Cancer rehabilitation addresses ‘multitude of complex issues’ cancer survivors face
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A breakout session at the Cancer Center Survivorship Research Forum focused on the value of cancer rehabilitation for both patients and oncologists.
“Anytime I get an audience like this, the real goal is to get people to understand the full scope and scale of cancer rehabilitation,” Michael D. Stubblefield, MD, director of cancer rehabilitation at Kessler Institute for Rehabilitation and national medical director for Select Medical’s ReVital Cancer Rehabilitation program, told Healio. “Traditionally, this field has been about lymphedema management and fatigue, but I have been working to change the scope. Now, it’s really about comprehensive evaluation and management of the multitude of complex issues that cancer survivors face.”
A ‘big question mark’
When faced with some of the functional issues inherent to cancer survivorship, clinicians may not always recognize how they are related to cancer treatment or how they should be managed, Stubblefield said.
“To give you an example, I treat a lot of Hodgkin [lymphoma] survivors who were treated with radiation as long as 50 years ago and now have a number of neuromuscular, musculoskeletal pain and functional issues as a result,” Stubblefield said. “Most clinicians look at these patients and have a big question mark. They know something’s wrong, but they can’t pin down what it is, and they don’t know how to optimally evaluate or manage it.”
Stubblefield said his role is to diagnose the various underlying causes of symptoms like gait dysfunction or dropped head syndrome, and to manage those symptoms using comprehensive treatments such as physical therapy, occupational therapy, speech language pathology, pain management or injections.
“It’s important to make sure clinicians understand the scope and scale of what rehab is and get away from the idea that we just exercise patients or manage lymphedema,” he said. “Once they understand what we’re doing, I try to get them to understand the value of what we’re doing.”
A value proposition
Stubblefield emphasized the fact that — in addition to improving the lives of patients and survivors — cancer rehabilitation offers tremendous value to oncologists.
“Cancer rehabilitation hasn’t really been talked about in this way until recently,” he told Healio. “It’s not just about improving function and quality of life. It’s about keeping patients out of the emergency room and out of the hospital. It’s about minimizing their opioid requirements and, ideally, it’s about decreasing the overall cost of care.”
Even major cancer centers may not offer robust cancer rehabilitation services, he said.
Stubblefield — who previously served as chief of cancer rehabilitation at Memorial Sloan Kettering Cancer Center — said many of his colleagues didn’t initially understand the value of cancer rehabilitation, particularly in terms of how it could ease their workloads.
“They eventually started to realize that [cancer rehabilitation] could help take the load off of them, so they didn’t have to handle things like neuropathy or pain issues,” he said. “As far as institutional decision-making, though, the people who are trying to decide where to put their next center or what real estate to buy really have an impetus to stick to their core, which is treating cancer, and they don’t really understand cancer rehabilitation.”
Although survivorship care is an essential part of patient-centered cancer treatment, cancer centers often lack the resources to provide extensive survivorship services, Stubblefield said.
Theoretically, these patients can seek survivorship care in their communities; however, clinicians in these settings might feel unprepared or lack confidence to manage these patients.
“Folks in the community are often intimidated by these patients. They don’t understand them or feel comfortable managing them,” he said. “If you take a world-class internist and send them a complicated Hodgkin [lymphoma] or head and neck cancer survivor, there are going to be a lot of things that are very foreign to them.”
Select Medical owns or jointly manages more than 30 rehabilitation hospitals across the country, along with 1,900 outpatient therapy locations. Stubblefield was instrumental in creating Select Medical’s ReVital Cancer Rehabilitation, a national program with approximately 1,000 ReVital-certified therapists, all of whom have been through 6 months of training, with ongoing maintenance requirements.
“This program is in about 25 markets across the country and is continuing to grow,” he said. “A good deal of cancer care is now provided in the community oncology setting. We are going to build the programs to support these patients.”
He encouraged providers to refer survivors to rehabilitation centers, but added that he’d like to see more cancer centers incorporate cancer rehabilitation into their own programs.
“It’s not a proprietary thing. Cancer rehabilitation is important,” Stubblefield told Healio. “We’ve gotten so good at treating these cancers, but the treatments we use often lead to devastating consequences down the road. We need to equip our patients to take care of those issues.”
For more information:
Michael D. Stubblefield, MD, can be reached at Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052; email: mstubblefield@selectmedical.com.
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Stubblefield MD. Cancer rehabilitation. Presented at: Cancer Center Survivorship Research Forum, Sept. 11-12, 2023; Stanford, California.
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