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Cancer Rehabilitation:
What is is, who can benefit, and
how available is it in Canada
Jennifer M. Jones, PhD
Director, Cancer Rehabilitation and Survivorship Program
Butterfield/Drew Chair in Cancer Survivorship Research
Senior Scientist, Princess Margaret Research Institute
Associate Professor, Dept. of Psychiatry
Dalla Lana School of Public Health (cross-appointment)
University of Toronto
Objectives
• Introduce what cancer rehabilitation
• Examine where it fits into the cancer trajectory
• Provide an overview of who can benefit from cancer rehab
• Discuss the current landscape of cancer rehabilitation and
the need for advocacy to increase access to this essential
component of cancer care.
39%
Growing number of Cancer Survivors in Canada
• 45% of Canadians are expected to be diagnosed
with cancer in their lifetime
• With an aging and growing population, the
number of new cancer cases is increasing
• BUT the good news…Cancer-specific mortality
has decreased for almost all types of cancer and
there is a growing number of people with
advanced and metastatic cancer who are living
longer with their disease
=a rapidly growing number of cancer survivors
with ~2.5 million survivors expected in Canada by
2040
• Number of cancer survivors increasing at 2x the
rate of new diagnosis
26%
Decrease in cancer-specific mortality between 1988-2023
Side effects of cancer
• The majority of people diagnosed with cancer will experience
impairments to physical functioning and related disability
• These often go undetected/unreported and untreated
CANCER
SIDE EFFECTS
• Acute
• Persistent
• Late
Social
Roles
Work
Roles
Quality of
Life
a Acute refers to impairments that may occur during or immediately after treatment; long‐term refers to impairments that may begin during or immediately after treatment but persist for an extended
period of time; and late‐onset impairments are those that may occur months or years after treatment is complete.
Nekhlyudov et al. Cancer-related impairments and functional limitations among long-term cancer survivors: Gaps and opportunities for clinical practice. Cancer. 2022 Jan 15;128(2):222-229
Health Status and Disability in Cancer
0%
10%
20%
30%
40%
50%
60%
Fair/Poor health > 1 limitations of
ADL
> 1 functional
limitation
Unable to work
30%
11%
58%
17%
11%
3%
29%
5%
Cancer Hx n=4878
No Cancer Hx n=90,737
Ref: Hewitt et al. 2003 J Gerontol A Biol Sci Med Sci. 58 (1): M82-M91
Physical
Effects
“The experience of entering the medical system for many cancer patients is that they
feel very good at the beginning, and then the treatments make them profoundly ill
and often disabled. When they are sicker and more debilitated than they have ever
been, they are discharged to follow-up care, which may include such things as routine
screening for cancer recurrence, managing ongoing medications, and others, but this
does not generally include a multidisciplinary rehabilitation intervention. In effect, the
medical system creates a situation where high-functioning individuals are given life-
prolonging treatments and then left to struggle with how to recover from the toxic
adverse effects of these therapies”.
Silver and Gilchrist 2011
Need for Cancer Rehabilitation
A call for action
• In 2017, the World Health Organization (WHO) initiated Rehabilitation 2030 - a
call to action to advance global access to high-quality rehabilitation as an
essential health care service for individuals with noncommunicable diseases. This
initiative emphasized that:
 Rehabilitation should be available for all the population and through all
stages of the life course.
 Efforts to strengthen rehabilitation should be directed towards supporting
the health system as a whole and integrating rehabilitation into all levels of
health care.
 Rehabilitation is an essential health service and crucial for achieving
universal health coverage.
• Given the acute, persistent, and late effects of cancer and its associated
treatments, the WHO designated oncology as a priority area for this initiative.
What is cancer rehabilitation?
Cancer Rehabilitation A process to restore mental and/or
physical abilities lost to injury or
disease, in order to function in a normal
or near-normal way.
National Cancer Institute
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 to maintain or
restore function, reduce symptom burden, maximize independence,
and improve quality of life in this medically complex population.
Silver et al. 2015
What counts as rehab?
11
Physical
Rehabilitation
Medicine
(Physiatry)
Specialized
multidimensional
rehabilitation
Hospital-based
Exercise
Community-
based Supervised
Exercise
General self-
directed
Community
Exercise
Level 1/2
Level 3/4
Who delivers cancer rehabilitation?
