I am thrilled to be sharing Part 3 - my reflections on the future of Oncology Rehabilitation (Onc R).This three-part series for the APTA MI Lines blog has offered everyone a journey through the past or history of oncology rehabilitation (Part 1), the present state of the profession of Onc R (Part 2) and now we’ll complete our journey focusing on the future of Onc R, which is absolutely magnific! So buckle up my friends!
My colleagues Chris Wilson and Lori Boright have traveled with you through the incredible levels of evolution that our profession has completed to bring Onc R to not only Michigan but globally. We are so thrilled every day to read the rigorous research published regarding rehab for persons diagnosed and living with and beyond cancer (PDLWBC), to celebrate the collaborations among clinicians all over the world as well as the new Onc R programs being created constantly, and acknowledge and praise all rehab professionals including occupational therapists, certified occupational therapist assistants, speech language pathologists, social workers, involved at all levels of care for PDLWBC. It is so very exciting! The physical therapy profession is truly leading the way as a catalyst for increasing quality of life for all PDLWBC. We feel especially blissful as we published our textbook entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians (https://www.elsevier.com/books/oncology-rehabilitation/doherty/978-0-323-81087-6). This book was co-edited by Chris, Lori and me but we are blessed to have 56 additional authors from 17 states and 4 countries bring their Onc R expertise to the written word. There are so many incredible therapists leading the world-wide charge to improve the lives of PDLWBC that it makes my heart sing!!
You might think that this is it. How could we do more? Well, the physical therapy profession is just getting started. Let’s explore the possibilities! The residency programs are growing in number so now it is time to develop “Fellowships”. These may include advanced specializations such as research, pediatric oncology, oncologic pelvic health, and acute care oncology to name a few - and we have colleagues in the national arena that are working on this opportunity right now.
The concept of rehab navigation is a new and exciting area; imagine having a rehab professional who manages all aspects of movement and function with a PDLWBC throughout their entire cancer journey and into survivorship. There are currently a small and mighty group of individuals pioneering this role, but it is growing rapidly and once again the physical therapy profession is leading the way. This new area of specialty will allow patients to receive rehab earlier in their continuum of care and help prevent the severity of adverse effects (AEs) from cancer treatment.
The oncology population is desperately in need of frequent and reimbursable telerehabilitation. Their mental, physical, psychosocial, and psychoemotional stability is challenged daily during and after treatment for cancer. Having easy access to rehab via telerehab can provide continuity of care during times when patients can’t travel to a clinic. Oh, I know that some of you are shaking your heads saying that insurance just won’t pay for it and do not see the value. Well then, we are going to change that! As doctors of physical therapy and licensed physical therapist assistants, we can no longer stand by and just accept the health injustices put upon our profession but more importantly put upon our patients. Once again, we are leading the charge in bringing health justice to cancer care.
And while we’re on the subject of health justice, the utilization of artificial intelligence in rehabilitation is not only fascinating but essential to bring Onc R to geographically remote individuals. This allows information and communication technologies to assist (synchronously and asynchronously) in the decentralization of Onc R for those facing traditional logistical challenges to rehab, including time, distance to travel, difficult terrains, costs, and limited access to clinical facilities. And since the future absolutely has opened the door to treating patients in and outside of our state, there will be more work needed to assist the changes in state laws that currently prohibit interstate rehabilitation services; this can be achieved by the growing interstate licensure compact (https://www.apta.org/your-practice/licensure/licensure-compact). We will once again lead the way!
The previous blogs highlighted how Onc R should begin at the time of diagnosis. I couldn’t agree more. There is a small scattering of hospitals that have standard orders on the inpatient units for all persons diagnosed with cancer to receive a physical therapist (PT) consult. The goal is that Onc R becomes standard of care for every single person diagnosed with cancer; that a PT is an essential component of every cancer care team/tumor board/survivorship clinic; and that patients have easy access to a PT consult and whatever follow-up care is needed in every setting including inpatient, outpatient, inpatient rehabilitation, skilled nursing facility, palliative care, and hospice care. This aims to provide Onc R to not only every single person diagnosed with cancer but also guarantees special emphasis on those that are currently marginalized and undertreated.
I am very passionate about lifestyle medicine and humanistic care, incorporating cultural norms and beliefs as well as integrative therapies into our practices and truly treating each ‘person’ not treating diseases or AEs. I am proud that our profession is making substantive changes in entry-level education as well as clinical practice to try and incorporate these treatment philosophies into our profession, however, we need to be more comprehensive with our care through addressing all a patients’ needs. Once again, we will lead the way in making this the rule instead of the exception! The great news is there is hard work going on in many states right now to change the laws so that PTs are autonomous healthcare practitioners, where patients no longer will need the often-unnecessary administrative barrier of a prescription to access physical therapy services. This is absolutely the future of the physical therapy profession. I have no doubt that in the near future, PTs across the nation will be able to treat patients diagnosed with cancer without struggling to convince the medical community that rehab is essential. We will also help insurance companies to recognize the value of Onc R as early rehab intervention saves money, decreases the prevalence of AEs from cancer treatment, and provides the opportunity for every person to enjoy quality of life after cancer.
But wait, there’s more! The care that I have been referring to throughout this blog is secondary, tertiary, and quaternary prevention. Secondary prevention refers to prehabilitation, education, and consultation at the moment of diagnosis to prepare a person for the treatment of cancer. Tertiary care is where PTs “live” most of the time…treating the AEs caused from the cancer and the treatments for cancer. Through education and traditional physical therapy interventions we can prevent, mitigate, and manage AEs. Quaternary care is preventing the overmedicalization of care, which is our role as rehab navigators, members of cancer care teams, tumor board committees, survivorship clinics, and more. But let’s not forget about primordial and primary prevention. PTs are very well positioned and have the expertise to help with community and individual prevention of cancer. Primordial prevention requires changes in local and state laws to build, create, and implement programs and spaces that provide safe, easily accessible opportunities for physical activity (walking/biking paths), good nutrition (farmers markets located in food deserts), decreasing stress (group community programs of education, support groups, meditation) and so much more. Primary prevention is the individual lifestyle behaviors that can actually prevent cancer from occurring. The research is abundant and provides lots of guidance that healthy eating, good sleep, stress reduction, daily physical activity, spiritual practices, and related behaviors can positively impact epigenetic changes and decrease systemic inflammation (a driver of cancer) which will reduce the risk of cancer development. Once again, we will lead the way in the primordial and primary prevention domains!
Isn’t this absolutely epic?! The future of Onc R is crazy exciting, filled with so many possibilities, so many evolutionary leaps and bounds and PTs are up to the challenge! We have such great leaders nationally and globally that I have no doubt that in not too many years this blog will highlight exactly these successes and the continued evolution of our great profession!
Blessings to all of you!
Deb Doherty, PT, PhD is an associate adjunct professor at Oakland University in Rochester, MI. Deb is retired from clinical practice and continues to work as a cancer coach and participates in research focusing on oncology rehabilitation. She is the co-editor of the book entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians published by Elsevier. Deb also serves as the chair of the Research Committee for the APTA MI Onc Rehab SIG as well as a frequent lecturer on Onc Rehab to clinicians, students and survivors.
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