Prehabilitation and Rehabilitation Ease the Transition Back to Everyday Life for Cancer Patients
The availability of cancer prehabilitation and rehabilitation is good news for the 14 million cancer survivors in the United States, many of whom say they’ve found it hard to transition to a new way of life when their medical care ended. Through the Memorial Hermann Cancer Network, patients have access to the entire continuum of cancer care: prevention, screening, diagnosis, prehabilitation, treatment, rehabilitation after treatment, and ongoing survivorship support. The network now includes eight Cancer Centers located across the city, along with 19 Breast Care Centers and 11 TIRR Memorial Hermann Rehabilitation Network locations offering support for cancer rehabilitation.
Several factors have converged to create a need for cancer prehabilitation and rehabilitation, including a growing population of cancer patients. Because of education, screening programs and advances in cancer treatment, more patients live longer, and many have multiple functional deficits, ranging from cognitive issues in brain tumor patients to swallowing and eating difficulties in head and neck cancer patients.
“Cancer rehabilitation is emerging as a very important component of Memorial Hermann’s cancer program, with a particular focus on prehabilitation for specific patient populations,” says Carolina Gutiérrez, M.D., a fellowship-trained physiatrist who focuses her practice on cancer rehabilitation at TIRR Memorial Hermann and is a clinical assistant professor at McGovern Medical School at UTHealth.
“As an example, we can help head and neck cancer patients anticipate and prepare for treatment-related challenges to their physical health that may include swallowing, lymphedema, and problems with neck and shoulder movement. For patients with breast cancer, we can help prepare for challenges including fatigue, deconditioning, cognitive changes, neuropathy and lymphedema. The medical literature supports prehabilitation, and our experience has shown that patients who have access to it have much better functional and quality of life outcomes.
The goal of prehabilitation is to prevent or lessen the severity of anticipated treatment-related problems that could lead to later disability. “A comprehensive baseline assessment is critical to creating a successful prehabilitation plan for each patient,” Dr. Gutiérrez says.
“By educating patients on the benefits of a prehabilitation plan we are giving them the opportunity to be active participants in their own cancer care. Early engagement and compliance with their rehabilitation plans can have highly desirable results – fewer deficits after treatment, better outcomes, better function and improved quality of life. We are giving patients the tools and motivation to help preserve function, helping them to become stakeholders in their journey to healing and recovery.”
“Texas Oncology, one of the largest cancer treatment and research providers in Texas, reached out to TIRR Memorial Hermann to provide prehabilitative and rehabilitative care to their patients as part of their Oncology Care Model compliance requirements,” says Anna de Joya, PT, D.Sc., NCS, director of new program development for Memorial Hermann Post Acute-care Services.
Texas Oncology has been selected to participate in the Oncology Care Model (OCM), a new initiative introduced by Centers for Medicare and Medicaid Services (CMS) to improve the effectiveness and efficiency of oncology care. Oncology practices selected to participate in the model have entered into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients, as well as a commitment to enhanced services to Medicare beneficiaries. These services include care coordination, patient navigation, follow-up after treatment, patient education, expanded survivorship programs that include rehabilitation, and advance care planning programs, such as prehabilitation, all of which are designed to enhance the quality of life for cancer survivors.
The goal of cancer prehabilitation is to prevent or lessen the severity of anticipated treatment related problems that could lead to later disability
According to Anna de Joya, “Patients are referred to Dr. Gutiérrez for evaluation, management and development of a comprehensive, personalized cancer rehabilitation care plan. She will make referrals as appropriate for physical therapy, occupational therapy, speech therapy, neuropsychology and other services.”
The goal of cancer prehabilitation is to prevent or lessen the severity of anticipated treatment-related problems that could lead to later disability.
TIRR Memorial Hermann’s cancer prehabilitation and rehabilitation programs support healthy lifestyles as patients continue ongoing surveillance with their oncologists and other specialists.
“After a diagnosis of cancer, patients should be evaluated for any functional needs that arise because of the cancer itself or as a result of treatment,” Dr. Gutiérrez says. “It’s important for physicians who create the plan of care to keep quality of life in mind along with quality of oncological care. For each patient, my role includes performing a functional assessment, investigation of factors underlying any functional deficits, and development of a comprehensive management plan. As part of a team approach, I will involve the expertise of specialized services as needed.”
To help patients and their physicians identify the need for rehabilitation, De Joya has created a self-assessment form for patients. The form includes a list of tasks and offers patients and family members the opportunity to check any problems they have, such as weakness, numbness or tingling, new joint pain, swelling associated with lymphedema, unsteadiness while standing or walking, fatigue during daily tasks, falls, difficulty changing positions in bed, inability to drive, difficulty swallowing, problems with learning and memory, and other issues.
“The self-assessment tool has been well received by physicians at Texas Oncology,” De Joya says. “It helps the oncologist know if the patient is having functional deficits and could benefit from an evaluation by a physiatrist. The physician faxes the form to us, which allows Dr. Gutiérrez and our therapists to see exactly what the patient reported from his or her own perspective.”
Dr. Gutiérrez presented the results of her recent research at the American Society of Clinical Oncology’s Cancer Survivorship Symposium held Jan. 27-28 in San Diego. The research, conducted at TIRR Memorial Hermann, is based on patients who presented for outpatient rehabilitation. The majority of patients represented included those with cancers of the brain, breast, prostate, melanoma, myelofibrosis and multiple myeloma.
“Compared to the U.S. population mean, cancer survivors presenting for a cancer rehabilitation consultation had lower physical health than mental health,” she says. “Our findings suggest the importance of screening cancer survivors for physical impairments and providing interventions focused on functional recovery. In the future we aim to assess the impact of a cancer rehabilitation consultation on patient physical and mental health, including effects on cancer-related symptoms and quality of life.”
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