Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services

Abstract

Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their respective roles in comprehensive oncology care, and highlights how these services can contribute complementary components of essential quality care. An understanding of how cancer rehabilitation and palliative care are aligned in goal setting, but distinct in approach may help facilitate earlier integration of both into the oncology care continuum-supporting efforts to improve physical, psychological, cognitive, functional, and quality of life outcomes in patients and survivors.

Physical Therapy in Patients with Cancer

“…In general, physical therapy helps to maintain mobility and improves body movements [7,107]. Physical therapists improve locomotion ability by exercises that include standing and walking, massage, manual stretching, strengthening, resisted exercises, aerobic exercises, patient education, and behavioral training.…”

“…Physical therapists often use four cancer rehabilitation stages and identify the stage before physical therapy for cancer patients ( Table 2) [7]. There are diferent approaches for therapy of cancer patients during each stage.…”

Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

“…[21][22][23] Rehabilitation professionals are an optimal addition to the cancer care team and offer expertise in functional assessment, morbidity management, and disability prevention. 24 Accumulating clinical evidence suggests that rehabilitation interventions are effective before, during, and after cancer treatment to screen for, assess, and treat patients' functional needs. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] Although mounting evidence suggests strong benefit from the integration of rehabilitation into the cancer continuum, 39,40 there is uncertainty around the critical components of a model for cancer rehabilitation.…”

Cancer rehabilitation and palliative care—two important parts of comprehensive cancer care

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In this issue of Supportive Care in Cancer, Julie K. Silver et al focus on cancer rehabilitation and palliative care delineating their respective roles in comprehensive oncology care [1]. The authors describe how cancer rehabilitation and palliative care are quite similar in goal setting, namely to improve physical, cognitive, psychological, and social aspects of quality of life in cancer patients-both specialties prioritizing goalconcordant care through identification of patient and family preferences and values.

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“…The authors describe how cancer rehabilitation and palliative care are quite similar in goal setting, namely to improve physical, cognitive, psychological, and social aspects of quality of life in cancer patients-both specialties prioritizing goalconcordant care through identification of patient and family preferences and values. So both-cancer rehabilitation and palliative care-are able to improve cancer-related symptoms or cancer treatment-related side effects leading not only to (1) improve quality of life of cancer patients and cancer survivors but also to (2) improve healthcare efficiencies. As palliative care is, cancer rehabilitation is an interdisciplinary team process and an individually planned targeted process with the patient and family as active members within the team.…”