Kwok-Leung Cheung Giuseppe Colloca Better Sooner and Later: Kwok-Leung Cheung Giuseppe Colloca

Disclosure Within the last 5 years, Kwok-Leung Cheung has received an honorarium from Chugal; received research funding from AstraZeneca; served as an advisory board member for AstraZeneca and Genomic Health. Giuseppe Colloca has no conflicts of interest to declare.

What is Cancer Rehabilitation? Cancer rehabilitation is defined as “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.”

What is Cancer Rehabilitation? Cancer rehabilitation, similar to stroke and orthopedic rehabilitation, utilizes a multidisciplinary approach to assessment and treatment that helps to: Address disease-related and treatment-related impairments; Decrease the number and/or severity of impairments and long-term problems; Minimize survivors’ distress and disability.

Rehabilitation Interventions Focused on Improving Physical Health and Decreasing Disability.

Interdisciplinary Rehabilitation Team Strategies

Interdisciplinary Rehabilitation Team Strategies

Impairments vs. disability

Examples of Functional Assessment

Identifying Physical Impairments in Patients With Cancer

Identifying Physical Impairments in Patients With Cancer

Identifying Physical Impairments in Patients With Cancer

Common Impairments Treated General Physical Impairments Difficulty returning to premorbid activities Joint pain, diffuse (e.g., arthralgias) Musculoskeletal pain (e.g., myalgias) Neuropathic pain Somatic pain Visceral pain Weakness Fatigue Deconditioning

Functional Disabilities Inability to return to work Difficulty caring for children/grandchildren Limited mobility due to safety concerns (walking, driving, etc.) Inability to travel and take vacations Difficulty with ADLs (e.g., dressing, bathing) Difficulty with IADLs (e.g., chores, shopping)

Cancer Rehabilitation and the Care Continuum

What is Cancer Prehabilitation?

What is Cancer Prehabilitation? “process on the cancer continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment and includes physical and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments.”

Examples of Prehabilitation Goals ▪ Improve cardiovascular, pulmonary, and/or musculoskeletal function. ▪ Improve balance and reduce the risk of falls. ▪ Reduce anxiety and improve coping with specific cognitive behavioral strategies. ▪ Improve quality of sleep with sleep hygiene education. ▪ Optimize surgical outcomes with smoking cessation interventions. ▪ Optimize diet with nutrition counseling. ▪ Begin preoperative pelvic floor muscle strengthening to improve continence outcomes. ▪ Begin pretreatment swallowing exercises to improve swallowing outcomes. ▪ Implement home safety strategies to avoid falls. ▪ Facilitate return to work with adaptive equipment.

Prehabilitation → Rehabilitation Nutrition Exercise Anxiety Smoking/Alcohol

Prehabilitation → Rehabilitation Surgery in adults Cancer surgery in older adults Single vs multi-modality approach Prehabilitation vs rehabilitation Enhanced recovery after surgery (ERAS)

Improving the Oncology-Rehabilitation Interface   ▪ Include trained rehabilitation professionals in the formal cancer care programming, ▪ Educate all staff involved in the care of oncology patients about impairment-driven cancer rehabilitation care. ▪ Establish a multidisciplinary cancer rehabilitation program/service line ▪ Use screening tools to identify impairments. ▪ Identify screening opportunities and integrate with appropriate on-site and/or local referral resources. ▪ Require documentation of the navigation process, including cancer rehabilitation referrals. ▪ Track patient functional outcomes across the continuum of care beginning with a baseline assessment. ▪ Include reassessments to identify new or ongoing rehabilitation needs. ▪ Include the patient as a partner in his/her rehabilitation care.