Cancer rehabilitation is a
multidisciplinary field
with the goal of
optimizing physical,
social, emotional, and
vocational functioning
Cancer
Rehabilitation
disciplines
Physical and
rehabilitation
medicine
(physiatry)
Physiotherapy (PT)
Occupational
Therapy (OT)
Speech and
language
pathology (SLP)
Nutrition
Social Work (SW)
Kinesiology (RKin),
Exercise
physiology
Certified Exercise
Professionals (CEP)
Neuropsychology
Vocational
Therapy
Recreational
therapy
Behavioural
therapy
Massage therapy
(RMT)
Stepped Care for Cancer Rehab
Level 1/2
•General Conditioning Activities, Unspecialized
•General Conditioning Activities, Specialized
Level 3/4
• Impairment-Directed Care, Uncomplicated
• Impairment-Directed Care, Complicated
Alfano CM, Cheville AL, Mustian K. Developing High-Quality Cancer Rehabilitation Programs: A Timely Need.
Am Soc Clin Oncol Educ Book. 2016;35:241-9. doi: 10.1200/EDBK_156164. PMID: 27249704.
Level I: General Conditioning Activities, Unspecialized
• Most people treated for cancer experience a decrease in
aerobic fitness and muscle quality
• All people diagnosed with cancer should receive
education and/or prescriptive counseling on progressive
aerobic conditioning, resistance training, and the benefits
of exercise in general.
*preventative role recurrence, mortality, and risks such as
cardiotoxicity
Level II: General Conditioning Activities, Specialized
• For some people, there is a need for an exercise
professional to provide some supervision. Community
based programs (i.e. Wellspring, EXCEL,
professional with some cancer experience)
Level 1/2
General Conditioning Activities, Unspecialized
General Conditioning Activities, Specialized
• Level III: Impairment-Directed Care, Uncomplicated
• Rehab specialist treatment (i.e OT, PT, RD, SLP). Cancer–related
impairments that limit function but are uncomplicated by symptoms or other
systemic concerns.
• Focuses on treating the impairment(s) to optimize function and also on
increasing activity levels with the goal to move to Level 1/2
• Level IV: Impairment-Directed Care, Complicated
• Specialist physician–directed evaluation and treatment (physiatrist) for
patients with problematic symptoms or co-occurring impairments.
• Focuses on treating impairments, ongoing symptom management, and
increasing activity levels to enable the survivor of cancer to safely transition
to Level 1/2 when possible.
Level 3/4
• Impairment-Directed Care, Uncomplicated
• Impairment-Directed Care, Complicated
Where does cancer rehab fit into the cancer
trajectory and who can benefit?
‘Disease Free’
Remission
Managed Chronic or
Intermittent Disease
Treatment Failure
Recurrence/ Second
Primary
Treatment with
Intent to Cure
Palliative Care
Diagnosis and
Staging
Death
Survivorship Care
Cancer Trajectory
Cancer rehabilitation across the treatment continuum
Chowdhury RA, Brennan FP, Gardiner MD. Cancer Rehabilitation and Palliative Care-Exploring
the Synergies. J Pain Symptom Manage. 2020 Dec;60(6):1239-1252
Dietz classification of cancer rehabilitation in the treatment continuum
Prehabilitation
• Everyone can benefit but target groups who may need more direct intervention include
those who are frail, have comorbidities, or are in poor health (level 3/4)
• Before the beginning of acute treatment to optimize function in order to improve
recovery and optimize treatment tolerability.
• Usually involves multidisciplinary interventions including physical conditioning, nutrition,
psychosocial counseling.
Lee K, Zhou J, Norris M, Chow C, Dieli-Conwright C. Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among
Patients Diagnosed with Cancer. Current Oncology Reports. 2020 22. 10.1007/s11912-020-00932-9.
Restorative/Supportive Cancer Rehabilitation
• During and after treatment- impairment
driven
• Cancer rehabilitation strategies are similar
to those used in other conditions (i.e.
cardiac rehabilitation)
• Typically takes a holistic approach rather
than addressing each symptom separately
• Varied interventions, delivered by specific
rehab professionals depending on the
issue
• Incorporates self management skills
teaching and health promotion efforts
deconditioning
functional
mobility and
musculoskeletal
impairments
ADLs
fatigue and sleep
difficulties
lymphedema
speech and
swallowing
difficulties
psychosocial
concerns
cognitive
impairments
vocational
difficulties
sexual dysfunction neuropathy pain
Supportive Rehabilitation
• Individuals living with people with slowly progressive disease or
chronic (usually hematological) malignancy.
