The first section of this report addresses the evidence of causation concerning impairments developed as a result of a cancer diagnosis and cancer treatment. The second section investigates the evidence regarding rehabilitation and physical activity as an effective intervention in the prevention and treatment of impairments from cancer diagnosis and cancer treatment. The third section discusses the underlying behavioral change theory for incorporation of our Cancer Survivorship Rehabilitation Algorithm (Appendix 1), which details our proposed use of rehabilitation and wellness services in the continuum of cancer care and includes an outline for a survivorship care plan. This section also discusses the efficacy of delivery of our product to healthcare professionals. The fourth section outlines our proposed methods of evaluation for the utilization of our algorithm

Carlson, Miranda

Christine, Nicole

Dawley, Cassandra

Dowd, Charles

Fedulow, Irina

Gerhardt, Lisa

Pike, Erin

Powers, Kaitlin

Serrani, Angela

English

Presentation proposing that standardized rehabilitation and wellness services be incorporated into cancer treatment as well as into a personalized plan of care to be carried out after cancer treatment ends. Proposal is based on research regarding evidence of causation concerning impairments developed as a result of a cancer diagnosis and cancer treatment, evidence regarding rehabilitation and physical activity as an effective intervention in the prevention and treatment of impairments from cancer diagnosis and cancer treatment, and the underlying behavioral change theory for incorporation of a Cancer Survivorship Rehabilitation Algorithm which includes the use of rehabilitation and wellness services in the continuum of cancer care and includes an outline for a survivorship care plan.https://dune.une.edu/dphp_resources/1000/thumbnail.jp

