Oncologists' and Physiatrists' Attitudes Regarding Rehabilitation for Patients With Advanced Cancer

Spill, Gayle R.; Hlubocky, Fay J.; Daugherty, Christopher K.

doi:10.1016/j.pmrj.2011.08.539

Cited by 39 publications

(45 citation statements)

References 42 publications

(43 reference statements)

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“…In our study, providers' perceptions of their AYA patients' distress, evaluated in a subsample of the study population, revealed no correlation between provider perceptions and patient survey results. These results, though obtained from a small subset of providers from a single institution, are consistent with prior research asking similar questions in different populations . For example, a recent review by Gouveia et al focused on this issue with respect to the difficulty that oncologists and other providers have in accurately detecting depressive and other psychological symptoms.…”

Section: Discussionsupporting

confidence: 85%

Psychological morbidities in adolescent and young adult blood cancer patients during curative‐intent therapy and early survivorship

Muffly

Hlubocky

Khan

et al. 2016

Cancer

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BACKGROUND: Adolescents and young adults (AYAs) with cancer face unique psychosocial challenges. This pilot study was aimed at describing the prevalence of psychological morbidities among AYAs with hematologic malignancies during curative-intent therapy and early survivorship and at examining provider perceptions of psychological morbidities in their AYA patients. METHODS: Patients aged 15 to 39 years with acute leukemia, non-Hodgkin lymphoma, or Hodgkin lymphoma who were undergoing curative-intent therapy (on-treatment group) or were in remission within 2 years of therapy completion (early survivors) underwent a semistructured interview that incorporated measures of anxiety, depression, and posttraumatic stress (PTS). A subset of providers (n 5 15) concomitantly completed a survey for each of the first 30 patients enrolled that evaluated their perception of each subject's anxiety, depression, and PTS. RESULTS: Sixty-one of 77 eligible AYAs participated. The median age at diagnosis was 26 years (range, 15-39 years), 64% were male, and 59% were non-Hispanic white. On-treatment demographics differed significantly from early-survivor demographics only in the median time from diagnosis to interview. Among the 61 evaluable AYAs, 23% met the criteria for anxiety, 28% met the criteria for depression, and 13% met the criteria for PTS; 46% demonstrated PTS symptomatology. Thirty-nine percent were impaired in 1 or more psychological domains. Psychological impairments were as frequent among early survivors as AYAs on treatment. Provider perceptions did not significantly correlate with patient survey results. CONCLUSIONS: AYAs with hematologic malignancies experience substantial psychological morbidities while they are undergoing therapy and during early survivorship, with more than one-third of the patients included in this study meeting the criteria for anxiety, depression, or traumatic stress. This psychological burden may not be accurately identified by their oncology providers. Cancer 2016;122:954-61. V C 2016 American Cancer Society.KEYWORDS: acute leukemia, adolescent and young adult, distress, lymphoma, psycho-oncology, psychosocial oncology, survivorship. INTRODUCTIONAdolescent and young adult oncology (AYAO) is an expanding field that encompasses the epidemiology, biology, therapeutic approaches, and supportive-care needs of adolescents and young adults (AYAs) with cancer. In addition to exploring host and disease-related characteristics of AYAs, there is particular interest in studying the experience of the AYA cancer patient. 1 Emerging literature has described the effect of cancer on specific psychosocial domains recognized as being of great relevance to AYAs, such as fertility, life adjustment, relationships, financial burdens, and employment. 2 However, less is known about the overall psychological effect of cancer itself on the AYA population.The transition from adolescence into young adulthood is associated with increasing autonomy and self-identity formation, and it is often identified as a vulnerable time...

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Section: Discussionsupporting

confidence: 85%

Psychological morbidities in adolescent and young adult blood cancer patients during curative‐intent therapy and early survivorship

Muffly

Hlubocky

Khan

et al. 2016

Cancer

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“…Despite this, most palliative care and hospice programs disregard physical performance while evaluating quality of life (QOL).” Eyigor suggested several possible reasons for this deficit, including a lack of knowledge or education about the benefits of rehabilitation in this population, a limited supply of physiatrists familiar with patients with advanced cancer, and oncologists not directing patients to rehabilitation. Eyigor recommended, “Including physiatrists in the overall plan for palliative care is likely to increase the success of general treatment in addition to patient‐family satisfaction.” In a survey study by Spill et al evaluating oncologists' and physiatrists' attitudes regarding rehabilitation for patients with advanced cancer, the researchers mailed out 820 surveys and received responses from 395 physicians (response rate of 48%) . Both groups had similar attitudes about care in many respects, but one area where they differed was with regard to rehabilitation services for patients with advanced cancer regardless of prognosis.…”

Section: Cancer Rehabilitation and The Care Continuummentioning

confidence: 99%

Impairment‐driven cancer rehabilitation: An essential component of quality care and survivorship

Silver

Baima

Mayer

2013

CA A Cancer J Clinicians

345

259

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Adult cancer survivors suffer an extremely diverse and complex set of impairments, affecting virtually every organ system. Both physical and psychological impairments may contribute to a decreased health-related quality of life and should be identified throughout the care continuum. Recent evidence suggests that more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones. Research has also demonstrated that the majority of cancer survivors will have significant impairments and that these often go undetected and/or untreated, and consequently may result in disability. Furthermore, physical disability is a leading cause of distress in this population. The scientific literature has shown that rehabilitation improves pain, function, and quality of life in cancer survivors. In fact, rehabilitation efforts can ameliorate physical (including cognitive) impairments at every stage along the course of treatment. This includes prehabilitation before cancer treatment commences and multimodal interdisciplinary rehabilitation during and after acute cancer treatment. Rehabilitation appears to be cost-effective and may reduce both direct and indirect health care costs, thereby reducing the enormous financial burden of cancer. Therefore, it is critical that survivors are screened for both psychological and physical impairments and then referred appropriately to trained rehabilitation health care professionals. This review suggests an impairment-driven cancer rehabilitation model that includes screening and treating impairments all along the care continuum in order to minimize disability and maximize quality of life.

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“…Although cancer rehabilitation is considered an important part of physical medicine and rehabilitation (PM&R) residency education, research has demonstrated that the quality and quantity of experiences may be improved [45]. Furthermore, variability exists regarding perceived appropriateness of rehabilitation for individuals with advanced cancer by both medical oncologists and physiatrists [84]. Consideration of these issues may help explain why many oncologists feel inadequately prepared for supportive care tasks [85].…”

Section: Advancing Collaborative Interdisciplinary Care Coordinationmentioning

confidence: 99%

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

Silver

Raj

et al. 2015

Support Care Cancer

175

112

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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.

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Oncologists' and Physiatrists' Attitudes Regarding Rehabilitation for Patients With Advanced Cancer

Cited by 39 publications

References 42 publications

Psychological morbidities in adolescent and young adult blood cancer patients during curative‐intent therapy and early survivorship

Psychological morbidities in adolescent and young adult blood cancer patients during curative‐intent therapy and early survivorship

Impairment‐driven cancer rehabilitation: An essential component of quality care and survivorship

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

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