• Focus to maximize function, independence, participation in life
activities, and quality of life
• Includes teaching self management skills and compensatory
strategies to increase self-care, accommodate impairments, and
manage symptoms from ongoing disease.
Where are we now?
The availability of cancer rehabilitation
Current landscape of Cancer Rehab
• Many oncology guidelines now include recommendations for cancer rehabilitation referral
and interventions rehabilitation is a recognized component of oncology care
– BUT there is currently no comprehensive rehabilitation guideline or clinical
pathway for cancer care.
• The availability of rehabilitation services for cancer patients remains limited in most
countries
• It is estimated that only 1-18 in 200 cancer patients have access to cancer rehabilitation
services
These gaps in access have significant
consequences, as timely and appropriate
rehabilitation can improve functional outcomes,
reduce symptom burden, and enhance overall
quality of life for cancer survivors.
Cancer Rehabilitation in Canada
• Comprehensive cancer rehabilitation programs are still the exception in cancer care in Canada
• It is estimated that ~20 sites across the country offer some form of cancer rehabilitation
programming. Less than 10 physiatrists who specialize in cancer rehabilitation
Causes:
1. The funding structure of cancer care remains focused on acute care and does not include outpatient
rehabilitation
• where funding is available, it is often short-term (grants) and/or depend on charitable organisations
and foundations
2. There is a limited pool of rehab professionals with training/expertise in cancer rehab
• creates a challenge to developing a comprehensive cancer rehabilitation program with a
multidisciplinary team = services are one-dimensional with a focus on treating
symptom/impairments separately
3. More research is needed to benefits and cost-savings and justify the ”ask”
ACRM blueprint to advance cancer rehab
• In 2019, the American Congress of Rehabilitation
Medicine(ACRM) created a blueprint to advance cancer
rehabilitation and proposed five steps:
Stimulating and
funding
research to
show benefits
of cancer rehab
Using that
science base to
develop clinical
practice
guidelines
increasing
clinical capacity
by educating
more cancer
rehabilitation
providers
Engaging in
marketing
campaigns
highlighting the
value of cancer
rehabilitation
Lobbying for
legislative
change to
improve access
and funding
Role of Advocacy
• Advocacy can take many forms including governmental lobbying, letter writing
campaigns, social media, sharing personal stories
– Contact and lobby you local representatives and those who serve on relevant
governmental committees.
– Partner with like-minded people who have relationships with “change makers”.
– Partner with patient and healthcare organizations and sponsor letter-writing
campaigns to voice advocacy
– Share personal stories can help to humanize the nature of the suffering that is ongoing
and faced by cancer survivors and help build support for change.
– Social media can be used to amplify your message
– Ask for and demand cancer rehab services
“tell the right story to the right person with the right data.”
Cancer rehabilitation is at a critical the
number of cancer survivors in Canada is
expected to double by 2040
Many will develop functional impairments
or become disabled because of cancer or
cancer treatment
However, there remain significant gaps in
the provision of rehabilitation services for
patients with cancer in Canada and this
contributes to a growing morbidity burden.
We need a change.
Smith et al., 2020
It is challenging, if not impossible, to imagine a high-quality
oncology care system that does not include rehabilitation service.
Cancer rehabilitation has been reported to be an effective and
efficient way to improve patient function, reduce symptom
burden, and reduce resource utilization. Given that cancer
patients’ life expectancies are consistently shown to be reduced
worldwide when their diagnosis is associated with disability,
rehabilitation must be considered an essential component to
comprehensive cancer care.
Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil.
2020 Jan;42(1):8-13. doi: 10.1080/09638288.2018.1514662. Epub 2018 Dec 21. PMID: 30574818.
“While we may be living clinically with no evidence of disease, we live with the evidence of the
history of our disease every day. Like petrified trees or fossilized shells, cancer treatments leave
permanent physical and psychological reminders of our cancer experience. As greater attention is
being focused on the optimized management of long-term toxicities in cancer survivorship, my
sincere hope is that there will be effort to educate cancer and non-cancer medical staff alike about
the real physical and psychosocial adverse effects as well as advances in treatment that will both
prevent development of long-term toxicity and yield better solutions for when they do occur. I hope
better options will be available to all cancer survivors with all stages and all disease types in the not-
so-distant future.
