Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
MinnesotaCancerPlanUpdate:SurvivorshipWorkGroup IssueAnalysis Issue#3:CancerRehabilitationandPhysicalImpairmentfromcancertreatment ISSUESTATEMENT&RATIONALE/EVIDENCEBASEDRESEARCH: Physicalimpairmentsaftercancertreatmentincreasedistress,morbidityandmortality.Targeted,cancer-specificphysicalrehabilitationand cancer-specificexercisehasbeenshowntoreducephysicalfrailty,reducedisability,lengthensurvivalandimprovequalityoflifeincancer survivors.Partofrequireddistressscreeningistheimperativetoutilizequalifiedprofessionalstoaddressthedistresscausedbyphysical impairmentsimposedbycancer.Researchhasshownthatcancersurvivorsarenotbeingreferredforexistingrehabilitationandcancerexercise servicesandthattherearenotenoughqualifiedrehabilitationprofessionalsandcancerexercisespecialiststomeettheneedsoftheincreasing numbersofcancersurvivors,particularlywithincreasingelderlyandfrailsurvivors.Additionally,minoritypopulationsandpopulationswhodo notaccesstraditionalmedicalservicesareexcludedfromthiscare. • • “CancerRehabilitationismedicalcarethatshouldbeintegratedthroughouttheoncologycarecontinuumanddeliveredbytrainedrehabilitation professionalswhohaveitwithintheirscopeofpracticetodiagnoseandtreatpatients’physical,psychological,cognitiveandfunctional impairmentsinanefforttomaintainorrestorefunction,reducesymptomburden,maximizeindependenceandimprovequalityoflifeinthis medicallycomplexpopulation.”SilverJK,RajVS,FuJB,WisotzkyEM,SmithSR,KirchRA.Cancerrehabilitationandpalliativecare:criticalcomponentsinthe deliveryofhigh-qualityoncologyservices.SupportCareCancer.2015Dec;23(12):3633-43. Cancertreatmentinducesastateofphysicalimpairmentthatcanleadtopoortreatmentoutcomesthatcouldbeamelioratedwithrehabilitation. Jack,S.Theeffectofneoadjuvantchemotherapyonphysicalfitnessandsurvivalinpatientsundergoingoesophagogastriccancersurgery.EJSOxx(2014)1e8.Kilgour R.Handgripstrengthpredictssurvivalandisassociatedwithmarkersofclinicalandfunctionaloutcomesinadvancedcancerpatients.SupportCareCancer(2013) 21:3261–3270.Koelwyn,G.RunningonEmpty:CardiovascularReserveCapacityandLateEffectsofTherapyinCancerSurvivorship.JournalofClinicalOncology,Vol 30,No36(December20),2012:pp4458-4461.Okumura,S.Impactofpreoperativequalityaswellasquantityofskeletalmuscleonsurvivalafterresectionof pancreaticcancer2015.Surgery.doi.org/10.1016/j.surg.2015.02.002.Silver,Jet.ImpairmentDrivenCancerRehabilitation:anessentialcomponentofqualitycare andsurvivorship.CACancerJ2013May17.doi:10.1002/caac.21186. • Distressincancersurvivorsishighlycorrelatedwithphysicallimitationsimposedbycancertreatment.Bornbaum,K.Adescriptiveanalysisofthe relationshipbetweenqualityoflifeanddistressinindividualswithheadandneckcancer.SupportCareCancer.2011.DOI10.1007/s00520-011-1326.Pentinnen,H. QoLandPhysicalperformanceandactivityofbreastcancerpatientsafteradjuvanttreatment.Psycho-Oncology2011.20:1211–1220.Banks,E.Ispsychological distressinpeoplelivingwithcancerrelatedtothefactofdiagnosis,currenttreatmentorlevelofdisability?FindingsfromalargeAustralianstudy.MJA2010;193: