In 2017, the World Health Organization (WHO) initiated Rehabilitation 2030, a call to action to advance global access to high‐quality rehabilitation as an essential health care service for individuals with non-communicable diseases. The objective of the initiative was to create a package of rehabilitation interventions that would strengthen health systems to provide rehabilitation services through better awareness and accessibility to resources for rehabilitation. Given the severe and persistent side effects of cancer and its associated treatments, the WHO designated oncology as a priority area for this initiative.
Daniel Santa Mina, an assistant professor at the University of Toronto’s Faculty of Kinesiology and Physical Education, worked with colleagues from West Virginia University Cancer Institute, Dartmouth Geisel School of Medicine, North East London Cancer Alliance and Harvard Medical School to conduct a systematic review of cancer rehabilitation guidelines, as the first step in developing the package of rehabilitation interventions for oncology.
Published in the prestigious CA: A Journal for Cancer Clinicians in October, “the review identified 69 guidelines related to rehabilitation in oncology. Twenty one of the guidelines were rated as high-quality, specifically recommended for rehabilitation practice in cancer care, and were advanced into the WHO’s package of rehabilitation interventions for oncology. This review is meant to be a key resource for clinicians in determining how to provide rehab for people with cancer,” says Santa Mina.
“A majority of people living with cancer experience compromised physical and cognitive function due to cancer treatments and its side effects. But, despite growing evidence that rehabilitation and exercise interventions reduce the negative impact of cancer treatments, they remain an underutilized service. With the population of cancer survivors projected to double worldwide in the coming decades, it’s imperative that we make up for this deficit in oncology care.”
According to existing evidence, more than 60 per cent of individuals living with or beyond cancer reported side effects associated with cancer treatment, yet only two to nine per cent were being referred to rehabilitation services for cancer treatment‐related impairment and disability.
“There are many reasons for this disconnect, but the commonly cited causes center on lack of awareness among oncology providers as to how and where to access rehabilitation services, inadequate integration of rehabilitation services into oncology care, as well as a lack of awareness among patients about the availability and benefit of these services,” says Santa Mina.
The researchers suggest integrating a rehabilitation provider onto cancer care teams to help with the physical assessment of patients throughout the continuum of cancer care and to promote the use of the rehabilitation guidelines.
“Multidimensional, interdisciplinary rehabilitation is the optimal model of care ideally implemented using an approach whereby measures of performance and function are routinely monitored after diagnosis to identify meaningful functional change and initiate guideline-based rehabilitation,” says Santa Mina. “Without relevant interdisciplinary rehabilitation guidelines in place, efforts will fall short of addressing the totality of patients' functional needs.”
To start, he suggests the findings of the review can be used by clinical staff in oncology rehabilitation to develop standards and protocols for their patients, to complement resources for clinical education and training of students and professionals, and support workforce planning that can improve care provision for individuals with cancer.