University of New England

Cancer Survivorship Care:  An Emphasis on Rehabilitation Needs in Maine   National Level: Cassandra Dawley, BS,  Charles Dowd, BS,  and Irina Fedulow, BS Maine Level: Miranda Carlson, BS, Lisa Gerhardt, BA,  Erin Pike, BS and Kaitlin Powers, ATC Community Level: Nicole Christine, BA and Angela Serrani, BS  Doctor of Physical Therapy Candidates, 2015 University of New England  August-December 2014 Today’s Presentation Background and Evidence - Maine, Community Wellness, Behavioral Change  Needs Assessment - Community Wellness and State of Maine Cancer Centers   Products and Sustainability - Algorithm, Logic Model, Budget, Evaluation and Future Recommendations Background Facts - 8,500 people in Maine diagnosed each year - ¼ of the total deaths in Maine each year  - 2007 Incidence of cancer in Maine was 515 per 100,000 people.  Evidence of Risk Factors Fatigue  - 60-96% of survivors Wagner, LI & Cella, D 2004        Cancer and Cancer Treatment Leads To Lymphedema - 21% of survivors Fu, M et al 2013 & Disipio, T et al 2013 Chemotherapy Induced Peripheral Neuropathy - 68.1% of survivors  Serenity, M et al 2014 All Lead to Decreased Quality of Life Evidence for Physical Therapy and Wellness Cancer-Related Fatigue - Exercise decreased fatigue during and following cancer treatment  - Palliative effect in patients during treatment - Recuperative effect post-treatment Puetz TW & Herring MP 2012   Lymphedema  - CDT is effective at decreasing pain and swelling and increasing quality of life   - Treatment of lymphedema with CDT is more effective than standard therapy without MLD or compression bandaging alone Lasinski BB et al 2011  Evidence for Physical Therapy and Wellness Chemotherapy-Induced Peripheral Neuropathy - 87.5% of participants in the intervention group experienced reduced symptoms with sensorimotor, endurance and resistance training while there were no changes in the control group Streckmann F et al 2014 and Streckmann F et al 2014    Quality of Life - Exercise during and after cancer treatment was found to have beneficial effects on quality of life and domains including physical functioning, role function, social function, and fatigue   Mishra SI et al 2012 and Mishra SI et al 2012 LIVESTRONG at the Freeport YMCA ● 2x/wk for 12 wks ● No Cost  ● Low Attendance ● No Transportation ● Limited PT involvement ● Pre/Post assessment http://www.ymcaofsouthernmaine.org/livestrongattheymca Community Wellness Needs Assessment  Community Wellness Needs Assessment  Cancer Community Center ● Calendar of class offerings ● No Cost  ● Varied Attendance ● No Transportation ● Limited PT involvement ● Program assessment http://cancercommunitycenter.org/ Maine Needs Assessment   1. Educational programs for rehab/survivorship  2. Rehabilitation services and relationship with PT   3. Patient navigator   4. Quality of life measures  5. a. Transportation or lodging to access treatment     b. Referral to wellness programs     6. Definition of “cancer survivorship”  7. Other services to cancer survivors   8. Services for children and adolescents  9. Patient satisfaction measures  10. Survivorship care plan  11. Maine Cancer Consortium Activity Tracker Goal 14: Increase awareness and utilization of rehabilitation and survivorship services throughout Maine. Maine Needs Assessment *ACoS Accredited Cancer Centers  http://www.masscamps.com/maps/NorthernMaine.htm image found from googleimages Maine Needs Assessment Results Definition of  Cancer Survivorship (Question 6) - 13 described survivorship as from  cancer diagnosis until death - The 14th said it was life after cancer treatment, returning to baseline health energy and psychological levels  Diagnosis Maine Needs Assessment Results  Patient Navigator Titles (Question 3) Survivorship Care Plans (Question 10) - Overall 6 said yes and 8 said no, 4 said they had plans to implement by 2015 - Out of the 6 that said yes, 5 are in the Southern Maine Region - Out of the 4 that said they have plans to by 2015, 3 were from the Southern Maine Region Maine Needs Assessment Results Estimated Percentage of Patients Referred to Physical Therapy (Question 2): -Northern Maine: ranged from very rare to “good relationship” -Central Maine: 2-25%  -Southern Maine: 10%-100%   Question 1 Maine Needs Assessment Results Question 5 Maine Needs Assessment Results Activity Tracker Use Patient Satisfaction Measure Use Yes (9) Yes(4)  No (10) No (5) (Question 9) (Question 11) Maine Needs Assessment Results Quality of Life Measures (Question 4)  -Quality of Life = Psychosocial issues  - PHQ-9 standardized tool used  -Unmet needs Hansen et al, 2013  -60.1% of patients reported unmet rehabilitation needs  Pediatric Services (Question 8)  -supportive care for families vs pediatric oncology services phs.org ICF Model Cancer Survivorship Rehabilitation Algorithm Implementing Behavioral Change Implementing Behavioral Change Creation of Algorithm - Determine whether or not the cancer survivor requires a rehabilitation screen by a physical therapist Behavioral Change Theory  - Determine which method would be most beneficial for prompting providers to make appropriate referrals  Smith WR 2000 Implementation of Algorithm  - Determine which method would be most effective to deliver the algorithm and promote referrals to physical therapy within the realm of cancer survivorship Bellizzi KM et al 2005 and Chambers SK et al 2012  Value Proposition - Decrease financial burden through utilizing our algorithm as a guideline to improve a patient’s quality of life  - There needs to be more of an emphasis on preventative care and tailoring treatments to meet the unique needs of every survivor  Budget of Physical Therapy In Oncology Team for One Year Fixed Expenses Salaries: - Senior PT - $71,040 - PT - $57,600 - PTA - $42,240 - Personnel - $34,560  = $205,440   Variable Expenses Supplies:  - EMR System  - Exercise and Other Equipment - Utilities  = $23,780             Total = $229,220 Revenue Total Income:  $309,600 Total Expenses:              $229,220         Revenue = $80,380                Income Billable Hours As PT: - Patients Per Year - Frequency of Visits - Services Provided -     = $309,600  Budget of Physical Therapy In Oncology Team for One Year Comparing a prospective surveillance model to traditional therapy model Stout et al 2012 Prospective Surveillance -Preoperative Baseline and follow-up 1, 3, 6, 9, and 12 months    $255.04 -If lymphedema is dx (>3-5% volume increase) pt is issued with ready-made garments               $344.00 -No compression bandages req’d  Prospective surveillance =$636.19 Traditional Therapy -Pt referred to PT, eval       $69.29 -Eval then CDT 5 visits/week for 2 weeks, 3 visits/ for 1 week             $1,388.48 -Custom made garments   $1400.00 -Bandages             $230.00 -Follow up             $37.15  Traditional model            =$3,124.92 Evaluation   - Research supports rehabilitation - Low developmental cost - Strengthens scope of practice for PT  Strengths - Limited professional representation - Great level of time and effort for 9 students Weaknesses - Interprofessional incorporation  - Create gold standard Opportunities - Sustainability - Behavioral changes required - No set baseline  Threats Recommendations        Mainedautrips.com    Questions? References - American Cancer Society Maine Cancer Consortium. Maine comprehensive cancer control plan 2011-2015. http://www.maine.gov/dhhs/mecdc/population-health/ccc/documents/cancerplan2011-2015.pdf. Updated October 2010. Accessed August 2014.  - Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health Behaviors of Cancer Survivors: Examining Opportunities for Cancer Control Intervention. Journal of Clinical Oncology. 2005: 23(34): 8884-8893.  - Chambers SK, Kam LY, Knott VE, Wilson C. Using the Theory of Planned Behavior To Understand Health Professionals’ Attitudes and Intentions To Refer Cancer Patients For Psychosocial Support. Psycho-Oncology. 2012: 21: 316-323.  - Disipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500-15.  - Hansen DG, Larsen PV, Holm LV, Rottmann N, Bergholdt SH, Søndergaard J. Association between unmet needs and quality of life of cancer patients: a population-based study. Acta Oncol. 2013;52(2):391-9.   References - Lasinski BB, McKillip Thrift K, Squire D et al. A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM R. August 2012;4(8):580-601.  - Mishra SI, Schrerer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O.  Exercise interventions on health-related quality of life for people with cancer during active treatment.  The Cochrane Database of Systematic Reviews 2012, Issue 8. CD008465.   - Mishra SI, Schrerer RW, Geigle PM et al.  Exercise interventions on health-related quality of life for cancer survivors.  The Cochrane Database of Systematic Reviews 2012, Issue 8. CD007566.  - Puetz TW, Herring MP. Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis.  Am J Prev Med.  August 2012;43(2):e1-24.  - Seretny M, Currie GL, Sena ES et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Pain. 2014.   References - Smith WR. Evidence for The Effectiveness of Techniques To Change Physician Behavior. CHEST Journal. 2000: 11(8): 8S-17S.  - Streckmann F, Zopf EM, Lehmann HC, et al. Exercise intervention studies in patients with peripheral neuropathy: a systematic review. Sports Medicine. 2014;44:1289-1304.  - Streckmann F, Kneis S, Leifert JA, et al. Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy. Ann Oncol. 2014;25(2):493-9.  - Wagner LI, Cella D. Fatigue and Cancer: Causes, Prevalence and Treatment Approaches. Br J Cancer. 2004, 91(5): 822–828.   

Cancer Survivorship Care: An Emphasis On Rehabilitation Needs In Maine

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Cancer Survivorship Care: An Emphasis On Rehabilitation Needs In Maine

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University of New England

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