S62–S67.Holm,L.Influenceofcomorbidityoncancerpatients’rehabneeds,participationinrehabactivitiesandunmetneeds:apopulation-basedcohortstudy. SupportCareCancer2014.22:2095-2105.Hayes,SLymphedemaAfterBreastCancer:Incidence,RiskFactors,andEffectonUpperBodyFunction.2008JClinOncol28, 3536-3542 • 25%ofcancersurvivorshavepoorphysicalhealthand10%havepoormentalhealthcomparedwith10%and6%ofadultswithoutahistoryof cancerrespectively.Weaver,K.MentalandPhysicalHealth-RelatedQualityofLifeamongUSCancerSurvivors:PopulationEstimatesfromthe2010NationalHealth InterviewSurvey.CancerEpidemiolBiomarkersPrev;2012.21(11);2108-1. • Inspiteofresearchshowingrehabilitationimprovesfunctionaloutcomes,cancersurvivorsreceivefewreferralstoqualifiedrehabilitation professionalsrelativetotheburdenofremediablephysicalimpairment.Cheville,A.Thedetectionandtreatmentofcancer-relatedfunctionalproblemsinan MinnesotaCancerPlanUpdate:SurvivorshipWorkGroup IssueAnalysis outpatientsetting”SupportiveCareinCancer.2009Jan;17(1):61.Cheville,A.AnExaminationoftheCausesfortheUnderutilizationofRehabilitationServicesAmong PeoplewithAdvancedCancer.AmJPhysMedRehabil2011;90(suppl):S27YS37.Cheville,A,etal.Prevalenceandtreatmentpatternsofphysicalimpairmentsin patientswithmetastaticbreastcancer.2008JClinOnc.26(16):2621-9.Cheville,A.BarrierstoRehabilitationFollowingSurgeryforPrimaryBreastCancer.JSurg Oncol2007;95:409-18.Thorsen,Letal.CancerPatientsNeedsforRehabilitationServices.ACTAOncologica.201150:212-222.Vargo,M.TheOncologyRehabilitationInterface:bettersystemsneeded.JClinicalOncol.2008.(16)2610.SpillGR,HlubockyFJ,DaughertyCK(2012)Oncologists’andphysiatrists’attitudes regardingrehabilitationforpatientswithadvancedcancer.PMR4(2):96–108.PergolottiM,(2015)Theprevalenceofpotentiallymodifiablefunctionaldeficitsandthe subsequentuseofoccupationalandphysicaltherapybyolderadultswithcancer.JGeriatrOncol.doi:10.1016/j.jgo.2015.01.004.SalakariMREffectofrehabilitation amongpatientswithadvancedcancer:asystematicreview.(2015)ActaOncol54(5):618–628.ChevilleAL,Roleofrehabilitationmedicineandphysicalagentsinthe treatmentofcancer-associatedpain.JClinOncol(2014)32(16):1691–1702. • Medicalfrailtyanduntreatedphysicalimpairmentincancersurvivorsincreasesthecostofcare,institutionalization,caregiverburden, hospitalizations,inabilitytoreturntoworkanddistress.Thisisaloomingcrisisincancercarethatmustbeaddressed.Winters-Stone,K.Preventing FrailtyinOlderCancerSurvivors.TopicsinGeriatricRehabilitation.2015.31(4),241-245.Schmitz,Ketal.Theintersectionofcancerandageing:establishingtheneed forbreastcancerrehabilitation.2007.CancerEpidemiologyBiomarkersandPrevention.2007;16:866-872.Hoppe,S.FunctionalDeclineinOlderpatientsreceiving firstlinechemotherapy.2013.JClinOncol.31;3877-3882.Bentley,Jetal.Functionalstatus,life-spacemobility,andqualityoflife:alongitudinalmediationanalysis. QualLifeRes.2013September;22(7):1621–1632.Cetal.OlderPeople’sQualityofLife(OPQOL)scoresandadversehealthoutcomes.HealthandQualityofLife Outcomes2011,9:72.Prado,CM.SarcopeniaandPhysicalFunctioninOverweightPatientswithAdvancedCancer.Canadianjournalofdieteticpracticeandresearch (2013)74(2):69.Silver,J.CancerRehabilitationmayimprovefunctionincancersurvivorsanddecreasetheeconomicburdenofcancertoindividualsandsociety. Work.(2013)46(4):455-72.PearceAM,Productivitylossesassociatedwithheadandneckcancerusingthehumancapitalandfrictioncostapproaches.ApplHealth EconHealthPolicy.