by Eileen Casey
In 1929 an article in the Journal of Medicine offered this advice about how to help patients who have suffered a heart attack:
“The nurse should be carefully instructed to do everything in her power to aid the patient in any physical activity so that all possible movements such as feeding himself or lifting himself in bed are spared…Finally the patient should be urged to spend at least 6 weeks and preferably 8 weeks or more absolutely in bed.”
This outlook had significant consequences and by the late 1930s many people were out of work due to cardiac disease. Slowly things started to change. By the 1950s medical research was beginning to show that this was the wrong approach to treat someone after a heart attack. By the 1960s it was known that early movement and supervised exercise were optimal. Cardiac Rehab was born. Today comprehensive cardiac rehab is the gold standard of care.
Oncology or cancer rehab is undergoing a similar evolution. In years past, a number of patients who finished acute cancer treatment were left to struggle with issues such as pain, profound fatigue, deconditioning or loss of motion due to surgery, chemo or radiation treatments. There was little in the way of help to offer these patients and many were left with the impression that this was their “new normal” that they just had to accept. With over 12 million cancer survivors in the U.S., and nearly a million new cancer diagnoses each year, we need to offer more to these patients.
Many professional organizations are recognizing the need for formal cancer rehab. The American College of Surgeons’ Commission on Cancer (COC) has become a leader in ensuring that cancer rehab is part of the continuum of care for oncology patients. The National Comprehensive Cancer Network (NCCN) has issued clinical guidelines for survivors including guidelines to address pain, fatigue, cognitive function and exercise. Many of these issues can be addressed with rehabilitation. A growing body of research suggests that exercise can help improve survival, prevent declines in fitness and improve outcomes of cancer treatments.
Despite the growing evidence demonstrating the benefit, many patients are never referred for formal rehab services. Some patients may be told to “stay active” or “exercise more” and some may even be referred to an exercise class; however, many survivors are not ready to exercise with people who are not healthcare providers. Exercise alone is not cancer rehab. Cancer rehab should be a comprehensive, multidisciplinary team approach. Care provided should be evidence-based. Outcomes, or how well patients respond to treatment, should be tracked. Rehab is meant to help improve function and decrease disability.
Think about someone who has had a stroke or broken bones and is having problems getting around. Their doctor would generally refer them to rehab first, not to a fitness center to exercise on their own. Rehab professionals would evaluate the person to see what their problems were and then develop a treatment program to help address those problems. Rehab would not change the fact that the person had a stroke or broken bones but could significantly improve how well that person functions. Once their maximum function was achieved, then the person would be ready to continue on with a community-based exercise program.
Rehab is almost a given for orthopedic issues, trauma, strokes, brain injuries or other neurological issues. A cancer diagnosis can be as life changing as a stroke or a major trauma. Cancer patients have to deal not only with the psychological trauma that a cancer diagnosis can produce but they are also given treatments that can cause physiological trauma that leave as many as 1 in 4 with physical problems. Rehab can help optimize their recovery. Yet for cancer patients this is not yet the standard of care, but progress is being made in that direction.
BMH has partnered with Oncology Rehab Partners to be able to provide a comprehensive, coordinated rehab program to oncology patients through the Survivorship Training and Rehab (STAR) Program® Certification. The STAR Program® was developed in response to the need for well-developed and integrated cancer rehab training. Our multidisciplinary team includes physical therapy, occupational therapy, speech therapy, nutrition and oncology nurses. By obtaining STAR Program® certification, the staff at BMH has made a commitment towards providing an integrated approach to cancer care that includes rehab for our patients.
Not every cancer patient needs rehab, and those who do may not need all services offered. But for those who do need it, the staff has been trained to help provide oncology patients with a range of services such as physical or occupational therapy, speech therapy and nutritional counseling. If you think you or someone you know may benefit from the program, please speak to your doctor about a referral.
Eileen Casey, PT, is the Director of Rehab Services at Brattleboro Memorial Hospital. She can be reached by calling 802-257-8255. The BMH STAR Program team will be hosting an open house on May 22 from 5 to 6 PM on the 1st floor of the Richards Building for anyone interested in learning more about the program and meeting with the staff. Light refreshments will be served.