Advancing Pediatric Oncology Rehabilitation: Survey Findings of Health Professionals’ Perceptions of Barriers to Care and a Framework for Action

Abstract

Purpose: To explore pediatric oncology referral practices, gather healthcare providers’ perspectives of barriers to access and provision of rehabilitation service across Canada, and inform a framework for action to optimize rehabilitation care and inform future research. Methods: A cross-sectional survey was conducted with Canadian healthcare professionals (HCPs) working in pediatric oncology. Results: A total of 54 responses were received, and 34 corresponded to HCPs who refer children with cancer to rehabilitation services. Results suggest that approximately 25% of children are referred to rehabilitation services, primarily when the child presents with, or is at risk of, significant functional disability due to surgery. A primary barrier to service provision identified across HCPs included a lack of funding and resources. Medical professionals further identified a lack of specialized pediatric oncology rehabilitation services, whereas rehabilitation professionals identified the lack of pediatric oncology specific space and equipment. Identified themes from open-ended survey questions include the need for (1) dedicated funding and resources, (2) improved access, and (3) the need for specialized pediatric oncology rehabilitation services. Conclusion: Several barriers exist in the Canadian healthcare context that impact the delivery of rehabilitation services for children with cancer. We propose a framework for action to advance clinical care and guide future research.

Implementation of physical rehabilitation programs for children with cancer across low‐ and middle‐income countries: A need of the hour perspective

“…Childhood cancer care in recent times has evolved to better advanced therapeutic regimens alongside improved supportive care lowering upsurged mortality rates over five decades 1 . Although accessibility to medical measures including pharmacotherapy, bone marrow transplantation, surgical‐palliative care strategies, and behavioral counseling is better in high‐income countries (HICs), barriers toward childhood cancer rehabilitation exist in both low‐ and high‐resource settings in these countries 2–6 . Spanning the cancer trajectory, a global estimate study 7 on childhood and adolescent cancers reports data estimates from five international World Health Organization (WHO)‐recognized research programs including International Incidence of Childhood Cancer, Third Edition (IICC‐3), 8 Global Cancer Observatory (GLOBOCAN), 9 Global Burden of Disease Study (GBD) 2016, 10 SurvCan, 11 and CONCORD (CONCORD‐3) 12 .…”

“…Greater than 90% of children from low‐ and middle‐income countries (LMICs) have reported to be at a greater risk of developing childhood cancers when compared to HICs 7,13 . In addition, a dearth of childhood cancer registries with unstructured data availability and limited access to essential cancer‐care facilities would result in lower hospital or day care admissions, further leading to lesser accessibility to physical rehabilitation (PR) services 6,7 . Scarce resources and affordable medical services promulgate the incidence, morbidity, or mortality of childhood cancers 14,15 .…”

“…1 Although accessibility to medical measures including pharmacotherapy, bone marrow transplantation, surgical-palliative care strategies, and behavioral counseling is better in high-income countries (HICs), barriers toward childhood cancer rehabilitation exist in both low-and high-resource settings in these countries. [2][3][4][5][6] Spanning the cancer trajectory, a global estimate study 7 on childhood and adolescent cancers reports data estimates from five international World Health Organization (WHO)-recognized research programs including International Incidence of Childhood Cancer, Third Edition (IICC-3), 8 Global Cancer Observatory (GLOBOCAN), 9 Global Burden of Disease Study (GBD) 2016, 10 SurvCan, 11 and CONCORD (CONCORD-3). 12 Greater than 90% of children from low-and middle-income countries (LMICs) have reported to be at a greater risk of developing childhood cancers when compared to HICs.…”

“…7,13 In addition, a dearth of childhood cancer registries with unstructured data availability and limited access to essential cancer-care facilities would result in lower hospital or day care admissions, further leading to lesser accessibility to physical rehabilitation (PR) services. 6,7 Scarce resources and affordable medical services promulgate the incidence, morbidity, or mortality of childhood cancers. 14,15 The global burden of childhood cancer analysis study Abbreviations: DALYs, disability adjusted life years; GBD, Global Burden of Disease; HICs, high-income countries; HRQoL, health-related quality of life; LMICs, low-and middle-income countries; MI, Mortality Index; PR, physical rehabilitation.…”

“…26 Consequential morbidities affect families who cannot avail benefits due to (a) unfamiliarity of PR services provided at wellequipped comprehensive cancer care centers; (b) scarce utilization of these services as a mandate during standard care; or (c) limited availability of concrete infrastructural resources at cancer care centers, inadequate referrals and qualified rehabilitation personnel. [4][5][6]27 Cancer treatment programs require a resilient multidisciplinary team to address an array of physical, psychological, and social problems confronted by children or adolescents during therapy, convalescence, and as survivors. 28,29 Likewise, the LMIC income strata may have varied sociocultural beliefs related to participation in cancer therapy, exercise programs, peer group activities, restriction, and isolation.…”