Integrating Function‐Directed Treatments into Palliative Care

Abstract

The growing acceptance of palliative care has created opportunities to increase the use of rehabilitation services among populations with advanced disease, particularly those with cancer. Broader delivery has been impeded by the lack of a shared definition for palliative rehabilitation and a mismatch between patient needs and established rehabilitation service delivery models. We propose the definition that, in the advanced cancer population, palliative rehabilitation is function-directed care delivered in partnership with other clinical disciplines and aligned with the values of patients who have serious and often incurable illnesses in contexts marked by intense and dynamic symptoms, psychological stress, and medical morbidity to realize potentially time-limited goals. Although palliative rehabilitation is most often delivered by inpatient physical medicine and rehabilitation consultation/liaison services and by physical therapists in skilled nursing facilities, outcomes in these settings have received little scrutiny. In contrast, outpatient cancer rehabilitation programs have gained robust evidentiary support attesting to their benefits across diverse settings. Advancing palliative rehabilitation will require attention to historical barriers to the uptake of cancer rehabilitation services, which include the following: patient and referring physicians' expectation that effective cancer treatment will reverse disablement; breakdown of linear models of disablement due to presence of concurrent symptoms and psychological distress; tension between reflexive palliation and impairment-directed treatment; palliative clinicians' limited familiarity with manual interventions and rehabilitation services; and challenges in identifying receptive patients with the capacity to benefit from rehabilitation services. The effort to address these admittedly complex issues is warranted, as consideration of function in efforts to control symptoms and mood is vital to optimize patients' autonomy and quality of life. In addition, manual rehabilitation modalities are effective and drug sparing in the alleviation of adverse symptoms but are markedly underused. Realizing the potential synergism of integrating rehabilitation services in palliative care will require intensification of interdisciplinary dialogue.

Aerobic capacity correlates with health‐related quality of life after breast cancer surgery

“…Therefore, even though the physical activity is not associated with HRQOL, it should be encouraged because it is a factor associated with recurrence and mortality. However, because physical activity is not simply related to physical impairment, but also to psychological factors and social economy status, it is important to have a multidisciplinary team approach rather than a single rehabilitation clinic (Cheville et al, 2017;Leclerc et al, 2017;Nottelmann et al, 2019). (Nottelmann et al, 2019).…”

“…Especially, the content of palliative rehabilitation is to improve HRQOL through improvement of function. Cheville, Morrow, Smith, and Basford (2017) introduced the concept of palliative rehabilitation, which included function-directed care of cancer patients. Nottelmann, Jensen, Vejlgaard, and Groenvold (2019) suggested using a new model that provides a tailored multidisciplinary palliative rehabilitation programme for patients during cancer-related treatment.…”

A new model of early, integrated palliative care: palliative rehabilitation for newly diagnosed patients with non-resectable cancer

“…Palliative care and rehabilitation professionals are trained to diagnose and treat complex problems through multidisciplinary interventions with the goal of improving quality of life. Rehabilitation services are underutilized among people with advanced cancer [9] even though maintenance of functional independence is central to quality of life and rehabilitation services tend to be most effective when initiated before the cancer related functional loss is too severe [10].…”

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation

“…Cheville et al likewise reported that less than 30% of outpatients with cancer and women with advanced cancer who had functional limitations used rehabilitation services . The reasons for low utilization include a workforce shortage of rehabilitation physicians and therapists trained in oncology and a low familiarity and recognition on behalf of patients and referring providers as to the need, value, and function of cancer rehabilitation …”

“…13 The reasons for low utilization include a workforce shortage of rehabilitation physicians and therapists trained in oncology 11,14 and a low familiarity and recognition on behalf of patients and referring providers as to the need, value, and function of cancer rehabilitation. 11,15 Research has indicated that individual treatments delivered by rehabilitation professionals can reduce impairments or functional limitations of cancer survivors. 16,17 For example, meta-analyses or systematic reviews support the use of exercise to reduce fatigue 18 and to improve physical fitness, physical and emotional function, and quality of life 19 ; education to manage pain 20 and fatigue 21,22 ; nonpharmacological interventions 23 or neuropsychological interventions 24 to improve cognitive functioning; groupbased self-management programs to improve physical functioning 25 ; massage therapy to improve pain, fatigue, and anxiety 26 ; and manual lymphatic drainage to manage lymphedema.…”