The health care delivery system in the United States is challenged to meet the needs of a growing population of cancer survivors. A pressing need is to optimize overall function and reduce disability in these individuals. Functional impairments and disability affect most patients during and after disease treatment. Rehabilitation health care providers can diagnose and treat patients' physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population. However, few care delivery models integrate comprehensive cancer rehabilitation services into the oncology care continuum. The Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health with support from the National Cancer Institute and the National Center for Medical Rehabilitation Research convened a subject matter expert group to review current literature and practice patterns, identify opportunities and gaps regarding cancer rehabilitation and its support of oncology care, and make recommendations for future efforts that promote quality cancer rehabilitation care. The recommendations suggest stronger efforts toward integrating cancer rehabilitation care models into oncology care from the point of diagnosis, incorporating evidence-based rehabilitation clinical assessment tools, and including rehabilitation professionals in shared decision-making in order to provide comprehensive cancer care and maximize the functional capabilities of cancer

Occupational therapy has a strong history of embracing concepts of client empowerment. However there is limited literature in the field on how to achieve empowerment, or on how to extend empowerment to the level of the community and social groups and services within it. This article discusses how concepts and strategies of participatory action research, an extension of empowerment theory, can be used to inform service development and evaluation in occupational therapy. The participatory action research approach is illustrated using two case examples of participatory action research programs for persons with chronic fatigue syndrome and individuals with autoimmune deficiency syndrome (AIDS). A critical analysis of the application of this approach to research and practice is provided. Finally, the paper identifies key principles of participatory action research that can be used to guide occupational therapy services and empower both individuals and communities.

Advances in medical treatment combined with changes in the demographics of persons who are becoming infected with autoimmune deficiency syndrome (AIDS) have transformed this illness from a rapidly progressing to a chronically disabling condition in a short period of time. This paper describes the development, implementation, and outcomes of a program of vocational services for persons with AIDS. This program was studied using a single group design, in which participatory action research strategies were used to investigate and improve the program as it unfolded. In addition to examining the overall outcomes of services, the study aimed to discover which components were most helpful to participants and which participants were most likely to benefit from the program. Of 129 participants of who initially enrolled, 39 dropped out before finishing the program. Sixty of the 90 participants who completed the program achieved employment, returned to school, or began a volunteer position or internship. Consequently, the overall success rate was 46.5% and the success rate for program completers was 66.7%. The occupational narrative, which participants told in their initial assessment interview, was closely associated with both program completion and successful outcomes. This association adds support to the importance of narrative for understanding participants and predicting future behavior, as well as for the therapy process.

Participation refers to a state of health in which a person is able to fully engage in roles and life situations. Adults living with and beyond cancer often report persistent participation restrictions that affect their productivity and quality of life. The American Occupational Therapy Foundation convened a group of scientists from seven different disciplines in a Planning Grant Collective (PGC) to stimulate research to identify scalable ways to preserve and optimize participation among cancer survivors. Participants identified challenges, prioritized solutions, and generated novel research questions that move beyond symptom and impairment mitigation as outcomes to identify interventions that improve participation in roles and life situations. This article summarizes the PGC discussion and recommendations regarding three challenges: (a) the dynamic and multi-faceted nature of participation, (b) a need to integrate the concept of participation within the culture of oncology, and (c) identification of priority areas in which new lines of research regarding participation would be most impactful.

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