While cancer treatments are helping people live longer, many physical and mental impairments can result from these treatments, which can affect patient function and quality of life. Muscular weakness, fatigue, pain, anxiety, cognitive problems, swallowing, speech problems and lymphedema are just a few some survivors may face. If they remain unaddressed, these impairments can result in disability.
Fortunately, evidence-based multidisciplinary cancer rehabilitation has been shown to improve patients overall health, functional outcomes and quality of life. A team of clinicians that can include nurses; physical, occupational and speech therapists; physiatrists, nutritionists; and social workers work with patients on a personalized recovery plan designed according to their physical and psychological impairments.
Cancer rehab programs like STAR (Survivorship Training and Rehabilitation) are proliferating around the country, affording more opportunities for nurses to become involved.
Cancer prehabilitation, the newest component of the STAR Program and an emerging medical discipline, is offered to patients between diagnosis and the start of treatments. Its goal is to obtain baseline assessments and then provide evidence-based multidisciplinary interventions to help newly diagnosed survivors become physically and emotionally stronger before they start cancer treatment. Cancer prehab can prevent complications from treatments and even increase treatment options.
Rehabilitation answers the need
In June, Lahey Hospital & Medical Center in Burlington, Mass., implemented a STAR Program in which an initial team of 35 clinicians received cancer rehab training. Nearly a quarter of the team consisted of nurses certified in oncology nursing, as well as nurse practitioners. The training involved 10 self-directed online modules (there also are modules for ongoing education and recertification). The online modules provided several resources that helped to develop the many evidence-based protocols which are not unfamiliar to nurses. They include assessment, diagnosis, outcome, planning, implementation and evaluation. The team was provided with standardized tools for collecting data and tracking outcomes. The program helps patients by not only focusing on physical assessment and rehabilitation, but also on psychological impairments, which are assessed and addressed with appropriate referrals.
Bringing different departments within a healthcare facility together, as is done in multidisciplinary cancer rehab, is an approach that is beneficial to patients and clinicians. Karen Masino, MS, RN, CNP, ACNP-BC, AOCNP, RD, LDN, is the co-coordinator of the STAR Program at Ingalls Memorial Hospital in Harvey, Ill. She works with a staff of 25, nearly half of whom are nurses and all are STAR Clinician certified. Masino said Ingalls Memorial patients are receiving better care now because providers are more proactive in identifying patients who need to be referred for rehabilitation. The programs greatest benefit was providing background for those who did not have an oncology background and training participants how to function as a team, she said. It really helped to get people to move out of silos to look at other resources and other professionals and to make sure our patients are connected to those resources.
Deanna Xistris, MSN, APRN, AOCN, the STAR Program coordinator at the Bennett Cancer Center in Stamford, Conn., who has a team of 25 clinicians (five of whom are nurses), finds the interface of clinicians in different disciplines empowering. This program helped develop awareness of what different focus areas are capable of, she said. It is nice to hear others say, Whoa, I didnt know nurses could do that.
Xistris, who has been working in outpatient oncology for more than 30 years and is involved in direct patient care and teaching, said while nurses have always been aware of treatment regarding ADLs, utilization of rehab was limited and targeted to the end of therapy. The STAR Program certification gives formal recognition to what Ive been trying to do for 20 years keep my patients functional during treatments and not just at the end, she said. With prehabilitation, the trajectory of recovery after treatment is not as steep.
Xistris shared a story about a patient who was having difficulty using her hand to pick up an object because of neuropathy caused by chemo. Six months ago I would not have thought to send the patient to PT, but now there are therapists at Bennett who are trained to understand the side effects of cancer treatments and how to screen and help improve patient function, she said.
She referred the patient to PT, the patient was given a driving test and as a result she was able to get hand controls for her car that her insurance will cover. Being able to resume driving means the survivor can get to work, pick her kids up from school, visit a friend and do errands. Being able to perform routine daily activities after cancer makes life feel normal again and brings confidence, a sense of purpose and peace of mind.