Creating Better Systems for Cancer Rehab Care Coordination

cherylGuarna_framedsmThe more I talk to cancer survivors and hear their stories, the more I believe the it is imperative we put in place guidelines for increasing cancer rehab referrals and improving care coordination. Survivors tell me that it is a huge burden to attend the multitude of appointment and tests associated with cancer treatment. Adding yet another appointment to the already packed calendar, while trying to maintain a sense of normalcy and tend to family and work obligation, seems all but impossible. But my sense is that survivors often view rehab as secondary to other treatments, and I wonder if that isn’t, at least in part, because their physicians don’t include cancer rehab on the list of treatment priorities. During a recent casual conversation with a survivor friend, she  said one doctor told her to “just keep doing what you’re doing.”  Other doctors routinely turn to rehab for their patients.  Why this drastic disparity?

There are a few reasons why there is such fragmentation when it comes to cancer rehab referrals.

  • A lack of knowledge about cancer rehab and its availability.

  • No systematic screening for rehab currently in place.

  • Not enough cancer care coordination support for already overburdened patients and their families.

The Commission on Cancer

There is movement in the right direction, though. The Commission on Cancer (CoC), a consortium of professional organizations that sets standards with the intention of improving survival and quality of life for cancer patients, has developed Cancer Survivorship Care Plans with mandated guidelines in order to improve the delivery of cancer care in CoC-accredited facilities. Three areas of patient-centered treatment in the CoC standards include:

  1. A patient navigation process to address healthcare disparities and barriers to care.

  2. Screening patients for psychosocial distress.

  3. A survivorship care plan that documents care received and seeks to improve cancer survivors’ quality of life.

These guidelines ensure access to rehabilitation services and identifies the rehabilitative services that are provided either on-site or by referral.

The Rehab Community at Work

Although the Standards of Care are for those seeking CoC accreditation, there are numerous organizations working to establish screening and assessment tools for physicians and cancer rehab clinicians. Cancer facilities and cancer rehab practices are developing, implementing and continually improving screening, referral and  surveillance tools  to minimize cancer rehab care fragmentation. Many of these tools require self-assessment, so patient education is key.

Oncology Rehab and Wellness Resource offers:

  • Pre-surgical Screening for baseline measures, patient education.

  • Pre-treatment screenings and consultations- baseline measures, education on possible side effects, recommendations on ongoing activity levels while you are in treatment.

  • Patient education on cancer related impairments to improve self detection of problems early on.

  • Increased patient education to help patients understand that most impairments are treatable.

  • Interventions during cancer treatment to maintain cardiorespiratory fitness, combat cancer related fatigue, and decrease the potential for deconditioning that is all too common in cancer patients and directly impacts quality of life.

  • Post-surgical and post-treatment evaluations to determine the impact of cancer treatments.

  • Screening tools to detect the onset of problems early on, such as lymphedema, joint restriction, scar adhesions, weakness and balance impairments.

  • Structured follow up assessments at pre-determined intervals to monitor for potential problems.

  • Post-surgical and post-treatment therapy interventions to address any impairments or deconditioning.

  • Post-rehab or post-cancer treatment fitness assessments and exercise programs developed by, and under the guidance of, Cancer Exercise Specialists.

The Importance of (Good) Communication

I am not sure why some physicians are so reluctant to incorporate rehab assessments while others are so proactive. I do know that trivializing a patient’s concerns about secondary conditions leads to a serious decline in patient/doctor communications and, ultimately, negatively impacts quality of life. We know that increasing awareness of cancer signs and symptoms leads to early detection and treatment and, thus, better outcomes. It makes sense that early detection and treatment of cancer related physical impairments also creates better outcomes. Although cancer rehab was first introduce in the 1970s, only recently has it become an integral part of the cancer care continuum. We need to step up education and awareness so it is an option for every survivor.

If you have questions or comments about this or previous blog posts, please contact Cheryl Guarna at (703) 789-0367 or email