies provided by Dr. Raj and his multidisciplinary team of physiatrists as well as physical, occupational, and speech therapists.

11/6/2014
(Historical Newsletter Articles,Medical Rehabilitation)