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Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services

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Abstract

Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their respective roles in comprehensive oncology care, and highlights how these services can contribute complementary components of essential quality care. An understanding of how cancer rehabilitation and palliative care are aligned in goal setting, but distinct in approach may help facilitate earlier integration of both into the oncology care continuum—supporting efforts to improve physical, psychological, cognitive, functional, and quality of life outcomes in patients and survivors.

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Acknowledgments

The authors would like to thank Julie A. Poorman, PhD, for assistance with manuscript preparation.

Conflict of interest

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Dr. Silver discloses that she is the founder of Oncology Rehab Partners, LLC that developed the STAR Program® (Survivorship Training and Rehabilitation). None of the other authors have disclosures.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA, 02129, USA

    Julie K. Silver

  2. Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA

    Vishwa S. Raj

  3. Department of Palliative, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd. Unit 1414, Houston, TX, 77030, USA

    Jack B. Fu

  4. MedStar National Rehabilitation Network, 102 Irving St, NW, Washington, DC, 20010, USA

    Eric M. Wisotzky

  5. Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI, 48108, USA

    Sean Robinson Smith

  6. American Cancer Society, 555 11th Street NW, Suite 300, Washington, DC, 20004, USA

    Rebecca A. Kirch

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Correspondence to Julie K. Silver.

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Silver, J.K., Raj, V.S., Fu, J.B. et al. Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer 23, 3633–3643 (2015). https://doi.org/10.1007/s00520-015-2916-1

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  • DOI: https://doi.org/10.1007/s00520-015-2916-1

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