Rehabilitation

Recommendation: 

Rehabilitation services are available for cancer survivors with physical and/or cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life.

Overview

Rehabilitation has quickly become a service that survivors and providers expect, and one that can assist in compliance to treatment through symptom management. The Commission on Cancer and JCAHO require accredited programs to have policies and procedures in place to ensure survivor access to rehabilitation services either on-site or by referral.

Cancer rehabilitation services include the following:

  • Lymphedema Program
  • Occupational Therapy
  • Pain Management
  • Speech Therapy
  • Physical Therapy
  • Audiology
  • Pelvic Floor Therapy

Therapist responsibilities:

  • Collaboration and coordination of care in a multidisciplinary team setting, managing issues impacting the survivor’s functional status through appropriate screening, assessment, and intervention across the care continuum
  • Addresses and integrates side effect management, integrative medicine issues in the context of evidence-based care and services
  • Provides treatment and education information about maintaining or restoring function, reducing symptom burden, maximizing independence and improving quality of life throughout survivorship

Standards/Accreditations

Certification

All rehabilitation staff (Physical Therapy, Occupational Therapy, Speech-Language Pathology, and Audiology) have degrees and are licensed providers. There are additional certifications for lymphedema therapy, pelvic floor therapy, myofascial release training, swallowing disorders, etc., that benefit the care of cancer survivors. Additional speech therapy specialty certifications that may of benefit include: BCS-S (Board Certified Specialist- Swallowing and Swallowing Disorders); MBSImp (Modified Barium Swallow Impairment Profile). The American Board of Physical Therapy Specialist (ABPTS) has scheduled the first Board Certification Examination for Oncology Specialist Certification in Spring 2019.

Resources to Help

Commission on Cancer Cancer Program Standards, 2016: Eligibility Requirement (ER)11

Caseload Benchmarks

There are no caseload benchmarks for cancer rehabilitation. The following information is based on typical rehabilitation caseloads. Physical therapy, occupational therapy, and speech therapy appointments are in 30-45 minute sessions. Lymphedema caseload is less as the average appointment time is 1 to 1.5 hours. The average number of physical therapy and occupational therapy appointments per survivor is 12 visits. Speech therapy appointments for head and neck survivors may average 12 visits as well. Audiology appointments are typically 1 hour with a baseline and two follow-up appointments over a period of a survivor’s treatment. Appropriate staffing can be calculated by considering the above treatment patterns, annual analytic cases, and the cancer program’s goals.

Insurance Considerations

Cancer rehabilitation is provided by healthcare providers with degrees and licenses in rehabilitation medicine, medical insurance should cover some or all of the costs of rehabilitation care. These covered items usually include evaluation and treatments. Insurance coverage may also differ between hospital-based and freestanding clinics. Obtaining reimbursement for preventive care and baseline examinations can sometimes be challenging.  As with all insurance concerns, survivors are encouraged to check with their insurance carriers about deductibles, co-pays and coverage limits. 

 

ACCC Member Program: Novant Health Cancer Care, Charlotte, N.C.

Novant Health Cancer Care and Rehabilitation Medicine began collaborating in 2005 to provide services beyond an established lymphedema program.

The original goal was to provide cancer survivors with easy, local access to trained rehabilitation providers when physical and/or cognitive impairments were identified.

Next steps were to target disease-specific diagnoses. Novant's first pilot focused on breast cancer survivors in need of physical therapy for decreased upper extremity range of motion. After education for clinical team members on need, services, and process for referrals, the program saw a 60 percent increase in physical therapy referrals.

Following this, a pilot addressing services for head and neck survivors was launched. The head and neck program was established to ensure a multidisciplinary approach for this complex patient population. An interdisciplinary tumor board, specific to head and neck survivors, was initiated. Referrals to ancillary team members (e.g., speech therapy, nutrition) were established as a standard of care for newly diagnosed survivors. Now, survivors benefit from coordinated services/visits from speech therapy, physical therapy, audiology, nutrition, nursing, radiation oncology, and medical oncology.