Download Workgroup: Survivorship Date: 7/14/216 Objective: Minnesota be a

DevelopingtheMinnesotaCancerPlan
Step2:RecommendObjectivesandStrategies
Workgroup:Survivorship
Date:7/14/216
Objective:Minnesotabealeaderindevelopingcancerrehabilitationandcancerexercisetobecomeaccessible
toallcancersurvivorswhoneedtheseservicesregardlessofdemographicsandethnicity
DesiredOutcome:
Attheendoffiveyears,whatwouldyouliketoaccomplish?Sincephysicalfrailtyandpoorphysicalfitnessisassociatedwithpoorcancer
outcomes,thescreeningandtreatmentofpost-cancerphysicalimpairmentshouldbeintegratedintostandardcancersurvivorshiptraining,
cancertreatmentandcancersurvivorshipcarewithaccesstoallwhoneededitandcoveredbyinsuranceasevidencedbasedmedical
treatment.
1.MajormedicaltrainingprogramsinMNhavingcourseworkinCancerRehabilitationandCancerExercise.2.EstablishLeadersinPMRand
OncologyatMajorMedicalTrainingprogramsinMNtoworkacrossbarrierstocreateinterdisciplinarysolutionstocancerrehabreferralsand
care.3.Establishcriteria/qualificationsforcommunityfacilitiesclaimingtobecancerexerciseprograms.4.Developinnovativetechnologies
andlegislativeinitiativesforremoteservicessuchastelemedicineandcomputerplatformsforcancerrehabandcancerfitness/wellness.5.
Requirestateprogramsreceivingfundingforsurvivorshiptoevaluateforphysicalimpairmentsaftercancertreatmentanddevelopreferral
pathwaysforservices.6.Workwithunderservedethnicgroups/racestoascertainthebarrierstoreceivingcancerrehabandcancer
exercise/wellnessservicesandadaptstrategiestomeettheseneeds.Ifyoudonotexpecttoachievetheobjectivebytheendoffiveyears,
whatwouldsuccesslooklike?Anyprogresstowardtheseinitiatives.
Alignment:
Partnerscurrentlyworkingonthisobjectiveandtypeofactivity:
Organization
UniversityofMNsurvivorshipservices
MayoSurvivorshipservices
Activity(suchasPSEchange,education,programmatic)
Screeningandtreatmentforphysicalimpairment
“
DepartmentofPMRUofMN
DepartmentofPMRMayo
Othermedicaltrainingprograms
ACS
TraininginscreeningandtxPhysImpairment
“
“
AdvocateforscreeningandtxPhysImpairment
Stakeholdersforthisissuenotcurrentlyworkingonitandpotentialrole:
Organization
Potentialrole(PSEchange,education,programmatic)
CHEN
Outreachtounderserved
Insurers
Barrierstoevidencebasedmedicalrehab
OncologyNurseCoordinators/Navigators
Education,developlistofservices
Regulatoryagencies
Advocatingscreening,treatment,access
Strategies
Strategy#1:MajormedicaltrainingprogramsinMNhavingcourseworkinCancerRehabilitationandCancer
Exercise.
Indicatortomeasureprogress(suchasincreasednumberofengagedstakeholders,increasedmediaevents,increasednumberoflocaljurisdictions
thatpasspolicy):Increasedcoursework/lecturesinoncologyandrehabtrainingprograms,
Rationale:
• “CancerRehabilitationismedicalcarethatshouldbeintegratedthroughouttheoncologycare
continuumanddeliveredbytrainedrehabilitationprofessionalswhohaveitwithintheirscopeof
practicetodiagnoseandtreatpatients’physical,psychological,cognitiveandfunctionalimpairmentsin
anefforttomaintainorrestorefunction,reducesymptomburden,maximizeindependenceand
improvequalityoflifeinthismedicallycomplexpopulation.”SilverJK,RajVS,FuJB,WisotzkyEM,SmithSR,
KirchRA.Cancerrehabilitationandpalliativecare:criticalcomponentsinthedeliveryofhigh-qualityoncology
services.SupportCareCancer.2015Dec;23(12):3633-43.
•
AnadequateworkforceofPhysicalMedicineandRehabilitationspecialistswithexpertiseincancer
rehabilitationisnecessarytomeettheneedsforfuturecancersurvivorsinMinnesota.Alfano,Cetal.Cancer
SurvivorshipandCancerRehabilitation:RevitalizingtheLink.JournalofClinicalOncology.2012.30:9.904-906.Cheville
AL(2014)Postacutecare:reasonsforitsgrowthandaproposalforitscontrolthroughtheearlydetection,treatment,
andpreventionofhospital-acquireddisability.ArchPhysMedRehabil95(11):1997–1999.Stout,N.TowardsaNational
InitiativeinCancerRehabilitation:RecommendationsfromaSubjectMatterExpertGroup.2016.ArchivesofPMR.
