December 2015 Vol 6, NO 6
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AONN+ 2015 Highlights
Addressing the Gap in Oncology Rehabilitation Care
“Cancer rehabilitation is an area of care that our patients desperately need. There’s a lot we can do with small changes in our practices, and some big changes,” said Matthew R. LeBlanc, BSN, RN, OCN, Nurse Navigator for Cancer Rehabilitation, Anne Arundel Medical Center, Annapolis, MD. In his presentation, Mr LeBlanc shared cancer rehabilitation research, as well as data he and his colleagues collected at Anne Arundel Medical Center, which revealed significant gaps in rehabilitation care for patients with cancer.
He explained how navigators can use these data to understand the type of care patients need, the type of care they are currently receiving, and how to integrate rehabilitation at the time of diagnosis. He also stressed the importance of rehabilitation in general, and how impairment-associated disabilities can affect patients’ perceptions of their identity. “These [impairments] won’t kill you; no one’s going to die from incontinence,” he said. “But it will destroy your life. It will keep you from doing the things that you need and want to do.”
Approximately 65% to 90% of patients with cancer need physical rehabilitation, according to Mr LeBlanc. In one study, only 6.1% of patients’ physical rehabilitation needs were documented in their medical records, and only 2 of 250 community-dwelling patients with cancer received rehabilitation services. “Patients are suffering unnecessarily. I view this as avoidable suffering, because we have great services, and few patients ever get their needs recognized,” he proclaimed. “We have therapists, physical therapists, occupational therapists, and speech language pathologists waiting and ready to take really good care of our patients; we’re just not getting patients to them.”
Mr LeBlanc also shared compelling data from a patient survey he and his colleagues conducted at Anne Arundel Medical Center. The most reported symptoms were pain and cognitive impairment, and patients with lung cancer and patients with stage IV disease reported having the most needs. However, they found that these patients were receiving almost no rehabilitation care. “Why does it seem like our stage IV cancer patients get less services and care when they objectively suffer more,” he asked. “We’re recording exactly how our patients are suffering; that’s sort of the first step to reducing that suffering.”
Since these data were collected, Anne Arundel Medical Center has increased their rehabilitation referrals for various symptoms by screening patients for their rehabilitation needs, thoroughly educating their oncology providers on the significance of rehabilitation, and streamlining the transition to rehabilitation care. “I think it makes more sense to automatically have a rehabilitation professional on the team to take care of these cancer patients to make sure that we’re catching things early,” Mr LeBlanc suggested.
Improving Navigation for Rehabilitation Care
Anne Arundel Medical Center’s rehabilitation navigation process includes a preoperative assessment, a postoperative assessment in the hospital, a repeat postoperative assessment 2 to 4 weeks later in the outpatient clinic, and checking in with the patient before chemotherapy and radiation begin.
Patients then continue to check in with the rehabilitation professional for 2 to 5 years, as they would with the medical oncologist. “These are visits even in the absence of noticeable impairments,” Mr LeBlanc explained. “At any moment, if the therapist or rehabilitation professional thinks you need more aggressive therapy, then you can move into 2 or 3 times a week of physical therapy, occupational therapy, or speech language therapy.”
Mr LeBlanc offered navigators a call to action, highlighting the specific ways in which their practices can improve rehabilitation care, including reading rehabilitation literature, meeting with rehabilitation professionals in their institution and community, and inviting rehabilitation professionals to tumor boards and staff meetings. Some institutional changes include making rehabilitation a nonnegotiable standard of care, and including a rehabilitation professional in the oncology team at the time of diagnosis.
“As oncology healthcare providers, our goal is to address the totality of patients’ suffering….We’re realizing that curative treatment only addresses part of the problem,” Mr LeBlanc said. “What I recommend, and what I hope to see within the next 10 years, is that when a patient is diagnosed with cancer, they get a palliative care person on their team and they get a rehab professional on their team from diagnosis. This is how we take care of cancer patients.”
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