I am OK, really, but I am not sure ‘otherwise healthy’ really applies to me.”
jennifer.jones@uhn.ca

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CCSN_June_06 2024_jones. Cancer Rehabpptx

  • 1. Cancer Rehabilitation: What is is, who can benefit, and how available is it in Canada Jennifer M. Jones, PhD Director, Cancer Rehabilitation and Survivorship Program Butterfield/Drew Chair in Cancer Survivorship Research Senior Scientist, Princess Margaret Research Institute Associate Professor, Dept. of Psychiatry Dalla Lana School of Public Health (cross-appointment) University of Toronto
  • 2. Objectives • Introduce what cancer rehabilitation • Examine where it fits into the cancer trajectory • Provide an overview of who can benefit from cancer rehab • Discuss the current landscape of cancer rehabilitation and the need for advocacy to increase access to this essential component of cancer care.
  • 3. 39% Growing number of Cancer Survivors in Canada • 45% of Canadians are expected to be diagnosed with cancer in their lifetime • With an aging and growing population, the number of new cancer cases is increasing • BUT the good news…Cancer-specific mortality has decreased for almost all types of cancer and there is a growing number of people with advanced and metastatic cancer who are living longer with their disease =a rapidly growing number of cancer survivors with ~2.5 million survivors expected in Canada by 2040 • Number of cancer survivors increasing at 2x the rate of new diagnosis 26% Decrease in cancer-specific mortality between 1988-2023
  • 4. Side effects of cancer • The majority of people diagnosed with cancer will experience impairments to physical functioning and related disability • These often go undetected/unreported and untreated CANCER SIDE EFFECTS • Acute • Persistent • Late Social Roles Work Roles Quality of Life
  • 5. a Acute refers to impairments that may occur during or immediately after treatment; long‐term refers to impairments that may begin during or immediately after treatment but persist for an extended period of time; and late‐onset impairments are those that may occur months or years after treatment is complete. Nekhlyudov et al. Cancer-related impairments and functional limitations among long-term cancer survivors: Gaps and opportunities for clinical practice. Cancer. 2022 Jan 15;128(2):222-229
  • 6. Health Status and Disability in Cancer 0% 10% 20% 30% 40% 50% 60% Fair/Poor health > 1 limitations of ADL > 1 functional limitation Unable to work 30% 11% 58% 17% 11% 3% 29% 5% Cancer Hx n=4878 No Cancer Hx n=90,737 Ref: Hewitt et al. 2003 J Gerontol A Biol Sci Med Sci. 58 (1): M82-M91 Physical Effects
  • 7. “The experience of entering the medical system for many cancer patients is that they feel very good at the beginning, and then the treatments make them profoundly ill and often disabled. When they are sicker and more debilitated than they have ever been, they are discharged to follow-up care, which may include such things as routine screening for cancer recurrence, managing ongoing medications, and others, but this does not generally include a multidisciplinary rehabilitation intervention. In effect, the medical system creates a situation where high-functioning individuals are given life- prolonging treatments and then left to struggle with how to recover from the toxic adverse effects of these therapies”. Silver and Gilchrist 2011 Need for Cancer Rehabilitation
  • 8. A call for action • In 2017, the World Health Organization (WHO) initiated Rehabilitation 2030 - a call to action to advance global access to high-quality rehabilitation as an essential health care service for individuals with noncommunicable diseases. This initiative emphasized that:  Rehabilitation should be available for all the population and through all stages of the life course.  Efforts to strengthen rehabilitation should be directed towards supporting the health system as a whole and integrating rehabilitation into all levels of health care.  Rehabilitation is an essential health service and crucial for achieving universal health coverage. • Given the acute, persistent, and late effects of cancer and its associated treatments, the WHO designated oncology as a priority area for this initiative.
  • 9. What is cancer rehabilitation?