(2015)doi:10.1007/s40258-015-0155-8 • AnadequateworkforceofPhysicalMedicineandRehabilitationspecialistswithexpertiseincancerrehabilitationisnecessarytomeettheneeds forfuturecancersurvivorsinMinnesota.Alfano,Cetal.CancerSurvivorshipandCancerRehabilitation:RevitalizingtheLink.JournalofClinicalOncology.2012. 30:9.904-906.ChevilleAL(2014)Postacutecare:reasonsforitsgrowthandaproposalforitscontrolthroughtheearlydetection,treatment,andpreventionof hospital-acquireddisability.ArchPhysMedRehabil95(11):1997–1999.NationalInstitutesofHealthClinicalCenter(2015)Cancerrehabilitationconference http://www.cc.nih.gov/rmd/crc/presentations.html.MukaiAThefutureofphysiatry:withchallengescomeopportunities.2011.PMR3(3):189–192.RajVSCancer rehabilitationeducationduringphysicalmedicineandrehabilitationresidency:preliminarydataregardingthequalityandquantityofexperiences.(2014)AmJPhys MedRehabil.doi:10.1097/PHM.0000000000000060.SmithSR,Cancersurvivorship:agrowingroleforphysiatriccare.(2014)PMR.doi:10.1016/j.pmrj.2014.12.004 • Exerciseforcancersurvivorsrequiresspecificexerciseprescriptionsfromqualifiedprofessionalsinrehabilitationandcancerexercisephysiology whoareabletoevaluatesafetyandcomorbitiesbeforeprescribingcorrectindividualexerciseprotocolforsurvivorship.LakoskiSG.Exercise rehabilitationinpatientswithcancer.NatRevClinOncol.2012;9(5):288–96.Sasso,JP.Aframeworkforprescriptioninexerciseoncologyresearch.JCachexia, Sarcopenia,Muscle.(2015)6:115-124.Brown,J.Theprescriptionorproscriptionofexerciseincolorectalcancercare.MedSciSportsEx.(2014)46(12):2202-2209. Betof,A.Effectsandpotentialmechanismsofexercisetrainingoncancerprogression:atranslationalperspective.BrainBehavImmun.(2013)30(0):S75S87.Midtgaard,J.Efficacyofmultimodalexercise-basedrehabilitationonphysicalactivity,cardiorespiratoryfitness,andpatientreportedoutcomesincancer survivors:arandomized,controlledtrial.(2013)AnnalsofOncology.24:2267-2273.Brown,J.Developmentofarisk-screeningtoolforcancersurvivorstoparticipate inunsupervisedmoderatetovigorous-intensityexercise:resultsfromasurveystudy.(2015)PMR.7:113-122.Campbell,K.Reviewofexercisestudiesinbreastcancer survivors:attentiontoprinciplesofexercisetraining.(2012)BrJSportsMed.46:909-916.Martin,E.Higherintensityexercisehelpscancersurvivorsremainmotivated.J CaSurvivorship(2016)10(3):524-533.Devin,J.Theinfluenceofhigh-intensitycomparedwithmoderateintensityexercisetrainingoncardiorespiratoryfitnessand bodycompositionincolorectalcancersurvivors:arandomizedcontrolledtrial.JCaSurvivorship(2016)10(3):467-479.Jones,LW.PrecisionOncology:Frameworkfor investigationofexerciseastreatmentforcancer.(2015)JClinOncol33:1-4.Schmitz,K.ConsensusStatement:AmericanCollegeofSportsMedicineRoundtableon MinnesotaCancerPlanUpdate:SurvivorshipWorkGroup IssueAnalysis ExerciseGuidelinesforCancerSurvivors.(2010)MedSciSportsEx1409-1426.Wolin,K.ImplementingtheExerciseGuidelinesforCancerSurvivors.