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Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care

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Abstract

Recent calls from oncology providers and cancer policy forums advocate for improved connections between rehabilitation services and cancer care delivery. Traditionally, this intersection has occurred when patients present with overt disability related to cancer treatment and is driven by reactive approaches to care. A growing body of evidence suggests that a proactive approach to functional screening and assessment encourages the identification and management of functional impairment and morbidity earlier in the cancer care continuum and contributes to better outcomes. A clinical pathway that prompts screening and referral to rehabilitation services in an expedited manner is needed. Cancer patient navigators provide care coordination through the duration of medical treatment, survivorship, and end-of-life. This article presents a framework for navigation workflows to support functional assessment and provide early triage pathways to the rehabilitation system of care. We provide a case example of novel approach to patient navigation from a Southeastern United States community cancer center that uses a patient navigator with a rehabilitation background to serve in this role. An overview of the position skills, functional assessment and referral pathways, and perspective on quality improvements related to this approach are described. The use of rehabilitation providers beyond traditional clinical roles should be further explored. Their expertise in functional assessment and interpretation could foster improvements in cancer care delivery and outcomes for survivors in both the short and long term.

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Notes

  1. http://oncologyrehabpartners.com/

  2. https://www.epic.com/software

  3. https://www.facs.org/quality-programs/cancer/coc/standards

References

  1. Cheville AL, Beck LA, Petersen TL, Marks RS, Gamble GL (2009) The detection and treatment of cancer-related functional problems in an outpatient setting. Support Care Cancer 17(1):61–67

    CAS  PubMed  Google Scholar 

  2. Pergolotti M, Deal AM, Lavery J, Reeve BB, Muss HB (2015) The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. J Geriatr Oncol 6(3):194–201

    PubMed  PubMed Central  Google Scholar 

  3. Penttinen H, Saarto T, Kellokumpu-Lehtinen P et al (2011) Quality of life and physical performance and activity of breast cancer patients after adjuvant treatments. Psycho-Oncology. 20(11):1211–1220

    CAS  PubMed  Google Scholar 

  4. Van Muijen P, Weevers N, Snels IA et al (2013) Predictors of return to work and employment in cancer survivors: a systematic review. Eur J Cancer Care 22(2):144–160

    Google Scholar 

  5. Silver JK (2014) Cancer rehabilitation and prehabilitation may reduce disability and early retirement. Cancer. 120(14):2072–2076

    PubMed  Google Scholar 

  6. Braithwaite D, Satariano WA, Sternfeld B, Hiatt RA, Ganz PA, Kerlikowske K, Moore DH, Slattery ML, Tammemagi M, Castillo A, Melisko M, Esserman L, Weltzien EK, Caan BJ (2010) Long-term prognostic role of functional limitations among women with breast cancer. J Natl Cancer Inst 102(19):1468–1477

    PubMed  PubMed Central  Google Scholar 

  7. Cheville AL, Kornblith AB, Basford JR (2011) An examination of the causes for the underutilization of rehabilitation services among people with advanced cancer. Am J Phys Med Rehabil 90(5):S27–S37

    PubMed  Google Scholar 

  8. McEwen S, Rodriguez AM, Martino R, Poon I, Dunphy C, Rios JN, Ringash J (2016) “I didn’t actually know there was such a thing as rehab”: survivor, family, and clinician perceptions of rehabilitation following treatment for head and neck cancer. Support Care Cancer 24(4):1449–1453

    PubMed  Google Scholar 

  9. Silver JK, Raj VS, Fu JB et al (2017) Most National Cancer Institute-designated cancer center websites do not provide survivors with information about cancer rehabilitation services. J Cancer Educ:1–7

  10. Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B (2017) Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am 28(1):49–64

    PubMed  Google Scholar 

  11. Silver JK (2015) Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. Semin Oncol Nurs 31(1):13–30

    PubMed  Google Scholar 

  12. Silver JK, Gilchrist LS (2011) Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions. Am J Phys Med Rehabil 90(5 Suppl 1):S5–S15

    PubMed  Google Scholar 

  13. National Academies of sciences, Engineering, and Medicine (2018) Long-term survivorship care after cancer treatment: proceedings of a workshop. The National Academies Press, Washington, DC. https://doi.org/10.17226/25043