  • 10. Cancer Rehabilitation A process to restore mental and/or physical abilities lost to injury or disease, in order to function in a normal or near-normal way. National Cancer Institute 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 to maintain or restore function, reduce symptom burden, maximize independence, and improve quality of life in this medically complex population. Silver et al. 2015
  • 11. What counts as rehab? 11 Physical Rehabilitation Medicine (Physiatry) Specialized multidimensional rehabilitation Hospital-based Exercise Community- based Supervised Exercise General self- directed Community Exercise Level 1/2 Level 3/4
  • 12. Who delivers cancer rehabilitation? Cancer rehabilitation is a multidisciplinary field with the goal of optimizing physical, social, emotional, and vocational functioning Cancer Rehabilitation disciplines Physical and rehabilitation medicine (physiatry) Physiotherapy (PT) Occupational Therapy (OT) Speech and language pathology (SLP) Nutrition Social Work (SW) Kinesiology (RKin), Exercise physiology Certified Exercise Professionals (CEP) Neuropsychology Vocational Therapy Recreational therapy Behavioural therapy Massage therapy (RMT)
  • 13. Stepped Care for Cancer Rehab Level 1/2 •General Conditioning Activities, Unspecialized •General Conditioning Activities, Specialized Level 3/4 • Impairment-Directed Care, Uncomplicated • Impairment-Directed Care, Complicated Alfano CM, Cheville AL, Mustian K. Developing High-Quality Cancer Rehabilitation Programs: A Timely Need. Am Soc Clin Oncol Educ Book. 2016;35:241-9. doi: 10.1200/EDBK_156164. PMID: 27249704.
  • 14. Level I: General Conditioning Activities, Unspecialized • Most people treated for cancer experience a decrease in aerobic fitness and muscle quality • All people diagnosed with cancer should receive education and/or prescriptive counseling on progressive aerobic conditioning, resistance training, and the benefits of exercise in general. *preventative role recurrence, mortality, and risks such as cardiotoxicity Level II: General Conditioning Activities, Specialized • For some people, there is a need for an exercise professional to provide some supervision. Community based programs (i.e. Wellspring, EXCEL, professional with some cancer experience) Level 1/2 General Conditioning Activities, Unspecialized General Conditioning Activities, Specialized
  • 15. • Level III: Impairment-Directed Care, Uncomplicated • Rehab specialist treatment (i.e OT, PT, RD, SLP). Cancer–related impairments that limit function but are uncomplicated by symptoms or other systemic concerns. • Focuses on treating the impairment(s) to optimize function and also on increasing activity levels with the goal to move to Level 1/2 • Level IV: Impairment-Directed Care, Complicated • Specialist physician–directed evaluation and treatment (physiatrist) for patients with problematic symptoms or co-occurring impairments. • Focuses on treating impairments, ongoing symptom management, and increasing activity levels to enable the survivor of cancer to safely transition to Level 1/2 when possible. Level 3/4 • Impairment-Directed Care, Uncomplicated • Impairment-Directed Care, Complicated
  • 16. Where does cancer rehab fit into the cancer trajectory and who can benefit?
  • 17. ‘Disease Free’ Remission Managed Chronic or Intermittent Disease Treatment Failure Recurrence/ Second Primary Treatment with Intent to Cure Palliative Care Diagnosis and Staging Death Survivorship Care Cancer Trajectory
  • 18. Cancer rehabilitation across the treatment continuum Chowdhury RA, Brennan FP, Gardiner MD. Cancer Rehabilitation and Palliative Care-Exploring the Synergies. J Pain Symptom Manage. 2020 Dec;60(6):1239-1252 Dietz classification of cancer rehabilitation in the treatment continuum
  • 19. Prehabilitation • Everyone can benefit but target groups who may need more direct intervention include those who are frail, have comorbidities, or are in poor health (level 3/4) • Before the beginning of acute treatment to optimize function in order to improve recovery and optimize treatment tolerability. • Usually involves multidisciplinary interventions including physical conditioning, nutrition, psychosocial counseling. Lee K, Zhou J, Norris M, Chow C, Dieli-Conwright C. Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among Patients Diagnosed with Cancer. Current Oncology Reports. 2020 22. 10.1007/s11912-020-00932-9.
  • 20. Restorative/Supportive Cancer Rehabilitation • During and after treatment- impairment driven • Cancer rehabilitation strategies are similar to those used in other conditions (i.e. cardiac rehabilitation) • Typically takes a holistic approach rather than addressing each symptom separately • Varied interventions, delivered by specific rehab professionals depending on the issue • Incorporates self management skills teaching and health promotion efforts deconditioning functional mobility and musculoskeletal impairments ADLs fatigue and sleep difficulties lymphedema speech and swallowing difficulties psychosocial concerns cognitive impairments vocational difficulties sexual dysfunction neuropathy pain
  • 21. Supportive Rehabilitation • Individuals living with people with slowly progressive disease or chronic (usually hematological) malignancy. • Focus to maximize function, independence, participation in life activities, and quality of life • Includes teaching self management skills and compensatory strategies to increase self-care, accommodate impairments, and manage symptoms from ongoing disease.
