The State and Future of Cancer Rehabilitation in the United States | Juzo USA
October 2023

The State and Future of Cancer Rehabilitation in the United States

Jill Binkley, PT, MSc, CLT, FAAOMPT

It is important to address the physical and emotional aspects of recovery for breast cancer survivors. Specialized, evidence-based rehabilitation—including physical and massage therapy, nutrition counseling, exercise, lymphedema management and emotional support—has proven benefits for survivors. Jill Binkley is a breast cancer survivor and passionate advocate for rehabilitation. She founded TurningPoint Breast Cancer Rehabilitation to help improve the quality of life for those impacted by breast cancer through rehab programs. Jill shared her perspective of the state of cancer rehabilitation in the U.S., and her hopes for the future in the post below. Learn more about TurningPoint and helpful resources at myturningpoint.org.

In 2023, it is estimated that there will be 1.9 million newly diagnosed cancer cases in the United States. A cancer diagnosis impacts all aspects of an individual’s life, including social, emotional and physical well-being.

Issues such as lymphedema, fatigue, chemotherapy-related peripheral neuropathy and reduced functional ability often affect a survivor’s ability to fully participate in activities for years after their diagnosis. Rehabilitation and exercise have been shown to be of benefit in reducing and even preventing these issues. In fact, it is estimated that 60-to-90% of survivors of cancer experience physical impairments that are responsive to rehabilitation. Unfortunately, most cancer survivors of report that they did not know about or receive rehabilitation services to address these physical impairments.

Comprehensive models of care that include rehabilitation have been shown to significantly improve physical functioning, quality of life, activities of daily living and activity participation. The Prospective Surveillance Model of Rehabilitation for breast cancer, introduced a decade ago, is gradually being adopted in the U.S., but unfortunately is not widespread. Application of the model is just beginning to be researched and implemented in other cancer types.

For the 20-to-30% of individuals with breast cancer that develop lymphedema, there have been technological advances in early detection of this disease during rehabilitation, including accurate and efficient measures of limb volume and bioimpedance. We now understand much more about lymphedema risk and the benefit of early detection in reducing or even preventing lymphedema. There is promising research, such as the role of prophylactic compression and lymph node bypass surgery that, combined with other evidence-based risk reduction measures, may change the landscape of lymphedema management.

The benefits of prospective surveillance, rehabilitation navigation and rehabilitation and exercise intervention for cancer patients are now documented. There have been advances in the understanding of the importance of rehabilitation for individuals with metastatic cancer and in palliative care and hospice settings. The ideal future of cancer rehabilitation includes widespread implementation of these models and approaches through increasing our oncology rehabilitation workforce, as well as awareness among the medical community of the role of rehabilitation for individuals with cancer.

Addressing the adverse physical and emotional effects of cancer early and universally will improve patients’ quality of life, reduce disparity in survivorship outcomes, and reduce the human and financial toll of addressing treatment side effects once they become more severe and chronic.

Suggested References:

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Truant TLO, Lambert LK, Thorne S. Barriers to equity in cancer survivorship care: perspectives of cancer survivors and system stakeholders. Glob Qual Nurs Res. 2021;8:23333936211006703. doi:10. 1177/23333936211006703.

Stout NL, Silver JK, Alfano CM, Ness KK, Gilchrist LS. Long-term survivorship care after cancer treatment: a new emphasis on the role of rehabilitation services. Phys Ther. 2019;99(1):10-13. doi:10.1093/ ptj/pzy115.

Rafn BS, Singh CA, Midtgaard J, Camp PG, McNeely ML, Campbell KL. Self-managed surveillance for breast cancer-related upper body issues: a feasibility and reliability study. Phys Ther. 2020;100(3):468-476. doi:10.1093/ptj/pzz181.

Stout NL, Sleight A, Pfeiffer D, Galantino ML, deSouza B. Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care. Sup- port Care Cancer. 2019;27(12):4497-4505. doi:10.1007/s00520-019- 04741-0.

Stout NL, Binkley JM, Schmitz KH, et al. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012; 118(8)(suppl):2191-2200. doi:10.1002/cncr.27476.

Flores AM, Nelson J, Sowles L, et al. Lymphedema signs, symptoms, and diagnosis in women who are in minority and low-income groups and have survived breast cancer. Phys Ther. 2020;100(3):487-499. doi:10.1093/ptj/pzaa002.

Crystal commented on Oct 18, 2023
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Awesome article!

 
 

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