    Google Scholar 

  14. Stout NL, Silver JK, Raj VS, Rowland J, Gerber L, Cheville A, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Padgett L, Wolf T, Winters-Stone K, Campbell G, Hendricks J, Perkin K, Chan L (2016) Toward a national initiative in cancer rehabilitation: recommendations from a subject matter expert group. Arch Phys Med Rehabil 97(11):2006–2015

    PubMed  Google Scholar 

  15. Alfano CM, Cheville AL, Mustian K (2016) Develo** high-quality cancer rehabilitation programs: a timely need. Am Soc Clin Oncol Educ Book 35:241–249

    PubMed  Google Scholar 

  16. Alfano CM, Zucker DS, Pergolotti M, Ness KK, Jones LW, Price ND, Schmitz KH, Ligibel JA (2017) A precision medicine approach to improve cancer rehabilitation’s impact and integration with cancer care and optimize patient wellness. Curr Phys Med Rehabil Rep 5(1):64–73

    Google Scholar 

  17. Cheville AL, Mustian K, Winters-Stone K, Zucker DS, Gamble GL, Alfano CM (2017) Cancer rehabilitation: an overview of current need, delivery models, and levels of care. Phys Med Rehabil Clin 28(1):1–17

    Google Scholar 

  18. Krok-Schoen JL, Oliveri JM, Paskett ED (2016) Cancer care delivery and women’s health: the role of patient navigation. Front Oncol 6:2

    PubMed  PubMed Central  Google Scholar 

  19. Paskett ED, Krok-Schoen JL, Gray DM (2017) Patient navigation—an effective strategy to reduce health care costs and improve health outcomes. JAMA Oncol 3(6):825–826

    PubMed  Google Scholar 

  20. Rocque GB, Pisu M, Jackson BE, Kvale EA, Demark-Wahnefried W, Martin MY, Meneses K, Li Y, Taylor RA, Acemgil A, Williams CP, Lisovicz N, Fouad M, Kenzik KM, Partridge EE, for the Patient Care Connect Group (2017) Resource use and Medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol 3(6):817–825

    PubMed  PubMed Central  Google Scholar 

  21. National Academies of Sciences E, Medicine (2018) Establishing effective patient navigation programs in oncology: proceedings of a workshop. The National Academies Press, Washington, DC

    Google Scholar 

  22. Stout NL, Alfano CM, Belter CW, Nitkin R, Cernich A, Lohmann Siegel K, Chan L (2018) A bibliometric analysis of the landscape of cancer rehabilitation research (1992-2016). J Natl Cancer Inst 110:815–824

    PubMed  PubMed Central  Google Scholar 

  23. Ulmer C, Ball J, McGlynn E, Hamdounia SB (2012) Essential health benefits: balancing coverage and cost. National Academies Press

  24. Carvalho E, Bettger JP, Goode AP (2017) Insurance coverage, costs, and barriers to care for outpatient musculoskeletal therapy and rehabilitation services. N C Med J 78(5):312–314

    PubMed  PubMed Central  Google Scholar 

  25. Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA (2015) Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer 23(12):3633–3643

    PubMed  Google Scholar 

  26. Dietz JH (1981) Rehabilitation oncology. Wiley, New York

    Google Scholar 

  27. Cheville AL, McLaughlin SA, Haddad TC, Lyons KD, Newman R, Ruddy KJ (2019) Integrated rehabilitation for breast cancer survivors. Am J Phys Med Rehabil 98(2):154–164

    Google Scholar 

  28. Dalzell MA, Smirnow N, Sateren W et al (2017) Rehabilitation and exercise oncology program: translating research into a model of care. Curr Oncol 24(3):e191–e198

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian C, Gerber LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Smith RA (2012) A prospective surveillance model for rehabilitation for women with breast cancer. Cancer 118(8 Suppl):2191–2200

    PubMed  Google Scholar 

  30. Alfano CM, Pergolotti M (2018) Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabil Nurs 43(4):186–194

    PubMed  Google Scholar 

  31. Halpern MT, McCabe MS, Burg MA (2016) The cancer survivorship journey: models of care, disparities, barriers, and future directions. Am J Phys Med Rehabil (36):231–239

    Google Scholar 

  32. Gunn C, Battaglia TA, Parker VA, Clark JA, Paskett ED, Calhoun E, Snyder FR, Bergling E, Freund KM (2017) What makes patient navigation most effective: defining useful tasks and networks. J Health Care Poor Underserved 28(2):663–676