  • 22. Where are we now? The availability of cancer rehabilitation
  • 23. Current landscape of Cancer Rehab • Many oncology guidelines now include recommendations for cancer rehabilitation referral and interventions rehabilitation is a recognized component of oncology care – BUT there is currently no comprehensive rehabilitation guideline or clinical pathway for cancer care. • The availability of rehabilitation services for cancer patients remains limited in most countries • It is estimated that only 1-18 in 200 cancer patients have access to cancer rehabilitation services These gaps in access have significant consequences, as timely and appropriate rehabilitation can improve functional outcomes, reduce symptom burden, and enhance overall quality of life for cancer survivors.
  • 24. Cancer Rehabilitation in Canada • Comprehensive cancer rehabilitation programs are still the exception in cancer care in Canada • It is estimated that ~20 sites across the country offer some form of cancer rehabilitation programming. Less than 10 physiatrists who specialize in cancer rehabilitation Causes: 1. The funding structure of cancer care remains focused on acute care and does not include outpatient rehabilitation • where funding is available, it is often short-term (grants) and/or depend on charitable organisations and foundations 2. There is a limited pool of rehab professionals with training/expertise in cancer rehab • creates a challenge to developing a comprehensive cancer rehabilitation program with a multidisciplinary team = services are one-dimensional with a focus on treating symptom/impairments separately 3. More research is needed to benefits and cost-savings and justify the ”ask”
  • 25. ACRM blueprint to advance cancer rehab • In 2019, the American Congress of Rehabilitation Medicine(ACRM) created a blueprint to advance cancer rehabilitation and proposed five steps: Stimulating and funding research to show benefits of cancer rehab Using that science base to develop clinical practice guidelines increasing clinical capacity by educating more cancer rehabilitation providers Engaging in marketing campaigns highlighting the value of cancer rehabilitation Lobbying for legislative change to improve access and funding
  • 26. Role of Advocacy • Advocacy can take many forms including governmental lobbying, letter writing campaigns, social media, sharing personal stories – Contact and lobby you local representatives and those who serve on relevant governmental committees. – Partner with like-minded people who have relationships with “change makers”. – Partner with patient and healthcare organizations and sponsor letter-writing campaigns to voice advocacy – Share personal stories can help to humanize the nature of the suffering that is ongoing and faced by cancer survivors and help build support for change. – Social media can be used to amplify your message – Ask for and demand cancer rehab services “tell the right story to the right person with the right data.”
  • 27. Cancer rehabilitation is at a critical the number of cancer survivors in Canada is expected to double by 2040 Many will develop functional impairments or become disabled because of cancer or cancer treatment However, there remain significant gaps in the provision of rehabilitation services for patients with cancer in Canada and this contributes to a growing morbidity burden. We need a change.
  • 28. Smith et al., 2020 It is challenging, if not impossible, to imagine a high-quality oncology care system that does not include rehabilitation service. Cancer rehabilitation has been reported to be an effective and efficient way to improve patient function, reduce symptom burden, and reduce resource utilization. Given that cancer patients’ life expectancies are consistently shown to be reduced worldwide when their diagnosis is associated with disability, rehabilitation must be considered an essential component to comprehensive cancer care. Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil. 2020 Jan;42(1):8-13. doi: 10.1080/09638288.2018.1514662. Epub 2018 Dec 21. PMID: 30574818.
  • 29. “While we may be living clinically with no evidence of disease, we live with the evidence of the history of our disease every day. Like petrified trees or fossilized shells, cancer treatments leave permanent physical and psychological reminders of our cancer experience. As greater attention is being focused on the optimized management of long-term toxicities in cancer survivorship, my sincere hope is that there will be effort to educate cancer and non-cancer medical staff alike about the real physical and psychosocial adverse effects as well as advances in treatment that will both prevent development of long-term toxicity and yield better solutions for when they do occur. I hope better options will be available to all cancer survivors with all stages and all disease types in the not- so-distant future. I am OK, really, but I am not sure ‘otherwise healthy’ really applies to me.”

Editor's Notes

  1. 11.