Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment plans aimed at improving recovery time in patients following surgery using a multidisciplinary team approach. These protocols have been shown to optimize pain control, improve mobility, and decrease postoperative ileus and other surgical complications, thereby leading to a reduction in length of stay and readmission rates. To date, no ERAS-based protocols have been developed specifically for pediatric patients undergoing oncologic surgery. Our objective is to describe the development of a novel protocol for pediatric, adolescent, and young adult surgical oncology patients. Our protocol includes the following components: preoperative counseling, optimization of nutrition status, minimization of opioids, meticulous titration of fluids, and early mobilization. We describe the planning and implementation challenges and the successes of our protocol. The effectiveness of our program in improving perioperative outcomes in this surgical population could lead to the adaptation of such protocols for similar populations at other centers and would lend support to the use of ERAS in the pediatric population overall.
81 Background: Up to 20% of childhood cancer survivors suffer from a significant physical function impairment due to cancer or cancer treatment. Early intervention with Occupational Therapy (OT) and Physical Therapy (PT) increases engagement in personal care, leisure interests, school-based tasks, return to work, and prevents cognitive decline. Despite this, less than 30% of childhood cancer survivors receive PT services. To date, facilitators and barriers to implementing cancer rehabilitation (CR) for pediatric cancer survivors have not been adequately explored. Thus, the aim of this research was to identify system-level barriers and facilitators to CR delivery based on surveys completed by hospital administrators, oncology physicians, advanced practice providers, and OT/PT therapists. Methods: A cross-sectional method was employed. Three previously published cardiac rehabilitation delivery instruments specific for administrators, OT/PT therapists and clinical providers respectively were adapted to evaluate CR delivery. All surveys used a 5-point Likert-type response format (e.g., 1 = strongly disagree to 5 = strongly agree). Surveys ranged from 12 items (therapist survey) to 23 items (administrator survey). Questions pertained to knowledge, attitudes, and perceptions regarding CR. Results: A total of 20 administrators (mean age, 49.95 years old, 65% non-Hispanic White, 65% female), 20 providers (mean age, 43.4 years old, 71.4% non-Hispanic White, 67% female), and 20 therapists (mean age, 38.3 years old, 70% non-Hispanic white, 84% female) completed surveys. Administrators’ results indicated mid-range CR knowledge (median: 3.5; IQR 2,5), and all perceived CR as important or extremely important to outpatient care (median: 5; IQR 4,5). Limited insurance coverage and lack of space were the top barriers identified by administrators. Eighty percent of providers endorsed that clinical practice guidelines promote CR referral (median 4; IQR 4,5) and none reported being skeptical of CR benefits. Provider-identified barriers included an inconvenient referral process, lack of CR patient-education materials, and inadequate information on external CR resources. Therapists identified rate of absenteeism and referral rates as barriers to CR. Ninety percent of therapists reported hybrid CR delivery (supervised and unsupervised exercise) could facilitate CR participation (median 4; IQR 4,4). Conclusions: System-wide, there was adequate knowledge and positive perceptions and attitudes regarding CR. However, we identified multiple barriers presenting opportunities for multilevel interventions. These included: insurance coverage advocacy, streamlining referral processes to CR services, providing information on external CR programs, providing patient education materials, and leveraging hybrid CR delivery to optimize participation.
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