CREATE Childhood Cancer Rehabilitation Program development: Increase access through interprofessional collaboration

Abstract

Background Cancer and its treatment can lead to functional limitations affecting ongoing development in children and adolescents. We developed a pediatric cancer rehabilitation program that integrates evidence‐based rehabilitative care into cancer treatment. The program utilizes the CREATE (collaboration, rehabilitation/research, education, assessment, treatment, evaluation) Childhood Cancer Rehabilitation model. We aim to describe the structural and process components of our rehabilitation program and provide an access and utilization analysis. Procedures To evaluate the rehabilitation program, we identified new patients with oncologic diagnoses from 2002 to 2019 using our database. To evaluate rehabilitative care, descriptive data, including the timing and type of rehabilitation services utilized within 5 years of a child's diagnosis, were collected and reviewed. Statistical analysis focused on change over time. Results Among 1974 children assessed, 1580 (80.0%) received care from at least one rehabilitation service. Between 2002 and 2018, the percentage of children receiving rehabilitation services grew significantly throughout all disciplines, except for outpatient speech‐language pathology. Utilization differed by age and diagnosis. Integrating therapists in the clinic improved patient access, reduced the time to access outpatient services, and increased the number of attended visits. Additional factors supporting program growth included: identifying leaders, using a prospective surveillance model, education, and program evaluation. Conclusion A multimodal interprofessional approach, such as the CREATE model, improves access to and the efficiency of evidence‐based rehabilitation services promoting recovery, ongoing development, and quality of life.

Clinical practice guideline and expert consensus recommendations for rehabilitation among children with cancer: A systematic review

“…Strategies to support adherence may include the use of automatic orders for rehabilitation referrals, clinical champions, and interdisciplinary team collaboration. 21,22,24 Available guidelines do have some limitations, however, including recommendations that are sometimes too vague to inform care (e.g., recommendation for evidence-based rehabilitation training) and are based on low-quality evidence. Recommendations based on highquality evidence focused on LTFU care, fatigue, and psychosocial/ mental health screening (see Table S4).…”

“…Adhering to guidelines may increase the number of children referred to rehabilitation and can support equity in how rehabilitation services are provided within pediatric oncology. Strategies to support adherence may include the use of automatic orders for rehabilitation referrals, clinical champions, and interdisciplinary team collaboration 21,22,24 . Available guidelines do have some limitations, however, including recommendations that are sometimes too vague to inform care (e.g., recommendation for evidence‐based rehabilitation training) and are based on low‐quality evidence.…”

“…20 In contrast, at a single institution with specific pediatric oncology rehabilitation programing, 96% of children with ALL received inpatient PT within a year of diagnosis. 21 Access to care also differs based on diagnosis and rehabilitation service, with speech therapy typically having the lowest utilization rates (range, 4%-10%). 21,22 Among CCS ≥5 years posttreatment, 9% reported using PT services, a rate similar to that among siblings.…”

“…21 Access to care also differs based on diagnosis and rehabilitation service, with speech therapy typically having the lowest utilization rates (range, 4%-10%). 21,22 Among CCS ≥5 years posttreatment, 9% reported using PT services, a rate similar to that among siblings. 23 These varying utilization rates highlight the lack of consistency in rehabilitation service provision in pediatric oncology.…”

“…Across 330 US hospitals, only 27% of children diagnosed with acute lymphoblastic leukemia (ALL) received inpatient physical therapy (PT) within 1 year of diagnosis 20 . In contrast, at a single institution with specific pediatric oncology rehabilitation programing, 96% of children with ALL received inpatient PT within a year of diagnosis 21 . Access to care also differs based on diagnosis and rehabilitation service, with speech therapy typically having the lowest utilization rates (range, 4%–10%) 21,22 .…”