title: Cancer Rehabilitation: An Overview of Current Need, Delivery Models, and Levels of Care.
abstract: The relevance of cancer rehabilitation as a public health issue grows steadily as cancer incidence, survival, and mean patient age increase. Reported rates of physical impairment and disability are already high, prior to the anticipated influx of aged cancer survivors. Despite the high prevalence of cancer-related disablement, treatment rates, even for readily remediable physical impairments, are as low as 1-2%. In addition to low referral rates, a challenge to patient-centric cancer rehabilitation is a fractured system that requires multiple visits to a range of specialists to address even a single issue, and cancer survivors generally have several. Effective solutions must acknowledge the limited cancer rehabilitation clinical work force and its clustering in tertiary centers, as well as the lack of consensus regarding the essential and effective components of a cancer rehabilitation program. A number of models of cancer rehabilitation service delivery have been developed, but, as yet, none have been empirically validated. This paper describes these models and proposes a taxonomy for stratifying the needs of cancer survivors. Modalities used to preserve or restore function among survivors range from simple, relatively intuitive activities to complex, integrated programs that include diagnostic and multi-modal pharmacological, manual, and even procedural interventions. Criteria for determining a survivor's needs across this spectrum are proposed, and the role of the physiatrist as a vital advocate and champion discussed.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: Cheville.andrea@mayo.edu.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cheville
authors.affiliation: University of Rochester Medical Center, Department of Surgery, 601 Elmwood Avenue, Rochester, NY 14642, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Mustian
authors.affiliation: School of Nursing, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA.
authors.forename: Kerri
authors.initials: K
authors.lastname: Winters-Stone
authors.affiliation: Swedish Cancer Institute, Swedish Medical Center, 1101 Madison, Suite 200, Seattle, WA 98104, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Zucker
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Gamble
authors.affiliation: American Cancer Society, Inc, 250 Williams Street NW, Atlanta, GA 30303, USA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Alfano
mesh_terms: D000073116:Cancer Survivors; D006233:Persons with Disabilities; D006801:Humans; D009369:Neoplasms / Q000534:rehabilitation*
keywords: Cancer rehabilitation; Delivery models; Levels of care