Position Statement - Rehabilitation of People with Cancer
Endorsed by the Oncology Nursing Society
Cancer survivors represent a unique population of men, women, and children with very specific physical and psychosocial needs. Currently, 15.5 million individuals are living with a cancer diagnosis which represents 4.8% of the US population (American Cancer Society [ACS], 2016); Miller et al., 2016). The projected number of cancer survivors in 2026 is 20.3 million (ACS, 2016) and by 2040, the estimate is 26.1 million. This positive trend in survival is primarily attributed to the advances in early detection and treatment as well as the aging of the US population (Miller et al., 2016).
Individuals are considered cancer survivors from the time of diagnosis throughout the balance of life (NCI, 2017). The continuum of cancer care experienced by the survivor may include surgery, irradiation, chemotherapy, and/or hormonal, immune, and targeted therapies. These treatments are associated with morbidities that may occur during active treatment or months and even years after the completion of treatment (ACS, 2016). Such treatment-related morbidities significantly impact the survivor’s quality of life (Mishra et al., 2015) and often these morbidities can be addressed through rehabilitation (Alfano et al., 2016). A growing body of evidence suggests survivors who experience fatigue, cognitive impairment, pain, lymphedema, sexual dysfunction, swallowing and communication problems, and bowel and bladder problems could benefit from rehabilitation services (Alfano et al., 2016, ACS, 2016). With the continued growth of this population, the US health care system is challenged to deliver the rehabilitation care needed by survivors in order to optimize overall functioning, reduce disability, and improve quality of life (Stout et al., 2016). At this time, most delivery models of care do not integrate comprehensive cancer rehabilitation services into the cancer care trajectory.
Cancer rehabilitation involves an interdisciplinary approach that should be delivered by trained rehabilitation professionals who are knowledgeable about cancer and the morbidities associated with the disease and its treatments. These rehabilitation professionals are poised to diagnose and treat the physical, psychological, and cognitive impairments for the purpose of maintaining and restoring function, reducing symptom burden, maximizing independence, and improving quality of life (Silver, 2015). Depending upon each survivor’s identified needs, the cancer rehabilitation team may include the physiatrist, advanced practice nurse, nurse, care coordinator/navigator, social worker, physical therapist, occupational therapist, speech-language pathologist, psychologist, and vocational rehabilitation specialist. As with rehabilitation for any diagnosis, the team composition may change throughout the survivorship trajectory based upon the survivor’s changing needs.
Essential to providing quality cancer rehabilitation is the knowledge of cancer pathologies, the morbidities resulting from the cancer and its treatments as well as the disease- or treatment-related morbidities that are amenable to prevention, restoration, support, or palliation through rehabilitation services. Competency in assessment, decision-making, coordination, and communication skills is a requisite for each discipline. Nurses who specialize in oncology and rehabilitation nursing are particularly positioned to employ these skills specific to the care of the cancer survivor. The rehabilitation nurse and the oncology nurse each bring a unique knowledge base and set of skills to the care of cancer survivors with rehabilitation needs. Typically, the knowledge and skills of each nursing specialty are employed separately in most settings in which cancer care is provided; yet, the rehabilitation needs of cancer survivors could be best addressed through a collaborative, integrated approach. Therefore, we propose the establishment of The Collaborative Oncology-Rehabilitation Nursing Model which highlights the uniqueness of each nursing specialty, yet incorporates the knowledge and skills of both to provide the highest level of cancer rehabilitation to cancer survivors. This requires that the requisite knowledge and skills be fully identified and integrated into the educational content of Association of Rehabilitation Nurses (ARN).