10.1016/j.apmr.2016.05.002.MukaiAThefutureofphysiatry:withchallengescomeopportunities.2011.PMR
3(3):189–192.RajVSCancerrehabilitationeducationduringphysicalmedicineandrehabilitationresidency:preliminary
dataregardingthequalityandquantityofexperiences.(2014)AmJPhysMedRehabil.
doi:10.1097/PHM.0000000000000060.SmithSR,Cancersurvivorship:agrowingroleforphysiatriccare.(2014)PMR.
doi:10.1016/j.pmrj.2014.12.004
•
Medicalfrailtyanduntreatedphysicalimpairmentincancersurvivorsincreasesthecostofcare,
institutionalization,caregiverburden,hospitalizations,inabilitytoreturntoworkanddistress.Thisisa
loomingcrisisincancercarethatmustbeaddressed.Winters-Stone,K.PreventingFrailtyinOlderCancer
Survivors.TopicsinGeriatricRehabilitation.2015.31(4),241-245.Schmitz,Ketal.Theintersectionofcancerand
ageing:establishingtheneedforbreastcancerrehabilitation.2007.CancerEpidemiologyBiomarkersandPrevention.
2007;16:866-872.Hoppe,S.FunctionalDeclineinOlderpatientsreceivingfirstlinechemotherapy.2013.JClinOncol.
31;3877-3882.Bentley,Jetal.Functionalstatus,life-spacemobility,andqualityoflife:alongitudinalmediation
analysis.QualLifeRes.2013September;22(7):1621–1632.Cetal.OlderPeople’sQualityofLife(OPQOL)scoresand
adversehealthoutcomes.HealthandQualityofLifeOutcomes2011,9:72.Prado,CM.SarcopeniaandPhysical
FunctioninOverweightPatientswithAdvancedCancer.Canadianjournalofdieteticpracticeandresearch(2013)
74(2):69.Silver,J.CancerRehabilitationmayimprovefunctionincancersurvivorsanddecreasetheeconomicburden
ofcancertoindividualsandsociety.Work.(2013)46(4):455-72.
•
•
•
Inspiteofresearchshowingrehabilitationimprovesfunctionaloutcomes,cancersurvivorsreceivefew
referralstoqualifiedrehabilitationprofessionalsrelativetotheburdenofremediablephysical
impairment.Cheville,A.Thedetectionandtreatmentofcancer-relatedfunctionalproblemsinanoutpatientsetting”
SupportiveCareinCancer.2009Jan;17(1):61.Cheville,A.AnExaminationoftheCausesfortheUnderutilizationof
RehabilitationServicesAmongPeoplewithAdvancedCancer.AmJPhysMedRehabil2011;90(suppl):S27YS37.
Cheville,A,etal.Prevalenceandtreatmentpatternsofphysicalimpairmentsinpatientswithmetastaticbreastcancer.
2008JClinOnc.26(16):2621-9.Cheville,A.BarrierstoRehabilitationFollowingSurgeryforPrimaryBreastCancer.J
SurgOncol2007;95:409-18.Thorsen,Letal.CancerPatientsNeedsforRehabilitationServices.ACTAOncologica.
201150:212-222.Vargo,M.TheOncology-RehabilitationInterface:bettersystemsneeded.JClinicalOncol.2008.(16)
2610.SpillGR,HlubockyFJ,DaughertyCK(2012)Oncologists’andphysiatrists’attitudesregardingrehabilitationfor
patientswithadvancedcancer.PMR4(2):96–108.PergolottiM,(2015)Theprevalenceofpotentiallymodifiable
functionaldeficitsandthesubsequentuseofoccupationalandphysicaltherapybyolderadultswithcancer.JGeriatr
Oncol.doi:10.1016/j.jgo.2015.01.004.SalakariMREffectofrehabilitationamongpatientswithadvancedcancer:a
systematicreview.(2015)ActaOncol54(5):618–628.ChevilleAL,Roleofrehabilitationmedicineandphysicalagentsin
thetreatmentofcancer-associatedpain.JClinOncol(2014)32(16):1691–1702.
M,Productivitylossesassociatedwithheadandneckcancerusingthehumancapitalandfrictioncostapproaches.
