There has been a lot more discussion about cancer rehabilitation in recent years but what exactly is it? Why is it being increasingly recognised as a necessary part of care? Why is there now a huge opportunity for Ireland to lead the way in enshrining cancer rehabilitation as an integral part on the care pathway of all people with cancer?
What is cancer rehabilitation?
The primary aim of rehabilitation is to enhance and restore functional ability and quality of life to people with physical impairment or disability. In the case of people living with and beyond cancer, the role of cancer rehabilitation is to address impairments caused by the cancer or the treatment of the cancer. These are many – for example, chemotherapy-induced peripheral neuropathy, fatigue, joint pain, problems with balance, cognitive impairment (or ‘chemobrain’), lymphoedema, incontinence, difficulty returning to work and many, many more. As advocated by the STAR Programme (the best practices model of cancer rehab care in the US), dual screening is the most effective means of identifying which patients require referral to appropriate cancer rehabilitation services. Dual screening is the process of screening for both physical and psychological impairment. A fully comprehensive cancer rehabilitation team will consist of a physiotherapist, occupational therapist and speech & language therapist with support from a dietitian, clinical psychologist, psychosexual counsellor, lymphoedema therapist, nurse continence advisor, smoking cessation counsellor, social worker, vocational counsellor and pharmacist. Access to a Rehabilitation Medicine Consultant, where available, is also beneficial. All staff on the cancer rehabilitation team should have a thorough understanding of the specific needs of people living with and beyond cancer.
Why the growing interest in cancer rehabilitation?
In 2005, the Institute of Medicine (IOM) in the US released a seminal report on cancer survivorship - From Cancer Patient to Cancer Survivor: Lost in Transition. The report advocated for the establishment of Cancer Survivorship as a distinct phase of care. It highlights the medical, functional and psychosocial consequences of cancer and the treatment of cancer. Since its publication it has helped define the components of high quality healthcare for people living with and beyond cancer. Cancer rehabilitation was identified as an essential part of survivorship care. The Commission on Cancer (CoC) has mandated that all CoC-accredited facilities in the US must ensure access to comprehensive cancer rehabilitation services, either on-site or by referral. They have also mandated that each patient must be screened for distress at least once throughout their care with referral to appropriate psychosocial support services, as required. It should, however, be acknowledged that a significant cause of psychosocial distress is the presence of physical impairment or disability and so many are also advocating for the widespread implementation of dual screening – that is, screening for physical impairment as well as psychosocial distress, with referral to a comprehensive rehabilitation team when appropriate. The growing body of evidence in the area of cancer rehabilitation is also driving development of services. Cancer rehabilitation is increasingly being recognised as being capable of improving function and quality of life of the cancer survivor as well as adding efficiencies to the health system in many circumstances. For example, prehabilitation (interventions in anticipation of acute cancer therapy) in people with lung and oesophageal cancer has been shown to reduce both hospital length of stay and readmission rate.
Why is there now an opportunity for the Irish healthcare system to lead the way?
In Ireland, the National Cancer Strategy for 2016-2025 is currently under development. This document will be the blueprint for how cancer services in Ireland will develop over the next 10 years. The last National Cancer Strategy was published in 2006 and this document did not mention the words rehabilitation or survivorship and as a result Ireland has been playing catch-up with the development of such services. There is now an opportunity for the roadmap to cancer services in Ireland to place a true emphasis on function and quality of life in people living with and beyond cancer. There is an opportunity for Ireland to be very clear that we not only want to have the highest standards of acute oncology care but that we want to ensure the best cancer outcomes on every level – including function and quality of life. From discussions with many Irish professionals working in the area of oncology, it is clear that there is currently a deficit in these services but a growing professional recognition of the value of accessing them. From speaking to people who have lived with cancer in Ireland it is clear that they want these services. They deserve to have access to these services. They need these services. Internationally, a sharp focus has been placed on cancer rehabilitation and survivorship. In Ireland, the National Cancer Strategy 2016-2025 needs to place the same priority on development of such services for people living with and beyond cancer. This is an opportunity for Ireland to become an exemplar internationally of the highest quality of cancer care. Cancer rehabilitation needs to become an integral part on the continuum of care of each and every Irish person with a cancer diagnosis. Waiting another 10 years for these services isn’t an option for many.
Dr. Chris McBrearty is the Founder and CEO of Strive Clinic, a comprehensive outpatient rehabilitation facility that will launch in 2016. This blog was originally posted on LinkedIn in July 2015.