Support Care Cancer DOI 10.1007/s00520-015-2917-0
LETTER TO THE EDITOR
Response to editorial by Richard Crevenna, MD, regarding “cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services” by Silver et al. Julie K. Silver 1 & Sean R. Smith 2 & Eric M. Wisotzky 3 & Vishwa S. Raj 4 & Jack B. Fu 5 & Rebecca A. Kirch 6
Received: 28 July 2015 / Accepted: 16 August 2015 # Springer-Verlag Berlin Heidelberg 2015
Richard Crevenna, MD, provided insightful comments in his editorial response to our article entitled “Cancer Rehabilitation and Palliative Care: Critical Components in the Delivery of High-Quality Oncology Services” [1]. We were impressed by Dr. Crevenna’s description of the recent initiatives in interdisciplinary care, particularly in symptom management, at the Comprehensive Cancer Centre of the Medical University of Vienna. Notable were the inclusion of a rehabilitation tumor board and the integration of rehabilitation services into a clinic dedicated to symptom management which extends beyond issues typically associated with rehabilitation (e.g., mucositis and nausea). We believe that this type of interdisciplinary collaboration is critical to the success of well-designed cancer rehabilitation programs. The need to support interdisciplinary collaboration is precisely why we wrote this article. In fact, the genesis of our article was Dr. Julie Silver’s invitation from the Multinational Association of Supportive Care in Cancer (MASCC) leader-
ship to be a plenary speaker at the 2015 annual meeting in Copenhagen, Denmark. Though not related by design, this meeting followed a landmark cancer rehabilitation “state of the science” initiative in the USA that was led by the Rehabilitation Medicine Department (RMD) at the National Institutes of Health (NIH) in collaboration with the National Center for Medical Rehabilitation Research (NCMRR) and the National Cancer Institute (NCI). In a variety of ways, every author on this paper participated in and supported this undertaking. During a conference at the NIH in June 2015, early findings were reported by workgroups comprised of subject matter experts. We anticipate publication of reports by the subject matter experts who participated in this cancer rehabilitation initiative. Dr. Silver co-chaired the Clinical Integration Work Group (CIWG) with Ana Acevedo, MD, a physiatrist from the NIH RMD. The CIWG developed preliminary recommendations in three related categories: education (preparing the workforce
* Julie K. Silver julie_silver@hms.harvard.edu
2
Department of Physical Medicine & Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI 48108, USA
3
MedStar National Rehabilitation Network, 102 Irving St, NW, Washington, DC 20010, USA
4
Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC 28203, USA
5
Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX 77030, USA
6
American Cancer Society, 555 11th Street NW, Suite 300, Washington, DC 20004, USA
Sean R. Smith srsz@med.umich.edu Eric M. Wisotzky eric.m.wisotzky@medstar.net Vishwa S. Raj vishwa.raj@carolinashealthcare.org Jack B. Fu jfu@mdanderson.org Rebecca A. Kirch rkirch@cancer.org 1
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02129, USA
Support Care Cancer
in cancer rehabilitation care), clinical care (delivering evidence-based cancer rehabilitation care), and research (identifying the key research questions in cancer rehabilitation and supporting research in this field). Although it may seem obvious that cancer rehabilitation healthcare professionals should be included in any endeavor that involves cancer rehabilitation, there are many times when this is not the case. Therefore, the CIWG recommended identifying healthcare professionals specifically trained in rehabilitation medicine to lead or at least participate in all aspects of cancer rehabilitation education, clinical care, and research. In order to properly frame this discussion and provide a foundation for future work, we must have a clear definition of cancer rehabilitation. During the construction of this article, we had an opportunity to examine historical definitions of cancer rehabilitation and craft a state-of-the-art definition. The consensus definition that we arrived at is worth repeating here as it provides a framework for addressing gaps in education, clinical care, and research in cancer rehabilitation: “Cancer rehabilitation is medical care that should be integrated throughout the oncology care continuum and delivered by trained rehabilitation professionals who have it within their scope of practice to diagnose and treat patients’ physical, psychological and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population” [1]. This definition takes into account many factors including the training of cancer rehabilitation healthcare professionals, appropriate and timely delivery of this medical care, and use of assessments and interventions that are currently supported by the scientific literature as well as those that will be studied in the future. The definition is also based upon critical concepts that are included in the International Classification of
Function (ICF)—a well-recognized framework that involves interdisciplinary care. During the same conference, physiatrists Vishwa Raj, MD, and Michael Stubblefield, MD, co-chaired the Rehabilitation Clinical Models for Cancer Care Workgroup. One of the key findings from this workgroup was that there is a need for better integration of different specialists (e.g., physiatrists, therapists, nurses, and psychologists) in order to provide truly comprehensive and interdisciplinary care. Critical to delivery of this care is the need for specialized training that incorporates the core principles of both oncology and rehabilitation as well as the use of specific assessments and interventions based on the latest research. As Dr. Crevenna emphasized, interdisciplinary collaboration is important, and much work is left to be done in order to better integrate rehabilitation into comprehensive cancer care. For example, in clinical care, rehabilitation professionals might participate in supportive care or symptom management rounds with palliative care teams. Administratively, rehabilitation clinicians might participate in the medical facility’s Cancer Committee and/or Survivorship Committee, using this opportunity to educate their interdisciplinary colleagues and direct best practices cancer rehabilitation care. Cancer rehabilitation professionals may also provide valuable input into research designed and conducted by palliative care teams (and vice versa). Ultimately, it is our hope that there will be more and deeper collaboration among rehabilitation, supportive care, and palliative care professionals as the services they deliver are unique and essential to high-quality oncology care.
Reference 1.
Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA (2015) Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer. (in press)