ApplHealthEconHealthPolicy.(2015)doi:10.1007/s40258-015-0155-8
Exerciseforcancersurvivorsrequiresspecificexerciseprescriptionsfromqualifiedprofessionalsin
rehabilitationandcancerexercisephysiologywhoareabletoevaluatesafetyandcomorbitiesbefore
prescribingcorrectindividualexerciseprotocolforsurvivorship.LakoskiSG.Exerciserehabilitationinpatients
withcancer.NatRevClinOncol.2012;9(5):288–96.Sasso,JP.Aframeworkforprescriptioninexerciseoncology
research.JCachexia,Sarcopenia,Muscle.(2015)6:115-124.Brown,J.Theprescriptionorproscriptionofexercisein
colorectalcancercare.MedSciSportsEx.(2014)46(12):2202-2209.Betof,A.Effectsandpotentialmechanismsof
exercisetrainingoncancerprogression:atranslationalperspective.BrainBehavImmun.(2013)30(0):S75S87.Midtgaard,J.Efficacyofmultimodalexercise-basedrehabilitationonphysicalactivity,cardiorespiratoryfitness,
andpatientreportedoutcomesincancersurvivors:arandomized,controlledtrial.(2013)AnnalsofOncology.
24:2267-2273.Brown,J.Developmentofarisk-screeningtoolforcancersurvivorstoparticipateinunsupervised
moderatetovigorous-intensityexercise:resultsfromasurveystudy.(2015)PMR.7:113-122.Campbell,K.Reviewof
exercisestudiesinbreastcancersurvivors:attentiontoprinciplesofexercisetraining.(2012)BrJSportsMed.46:909-916.
Martin,E.Higherintensityexercisehelpscancersurvivorsremainmotivated.JCaSurvivorship(2016)10(3):524-533.
Devin,J.Theinfluenceofhigh-intensitycomparedwithmoderateintensityexercisetrainingoncardiorespiratory
fitnessandbodycompositionincolorectalcancersurvivors:arandomizedcontrolledtrial.JCaSurvivorship
(2016)10(3):467-479.Jones,LW.PrecisionOncology:Frameworkforinvestigationofexerciseastreatmentforcancer.
(2015)JClinOncol33:1-4.Schmitz,K.ConsensusStatement:AmericanCollegeofSportsMedicineRoundtableon
ExerciseGuidelinesforCancerSurvivors.(2010)MedSciSportsEx1409-1426.Wolin,K.ImplementingtheExercise
GuidelinesforCancerSurvivors.(2012)JSupportOncol.10(5):171-177
•
Inspiteofresearchshowingrehabilitationimprovesfunctionaloutcomes,cancersurvivorsreceivefew
referralstoqualifiedrehabilitationprofessionalsrelativetotheburdenofremediablephysical
impairment.Cheville,A.Thedetectionandtreatmentofcancer-relatedfunctionalproblemsinanoutpatientsetting”
SupportiveCareinCancer.2009Jan;17(1):61.Cheville,A.AnExaminationoftheCausesfortheUnderutilizationof
RehabilitationServicesAmongPeoplewithAdvancedCancer.AmJPhysMedRehabil2011;90(suppl):S27YS37.Cheville,
A,etal.Prevalenceandtreatmentpatternsofphysicalimpairmentsinpatientswithmetastaticbreastcancer.2008J
ClinOnc.26(16):2621-9.Cheville,A.BarrierstoRehabilitationFollowingSurgeryforPrimaryBreastCancer.JSurgOncol
2007;95:409-18.Thorsen,Letal.CancerPatientsNeedsforRehabilitationServices.ACTAOncologica.201150:212222.Vargo,M.TheOncology-RehabilitationInterface:bettersystemsneeded.JClinicalOncol.2008.(16)2610.SpillGR,
HlubockyFJ,DaughertyCK(2012)Oncologists’andphysiatrists’attitudesregardingrehabilitationforpatientswith
advancedcancer.PMR4(2):96–108.PergolottiM,(2015)Theprevalenceofpotentiallymodifiablefunctionaldeficitsand
thesubsequentuseofoccupationalandphysicaltherapybyolderadultswithcancer.JGeriatrOncol.
doi:10.1016/j.jgo.2015.01.004.SalakariMREffectofrehabilitationamongpatientswithadvancedcancer:asystematic
review.(2015)ActaOncol54(5):618–628.ChevilleAL,Roleofrehabilitationmedicineandphysicalagentsinthe
treatmentofcancer-associatedpain.JClinOncol(2014)32(16):1691–1702.
•
Thisisan_x___evidence-basedpractice____promisingpractice____other.Pleaseexplain.
Doesthisstrategypromotehealthequitybyaddressingaracial,economic,geographicorotherbarrier?If
yes,explain.
