CANCER REHABILI-TATION

Past, Present and Future

A history of cancer rehabilita-tion An examination of the history of cancer

rehabilitation will steer us toward future success for our patients.

DeLisa JA.

Cancer. 2001 Aug 15;92(4 Suppl):970-4.

Dr. Howard Rusk (1960) A world to Care

A patient with bladder cancer who required a hemi-corporectomy at New York City’s Memorial Hospital

Able to return home after transferred to the Institute of Rehabilitation Medicine

Partner with Memorial Hospital’s Dr. Herbert Dietz

Dietz (1969) A successful cancer rehabilitation programAcute care hospital + A cancer hospitalNot duplicated in other facilities

Dietz model of cancer rehabilitation (1980)Preventative, Restorative, Supportive, Pal-

liative

The National Cancer Act (1971)National Cancer Institute (NCI), National Institutes of

Health (NIH), The Division of Cancer Control and Rehabilitation

A lack of a specific implementation plana lack of trained personnelFailure to educate referring health care pro-

fessionals

Lehman et al (1978)Assessment of problemsGaps and barriersA model of rehabilitation care

delivery

Arch Phys Med Rehabil 1978;59:410–9

Harvey et al (1982)○ 36 cancer rehabilitation program

○ Patient education, protocols for specific can-cer sites, family involvement, pain control methods

○ Referral patterns, team communications, ef-fective outcomes

JAMA 1982;247:2127–31

1970-1980

• A decline in federal funding and emphasis• Failure to educate oncologists about the po-

tential benefits of rehabilitation • Failure to prioritize cancer rehabilitation as

an important part of education• A shift in physiatric interest

A Review of the Literature since the Survey

O’Toole and Golden (1991)70 cancer patients admitted to a freestand-

ing rehabilitation hospital

West J Med 1991;155:384–7

Yoshioka (1994)A prospective 6-year study involving 301

terminal cancer patients in an inpatient hos-pice in Japan

Barthel mobility index : 12.4 → 19.978% Satisfaction

Am J Phys Med Rehabil 1994;73:199–206

DePompolo (1994)The experience of the cancer rehabilitation

program at the Mayo ClinicNeed of emotional support, pain, and im-

pairments in activity of daily living, and mo-bility

Sabers et al (1999)¾ pain, difficulty rising from chairGetting on and off a toilet, walking, climbing

stairs

Marciniak et al (1996)The Rehabilitation Institute of Chicago 159 consecutive patients admitted to inpa-

tient rehabilitation servicesFIM 42.9 → 56.0 Influencing factors

Metastatic disease (x)Radiation (o)

Arch Phys Med Rehabil 1996;77:54 –7

Stafford and Cyr (1997)Medicare Current Beneficiary Surveyby the Health Care Financing Administration

(HCFA)1647 respondents from 9745 elderly com-

munity-based Medicare beneficiaries○ Difficulty with one or more ADL(47%), Walking

(38%), bathing (20%),transfers (21%)

Cancer 1997;80:1973–80.

Van Harten in the Nertherlands (1998)147 cancer patients¼ need for professional care17% more than one problemsPhysical, psychological and cognitive func-

tions

Winningham (2001)Fatigue and pain are major concerns of

cancer patientsUsefulness and benefits of a variety of pro-

grams including exercises and rehabilitation intervention

Cancer 2001;92:988–997.

Integrating cancer rehabilitation into medical care at a cancer hospital

The University of Texas M. D. Anderson Cancer Center

○ 1960 ~1973 : rehabilitation consultation○ 1973 ~ ○ 1989 ~ Baylor College of Medicine

Lessons learned over 40 years○ Strong administrative commitment○ Strong PM&R department○ Marketing of the program○ Strong, continuing educational courses

Cancer. 2001 Aug 15;92(4 Suppl):1055-7.

Europe The policy framework for commissioning

cancer services review (1995)○ Integration of rehabilitation from diagnosis

NHS Cancer Plan ○ Department of Health (DH), 2000

Services beyond cancer centerRegional cancer networksNorthern Ireland Cancer Network (2006)

- The Cancer Care Workforce Team- AHP (Allied health professions)

Guidance on Cancer Services (2004)○ National Institute for Clinical Excellence (NICE)○ Improving Supportive and Palliative Care for

Adults with Cancer○ Four level version

National Cancer Network AHP Lead Fo-rum (2007)

○ a new model of cancer rehabilitation assess-ment and support

Present

U.SCancer survivorship

○ Mullan, F. (1985)Seasons of survival: reflections of a physician with can-

cer. New England Journal of Medicine. 270-273.

국가기관○ CDC○ NCI (National Cancer Institute)

비영리기관○ American Cancer Society○ National Coalition for Cancer Survivorship○ Cancer Care

Cancer RehabilitationAmerican Cancer Society

○ Physical side effectsChemotherapy, radiation effects, pain, fatigue, lym-

phedemaNCCN Task Force

○ Management of neuropathy in cancer (MD Stubblefield)

○ Bone Health and Cancer Care

M. D. Anderson Cancer Center Four full-time physiatrist

In the Section of Physical medicine and rehabilitation in the Department of Palliative and Rehabilitation Medicine within the Division of Cancer Medicine

Outpatient clinic○ Lymphedema, pain, disability evaluations, general de-

conditioning, gait abnormality, fatigue and spasticityInpatient rehabilitation unit

○ More than 400 patients admitted yearly○ Average length of stay 10days○ Brain and spinal tumor (28%), GU, lung, bone, GI,

breast, head and neck

National Rehabilitation Hospital http://www. nrhrehab.org/

AustraliaAustralian Cancer Survivorship Centre,

ACSC○ Patient-centred care○ Shared care○ Long-term follow-up clinics○ Supported self-management○ Multidisciplinary care

Canada

일본

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담당의→환자 · 가족② 방문간호지시서

담당의→왕진의② 진료의뢰

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간호사→방문간호스테이션정보제공

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방문간호스테이션↔케어매니저의뢰 실시보고

환자 · 가족↔케어매니저플랜작성 계약

국내현황 _ 진료 림프부종 클리닉

95 년 말 : 최초로 삼성서울 병원 림프부종 클리닉 개설이후 성모병원 , 일산병원 , 분당서울대병원 , 세브란스병원 , 아산병원 등에서 클리닉 개설

포괄적 암재활 서비스 제공 시작

국내현황 _ 연구 2006 년

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2007 년서울대병원 부종 초음파 연구 ( 서울대병원 )

2009 년진행성 암환자 연구 ( 국립암센터 )

2011 년림프부종 측정 도구 (impedence) 연구 ( 아산병원 )

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보건복지부 암정복추진개발사업“ 유방암 삶의 질에 상지 기능 장애가 미치는 영향 조사 및 삶의 질 향상을 위한 지속적 상지 재활 프로그램 개발”“ 한국 암 생존자의 기능 장애 실태와 국제 장애 분류 (ICF)의 임상적 적용을 통한 장애 관리 프로그램 개발”

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