(2012)JSupport Oncol.10(5):171-177 • Currentmodelsofmedicalcare,paymentsystemsandinaccuratecoveragedeterminationsworkagainsttheclinicalintegrationofeffective rehabilitationintooncologytothedetrimentofpatientoutcomes,healthandwellnessaftercancertreatment.Minnesotaneedstobeatthe forefrontofresearchandpolicydevelopmentthatfacilitateseffective,coveredrehabilitationcareforMinnesotacancersurvivors.Round,J.Acostutilityanalysisofarehabilitationserviceforpeoplelivingwithandbeyondcancer.BMCHealthServRes.2014.14(1):558.InstituteofMedicine(2013)Deliveringhighqualitycancercare:chartinganewcourseforasystemincrisis.NationalAcademiesPress,Washington,DC.StubblefieldMD.Currentperspectivesandemerging issuesoncancerrehabilitation.Cancer2013.119(Suppl11):2170–2178.MewesJCEffectivenessofmultidimensionalcancersurvivorrehabilitationandcosteffectivenessofcancerrehabilitationingeneral:asystematicreview.Oncologist(2012)17(12):1581–1593.PalacioA,Oncologyandphysicalmedicineand rehabilitation.AnnPhysRehabilMed(2009)52(7–8):568–578.ShinKY,Inpatientcancerrehabilitation:theexperienceofanationalcomprehensivecancercenter.Am JPhysMedRehabil(2011)90(5Suppl1):S63–68.StoutNL.Aprospectivesurveillancemodelforrehabilitationforwomenwithbreastcancer.Cancer(2012) 118(8Suppl):2191–2200.AlfanoCM,Anactionplanfortranslatingcancersurvivorshipresearchintocare.(2014)JNatlCancerInst106(11).doi:10.1093/jnci/dju287. GladieuxJE.Jimmoandtheimprovementstandard:implementingmedicarecoveragethroughregulations,policymanualsandotherguidance.(2014)AmJLawMed 40(1):7–25 • Racial/ethnicdisparitiesinaccesstoaccurateinformationaboutcancertreatmentthataffectstreatmentrelatedmorbidityaswellasreduced accesstorehabilitationinterventionsplacesthesepopulationsatgreaterriskofpooroutcomesfromcancertreatment.Hair,B.Racialdifferencesin physicalactivityamongbreastcancersurvivors:implicationsforbreastcancercare.(2014).Cancer.120(14):2174-2182.Black,D.Racialdisparitiesinadoptionof axillarysentinellymphnodebiopsyandlymphedemariskinwomenwithbreastcancer.(2014)JAMASurg149(8):788-796.Morehead-Gee,A.Racialdisparitiesin physicalandfunctionaldomainsinwomenwithbreastcancer.(2012)SupportiveCareCancer.20(8):1839-47.Owasu,C.Racialdisparitiesinfunctionaldisabilityamong olderwomenwithnewlydiagnosednon-metastaticbreastcancer.(2013)119(21):3839-46 Whatfactors&barrierscontributetothisissue? -Oncologydepartments/programslackintegrationwithrehabilitation,especiallyPhysiatry -ASCO,NCCNandCommissiononCancerintheirpublicationsandguidelinesdonotidentifyorpartnerwiththequalifiedprofessionalsfrom PMR,PT,OTandCancerexercisephysiologyinpolicyinitiatives -Inadequatemedicaltraininginmedicalschoolsandoncologyresidencyprogramsregardingthetypesandeffectivenessofrehabilitation interventions -PM&Rresidencytrainingprogramsnotdevotingadequatetime/resourcestotrainingincancerrehabilitation -PT,OT,SLPtrainingprogramsnotdevotingadequatetimeto/resourcestotrainingincancerrehabilitation -PaymentsystemsthathavesilosversusACOmodels -Poorunderstandingofmedicalprofessionalsregardingthespecificsofmedicalexerciseprescriptionsandhowtheymustbeadministeredto havebeneficial/safeeffectsoncancersurvivors(generallyhavebeenrelegatedtosportsmedicineprofessionals) -Lackofunderstandingofrehabilitationcareascoveredmedicalcareasopposedtocommunityexercise/wellness -LackofscreeningforphysicalimpairmentssinceCommissiononCancerimplementedDistressScreeningGuidelinebutnophysicalimpairment screeningguideline MinnesotaCancerPlanUpdate:SurvivorshipWorkGroup