•
Racial/ethnicdisparitiesinaccesstorehabilitationandexerciseinterventionsplacesthesepopulationsat
greaterriskofpooroutcomesfromcancertreatment.Hair,B.Racialdifferencesinphysicalactivityamongbreast
cancersurvivors:implicationsforbreastcancercare.(2014).Cancer.120(14):2174-2182.Black,D.Racialdisparitiesin
adoptionofaxillarysentinellymphnodebiopsyandlymphedemariskinwomenwithbreastcancer.(2014)JAMASurg
149(8):788-796.Morehead-Gee,A.Racialdisparitiesinphysicalandfunctionaldomainsinwomenwithbreastcancer.
(2012)SupportiveCareCancer.20(8):1839-47.Owasu,C.Racialdisparitiesinfunctionaldisabilityamongolderwomenwith
newlydiagnosednon-metastaticbreastcancer.(2013)119(21):3839-46
Rankthisstrategyforthegreatestpotentialfortraditionalandnon-traditionalpartnersworkingtogether.
Rank___of___strategies
Strategy#2:Developinnovativetechnologiesandprogramstoprovideaccesstorehabilitationinareasitisnot
available.
Indicatortomeasureprogress(suchasincreasednumberofengagedstakeholders,increasedmediaevents,
increasednumberoflocaljurisdictionsthatpasspolicy):Broadbandavailabilityforonlinerehabilitationand
cancerexercisewellnessapps.Advancingtelemedicinetechnologyforgreateroutreachincancerrehabilitation
Rationale:Mostcancerrehabilitationandcancerfitness/wellnessservicesareonlyinlargemetroareasofMN
Thisisan____evidence-basedpractice___x_promisingpractice____other.Pleaseexplain.
Doesthisstrategypromotehealthequitybyaddressingaracial,economic,geographicorotherbarrier?Ifyes,
explain.Accesstoservicesforthosewhocurrentlyareexcluded
Rankthisstrategyforthegreatestpotentialfortraditionalandnon-traditionalpartnersworkingtogether.
Rank___of___strategies
Strategy#3:Workwithstatepayorsonmodelsofcarethatenhancebetteroutcomesbyadequatecoverageof
rehabilitationandcancerfitness/wellnessservices
Indicatortomeasureprogress(suchasincreasednumberofengagedstakeholders,increasedmediaevents,increasednumberoflocaljurisdictions
thatpasspolicy):Payorshavecoverageforevidencebasedservicesthatimproveoutcomes
• Rationale:Currentmodelsofmedicalcare,paymentsystemsandinaccuratecoveragedeterminations
workagainsttheclinicalintegrationofeffectiverehabilitationintooncologytothedetrimentof
patientoutcomes,healthandwellnessaftercancertreatment.Minnesotaneedstobeatthe
forefrontofresearchandpolicydevelopmentthatfacilitateseffective,coveredrehabilitationcarefor
Minnesotacancersurvivors.Round,J.Acost-utilityanalysisofarehabilitationserviceforpeoplelivingwithand
beyondcancer.BMCHealthServRes.2014.14(1):558.InstituteofMedicine(2013)Deliveringhigh-qualitycancer
care:chartinganewcourseforasystemincrisis.NationalAcademiesPress,Washington,DC.StubblefieldMD.
Currentperspectivesandemergingissuesoncancerrehabilitation.Cancer2013.119(Suppl11):2170–2178.Mewes
JCEffectivenessofmultidimensionalcancersurvivorrehabilitationandcost-effectivenessofcancerrehabilitationin
general:asystematicreview.Oncologist(2012)17(12):1581–1593.PalacioA,Oncologyandphysicalmedicineand
rehabilitation.AnnPhysRehabilMed(2009)52(7–8):568–578.ShinKY,Inpatientcancerrehabilitation:the
experienceofanationalcomprehensivecancercenter.AmJPhysMedRehabil(2011)90(5Suppl1):S63–68.Stout
NL.Aprospectivesurveillancemodelforrehabilitationforwomenwithbreastcancer.Cancer(2012)
118(8Suppl):2191–2200.AlfanoCM,Anactionplanfortranslatingcancersurvivorshipresearchintocare.(2014)J
NatlCancerInst106(11).doi:10.1093/jnci/dju287.GladieuxJE.Jimmoandtheimprovement
standard:implementingmedicarecoveragethroughregulations,policymanualsandotherguidance.(2014)AmJ
LawMed40(1):7–25
Thisisan____evidence-basedpractice__x_promisingpractice____other.Pleaseexplain.
Doesthisstrategypromotehealthequitybyaddressingaracial,economic,geographicorotherbarrier?Ifyes,
explain.Payorshavedifferentpoliciesforstandardrehabilitationcare.Somecitizensdonotreceivecoveragefor
medicalservicesthatwouldimproveoutcomeofcancertreatment
Rankthisstrategyforthegreatestpotentialfortraditionalandnon-traditionalpartnersworkingtogether.
Rank___of___strategies