Overview of OT's Role in Cancer Rehab

 This is a question that I get asked all the time.  It is a good question. I think there is a lot of cross over between what OTs and PTs do, but occupational therapists have a distinct role in cancer rehabilitation. This goes back to not only their training and their clinical expertise, but also the research.

The Institute of Medicine brings together many experts who discuss very important issues in healthcare, and then come out with reports that tend to really change the way we practice medicine and make us take a hard look at what we are doing right and what we are doing wrong.

In 2006 there was an important report that came out from the Institute of Medicine called "From Cancer Patient to Cancer Survivor Lost in Transition". This report showed that as people transitioned from acute cancer care into the survivorship phase of treatment, they often have very fragmented care. They may have many problems that do not get addressed and they are really struggling.   

The Institute of Medicine made ten key recommendations and I think two relate to occupational therapy's role.

Survivorship needs to be a distinct phase of cancer care. What does that really mean? One of the things that I do when I go to hospitals is ask the people working there if they can write down on a piece of paper all of the different things that go into their survivorship care program. Sometimes this is easy for them to do and sometimes it is sort of hard for them to do. It really depends on how well developed "survivorship" is as a distinct phase of cancer care in that particular hospital or cancer center. 

The second recommendation was that everyone should be given a survivorship care plan. Keep in mind this care plan is really important. It should be an electronic document and, in fact, the American College of Surgeons Commission on cancer said to all of its accredited hospitals, which is more than 70% in the United States, that they need to develop a survivor care plan by 2015. As a result, every survivor should have a care plan by 2015. This electronic document has all of the different things that a care plan has including real services. The real services can include acute cancer treatments and survivorship care. For example, it states what someone should be doing now and what they need to be concerned about in the future, whether it is screening recommendations, cancer rehabilitation interventions or whatever. Again, this survivorship care plan is very important; however, a plan is only as good as the services that it documents.

Another very important Institute of Medicine report came out in 2007. This one was called "Cancer Care For the Whole Patient". In this report, it talked about the psychosocial needs of cancer survivors. One thing that this report found, that may surprise a lot of you and certainly did surprise a lot of people when it came out, is that cancer patients have many unmet psychosocial needs that are not due to a lack of resources.

In fact, this report said that there are a lot of resources available, but as clinicians, we are not doing such a great job of screening people for services, linking them to services, coordinating and monitoring their care and following up.  This is really important to be thinking about.   

There are three levels of services: onsite, community and remote. The onsite is what is available at your institution or practice. The community is what is available in your community. Finally, the remote services would be things typically found online. For example, these services may be found at the American Cancer Society, Live Strong or the Susan G. Komen website.   

Now, let us focus a little bit more closely on cancer rehabilitation. The American College of Surgeons has said that every one of its COC accredited hospitals and cancer centers must provide cancer rehabilitation for its patients. Certainly that is good news for the rehabilitation community. We, as clinicians, have tremendous opportunities to participate in this care.   

There is a tremendous opportunity that occupational therapists have to participate in cancer rehabilitation, and certainly all rehabilitation medicine professionals have this opportunity as well. It is really the bringing together of two different departments in a hospital setting. Certainly not all rehabilitation is in a hospital setting, but when you think about the two different groups of people, you are talking about an oncology department and a rehabilitation medicine department. Cancer rehab needs to combine the knowledge and clinical skills of people in the oncology department, as well as, the knowledge and clinical skills of people in the rehabilitation department.   

As the survivorship care plans become more commonplace, occupational therapists have an integral role in the development of this plan, goal setting and identification of occupations that the "survivor" wishes to engage in.  We can not only help the patient regain independence, but help them to identify goals for moving forward.