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Eric and I “met” during a twitter exchange on survivorship care. In this excellent article, he shares his perspective on what’s needed for a cancer survivorship plan. As a patient, I have a different perspective. From my view, while an MD needs to be part of your team, he/she shouldn’t necessarily lead it. My experience to date (here, here, and here) suggests that a wider range of assistance is needed. What about ongoing nutritional change? Exercise during/after chemo/surgery/radiation? How to deal with a new body, a fuzzy mind and new constraints? What about longer term after effects?
Stay tuned for our on-going debate!
The Commission on Cancer now requires all accredited cancer centers to provide a detailed survivorship care plan for all cancer survivors. The essential components of a survivorship care plan include:
1) Details of the cancer diagnosis
2) Providers involved in the patient’s care
3) Cancer treatments administered
4) Follow up surveillance including: schedule for follow-up visits, surveillance testing to rule-out cancer recurrence and identification and management of long-term and late effects.
5) Health promotion strategies including: smoking cessation, alcohol and dietary modifications, regular weight-bearing exercise
The bullets bolded above can best be addressed through cancer rehabilitation. Cancer rehabilitation has been 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.”
While this definition may be a mouthful, the concepts are simple. Cancer rehabilitation helps cancer survivors maintain and restore their functional health before, during, and after cancer treatment. Getting back to the survivorship care plan, the requirement to “identify and manage long-term and late effects” of cancer, is typically done through rehabilitation. Many of these long-term effects, are functional impairments such as stiffness, fatigue, and balance problems, which are best managed by rehabilitation specialists.
The survivorship care plan component to encourage regular weight-bearing exercise can best be managed by a rehabilitation specialist. The problem with exercise plans in cancer survivors being initially managed by exercise specialists (such as personal trainers), is that in general, they have minimal training and are unfamiliar with functional impairments in cancer survivors. A highly trained rehabilitation specialist, such as a physiatrist (a physician specializing in physical medicine and rehabilitation), physical therapist, or occupational therapist has extensive training in the identification and treatment of impairments that can affect function. If functional impairments are not adequately addressed, it may even make it unsafe for patients to begin an exercise program.
For the reasons stated above, the requirement to develop survivorship care plans is a great opportunity to develop strong cancer rehabilitation programs at cancer centers nationwide. Such programs are becoming more common, but there are still too many cancer patients across the United States that receive little to no rehabilitation. If you work in a cancer center, encourage your leadership to develop cancer rehabilitation programs. If you are a patient, demand that you have access to cancer rehabilitation services.
Through these efforts, cancer patients will not only have the opportunity to survive their cancer, but actually live well, get back to the vocational and recreational activities they enjoy, and have a high quality of life.
2) Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA. Cancer rehabilitation and palliative care: Critical components in the delivery of high-quality oncology services. Support Care Cancer. 2015 Aug 28
Eric Wisotzky, MD, is the chair of the Division of Rehabilitation Medicine, and the director of Cancer Rehabilitation at MedStar National Rehabilitation Network (NRH). Dr. Wisotzky graduated from medical school at Albany Medical College and completed a transitional internship at the National Naval Medical Center in Bethesda, Maryland. He trained at the Navy Aerospace Medicine Institute in Pensacola, Florida, and graduated as a flight surgeon. He was then stationed for the next three years at Point Mugu, California, as a flight surgeon.
Dr. Wisotzky was selected to be the team physician for the U.S. military triathlon team at the World Military Games in Mumbai, India. He received a Navy Commendation Medal for his military service.
After completing his active duty in the Navy, he started residency in Physical Medicine and Rehabilitation (PM&R) at New York-Presbyterian Hospital, the university hospital of Columbia and Cornell. Several months of this residency program included training in cancer rehabilitation at Memorial Sloan-Kettering Cancer Center.
Dr. Wisotzky served as chief resident and was also elected chair of the Association of Academic Physiatrists (AAP) Residents/Fellows Council. He has served as co-course director of the AAP’s Residents/Fellows Workshop. Dr Wisotzky speaks regularly at national conferences and is the author of several publications, including the MedStar NRH Press publication Managing Breast Cancer: A Guide to Living Well Through Physical Medicine and Rehabilitation.
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