IssueAnalysis -Healthcaresystemsthatdonotinterfacewithracialandethniccommunitiesonculturaldifferenceswithdietandexerciseaswellas survivorshipcareingeneral -Lackofpartnershipswithqualifiedcommunitycancerexerciseprofessionalsinaffordable,accessiblesettings -LackoftrainingforCancerExercisespecialists -Survivorsuneducatedoncancerexercisespecialistsversuscommunityfitnesstrainersandsafetyconcerns WhatarethePOLICYopportunitiestoaddresstheidentifiedfactors,andracial,economic,geographic,andotherbarriersthatcontributeto thisissue?WhatarethePOLICYopportunitiestoaddresstheidentifiedgaps? WorkwithASCO(MN)andACStodevelopstandardsforSurvivorshipProgramsutilizingexpertsincancerrehabilitationandcancerexercise physiologytosetpolicyfortrainingandimplementationofcancerrehabilitationandcancerexercise. Advancepolicyinmajorcancerorganizationstorequirephysicalimpairmentscreeningforcancersurvivorswithreferraltoqualified rehabilitationandexerciseprofessionalsfollowingrecommendationsoftheNIHExpertTaskForceonCancerRehabilitation. Requiremedicalschools,PMRresidenciesandOncologyresidencesinMNtohavetraininginevidencebasedcancerrehabilitation Developtelemedicineopportunitiesandpaymentmechanismsforcancerrehabilitation. Pilot/grantprojectstodevelopmodelsofcareforcancerrehabilitationandcancerexerciseinMinnesotamedicaltraininginstitutions. Requireoncologysurvivorshipprogramstotrackpercentageofminoritiesundertheircarereceivingscreeningforphysicalimpairmentand referralstoservices. WorkwithinsurancecompaniesinMinnesotatoevaluatecompliancewithstandardsofcarecoverageforphysicalimpairmentsasmedicalcare. Advancepolicystatementsfrommajoroncologyinstitutionstorequirecommunityprogramsstatingthattheyarea“CancerExerciseProgram” todisclosequalificationsofclassinstructors,certifyinstructorsascancerexercisetrainedifoffering“cancerexerciseclasses.” WhataretheSTRATEGYopportunitiestoaddressboththebarriersandthegapsrelatingtothisissue? MCAworkwithMNbranchofASCOandACStocreatepolicyonscreeningforphysicalimpairmentandreferraltoqualifiedrehabilitation professionals(PMR,PT,OT)andcertifiedcancerexercisespecialists. ReachouttoMedicaltrainingprogramleadersinOncologyandPMRinMNtodevelopcancerrehabilitationcurriculum. MinnesotaCancerPlanUpdate:SurvivorshipWorkGroup IssueAnalysis ReachouttoPT,OT,SLPtrainingprogramleadersinMNtodevelopcancerrehabilitationcurriculum. SeekgrantfundingforpilotmodelsofcancerrehabilitationembeddedinOncologySurvivorshipClinics. 1. Whoaretheexistingpartners/organizationsalreadyworkingonthisissue? AmericanCancerSociety AmericanAcademyofPhysicalMedicineandRehabilitation AmericanPhysicalTherapyAssociation AmericanOccupationalTherapyAssociation AmericanCollegeofSportsMedicine AmericanCongressofRehabilitationMedicine OncologyRehabPartners 2. Whichpartners/organizationsshouldworktogethertoaddressthisissue? Thoselistedaboveandinaddition: AmericanSocietyofClinicalOncology MNMedicalSchoolsandmedicalprofessionaltrainingprograms CancerHealthEquityNetwork Whichstrategiespromotehealthequity? MCAworkwithMNbranchofASCOandACS,alongwithCHENtocreatepolicyonscreeningforphysicalimpairmentandreferraltoqualified cancerrehabilitationprofessionals(PMR,PT,OT)andcertifiedcancerexercisespecialists.