    PubMed  Google Scholar 

  33. Shah C, Vicini FA, Arthur DW (2016) Bioimpedance spectroscopy for lymphedema assessment: clinical practice guidelines. J Clin Oncol 34(3_suppl):146–146

    Google Scholar 

  34. Cohen EE, LaMonte SJ, Erb NL et al (2016) American Cancer Society head and neck cancer survivorship care guideline. CA Cancer J Clin 66(3):203–239

    PubMed  Google Scholar 

  35. Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB (2017) Cancer care coordination: a systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med 51(4):532–546

    PubMed  Google Scholar 

  36. Mohile SG, Hurria A, Cohen HJ, Rowland JH, Leach CR, Arora NK, Canin B, Muss HB, Magnuson A, Flannery M, Lowenstein L, Allore HG, Mustian KM, Demark-Wahnefried W, Extermann M, Ferrell B, Inouye SK, Studenski SA, Dale W (2016) Improving the quality of survivorship for older adults with cancer. Cancer 122(16):2459–2568

    PubMed  PubMed Central  Google Scholar 

  37. Mohile SG, Dale W, Somerfield MR, Hurria A (2018) Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology summary. J Oncol Pract 14(7):442–446

    PubMed  PubMed Central  Google Scholar 

  38. Jolly TA, Deal AM, Nyrop KA, Williams GR, Pergolotti M, Wood WA, Alston SM, Gordon BBE, Dixon SA, Moore SG, Taylor WC, Messino M, Muss HB (2015) Geriatric assessment-identified deficits in older cancer patients with normal performance status. Oncologist. 20(4):379–385

    PubMed  PubMed Central  Google Scholar 

  39. Atkinson TM, Andreotti CF, Roberts KE, Saracino RM, Hernandez M, Basch E (2015) The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review. Support Care Cancer 23(12):3645–3652

    PubMed  PubMed Central  Google Scholar 

  40. Rowbottom L, Loucks A, ** R, et al. (2018) Performance of the vulnerable elders survey 13 screening tool in identifying cancer treatment modification after geriatric assessment in pre-treatment patients: a retrospective analysis. J Geriatr Oncol 10(2):229–234. https://doi.org/10.1016/j.jgo.2018.10.018

    PubMed  Google Scholar 

  41. Smith SK, Loscalzo M, Mayer C, Rosenstein DL (2018) Best practices in oncology distress management: beyond the screen. ASCO Educational Book 38:813–821. https://doi.org/10.1200/EDBK_201307

  42. Binkley JM, Harris SR, Levangie PK, Pearl M, Guglielmino J, Kraus V, Rowden D (2012) Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer 118(S8):2207–2216

    PubMed  Google Scholar 

  43. Pergolotti M, Lyons KD, Williams GR (2017) Moving beyond symptom management towards cancer rehabilitation for older adults: answering the 5W’s. J Geriatr Oncol 9(6):543–549. https://doi.org/10.1016/j.jgo.2017.11.009

    PubMed  Google Scholar 

  44. Stout NL, Silver JK, Alfano CM, Ness KK, Gilchrist LS (2018) Long-term survivorship care after cancer treatment: a new emphasis on the role of rehabilitation services. Phys Ther 99(1):10–13. https://doi.org/10.1093/ptj/pzy115

    Google Scholar 

  45. Mewes JC, Steuten LM, Ijzerman MJ, van Harten WH (2012) Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review. Oncologist 17(12):1581–1593

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Rehabilitation Medicine Department, National Institutes of Health, MSC 1604, 10 Center Drive, Bethesda, MD, 20892-1604, USA

    Nicole L. Stout

  2. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Alix Sleight

  3. Lee Health System, Fort Myers, FL, USA

    Denise Pfeiffer & Bianca deSouza

  4. School of Health Sciences, Stockton University, Galloway, NJ, USA

    Mary Lou Galantino

  5. School of Medicine, Center for Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Mary Lou Galantino

  6. Department of Physiotherapy, University of Witwatersrand, Johannesburg, South Africa

    Mary Lou Galantino

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Correspondence to Nicole L. Stout.

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Stout, N.L., Sleight, A., Pfeiffer, D. et al. Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care. Support Care Cancer 27, 4497–4505 (2019). https://doi.org/10.1007/s00520-019-04741-0

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