Millions of cancer survivors in the United States suffer from debilitating side effects that interfere with long-term recovery plans. "Many cancer survivors are living with more pain, fatigue and other disabilities than is necessary," said Candace L. Dyer, MD, breast cancer surgeon and physician director at The Breast Health Center at Kent Hospital in Rhode Island.

The number one distress identified among cancer survivors is the inability to function the way they had pre-cancer. Studies show that physical therapy is an effective, non-medication solution for the side effects associated with cancer and cancer treatments.

"Every cancer survivor wants to feel better and live well during and after cancer treatment. Continued care is often necessary to prevent, manage and heal the physical and psychological conditions that can develop from the treatment interventions relating to surgery, radiation and chemotherapy," explained Henry Sisun, MSPT, president, Rhode Island Rehabilitation Center.

Until now, this patient population has largely been ignored. But the state of Rhode Island is poised to make medical history by launching the country's first statewide initiative to provide its cancer survivors with access to reimbursable rehabilitation services.

In collaboration with Oncology Rehab Partners (ORP) and supported in part by the Gloria Gemma Breast Cancer Resource Foundation, the initiative aims to deliver quality rehab services to cancer survivors-whether they are in remission, living with cancer or are cured.

"There has been a lot more research in the areas of stroke and orthopedics and the patients' success after treatment or surgery," shared Allison Hoehn, OTR/L, CompHealth. "There has not been that level of research in cancer until now. As therapists, we need to make these patients functional so they can return to society."

Because of its small size and infrastructure, Rhode Island allows the program to be easily coordinated and adopted. If other states follow Rhode Island's lead, what has long been available for patients recovering from other medical crises, including orthopedic injury, cardiac arrest and stroke, may soon become status quo for cancer survivors: reimbursable post-treatment rehabilitation.

Training Individuals and Institutions

This year, more than 1.5 million Americans will be diagnosed with cancer and nearly 70 percent of those individuals will live at least five years post-diagnosis. The creation of a plan that documents available and appropriate interventions is essential to providing the best possible care to survivors.

Members of the Rhode Island cancer rehabilitation initiative, Oncology Rehab Partners, and the Gloria Gemma Breast Cancer Resource Foundation are (from left): Henry Sisun, RPh, MSPT; Maria Gemma, director of the Gloria Gemma Breast Cancer Resource Foundation; Brenda Larrivee, PT; Candace L. Dyer, MD; Julie Silver, MD, and Gary Calvino, director of development, Gloria Gemma Breast Cancer Resource Foundation.

"I look at survivorship as a joyful problem," said Lynda Clancy, MS, NP, director of cancer services, Fatima Hospital. "Years ago we didn't have to worry about all of the people surviving cancer, because they didn't. We are detecting cancers earlier, and today's treatments are less harsh and more effective. So now we have this pool of survivors whose physical and mental needs we must address."

ORP's Survivorship Training and Rehab (STAR) Programs are centered on a multidisciplinary therapeutic approach that involves specialists teaming up to help survivors increase strength and energy, alleviate pain, and improve daily function and well-being. The certifications were developed by Julie Silver, MD, a physiatrist and assistant professor at Harvard Medical School, and ORP co-founder Diane Stokes, MBA.

As a breast cancer survivor herself, Dr. Silver recognized-and personally struggled with-the gap in care. As a result, she endeavored to provide quality survivorship programs to enable survivors to recover their health and resume happy, fulfilling lives.

The STAR certifications-designed for hospital interdisciplinary teams and individual clinicians-are based on the latest research in cancer rehabilitation and fill the knowledge and skills gap needed to evaluate, treat and manage the needs of cancer patients and survivors. Communication between oncology and rehabilitation professionals within the same institution is crucial for cancer rehabilitation to be effectively implemented.

"The STAR Program gives us the means to focus on this patient population in a clear and consistent manner," said Clancy. "The program is designed in a way that providing these services is at the top of everyone's mind, from the physical therapist to the nurse practitioner."

Cancer patients and cancer survivors deserve the best possible care from knowledgeable health care practitioners who have been educated and trained to achieve the best results, according to Sisun. "Too often, physical therapists will treat patients upon referral from physicians when they do not possess the necessary expertise and training to achieve the best outcomes," he explained. "That short-changes the patient and casts a black eye on the profession."

All of the services integrated into the program, including consultations with physiatrists, physical therapy, occupational therapy, speech therapy and mental health counseling, are typically covered by health insurance.

Because of the collaboration between the oncologist, rehab therapist and other caregivers, patients will benefit from better outcomes in their healing process, both physically and emotionally, according to Julie Ptak, director, rehab therapy, CompHealth Allied Division.

Beginning with the Ocean State

"We've noticed over the years that there has been an absence of services in the post-treatment part of breast cancer," stated Gary Calvino, director of development for Gloria Gemma Breast Cancer Resource Foundation. "As an organization with a mission of awareness, education and support for survivors, bringing STAR to Rhode Island is a dream come true for us."

The concept of bringing the STAR Certifications to Rhode Island began to become a reality during a meeting between Calvino and Sisun. "We felt that Rhode Island is small enough to have a statewide impact and average enough to have national impact," Sisun told ADVANCE.

This move was prompted by the February 2011 announcement by the American College of Surgeons Commission on Cancer (CoC) requiring each of its 1,400 accredited hospitals to offer a follow-up care plan to every survivor and demonstrate that they have cancer rehab services available to their patients.

The plan is to have as many of Rhode Island's 11 CoC accredited hospitals STAR certified as possible in order to make evidence-based cancer rehabilitation services widely available to all survivors. Additionally, many of the state's physical therapy practices are in the process of obtaining the STAR Clinical Group certification.

Within Rhode Island, STAR has been or is in the process of being incorporated into Women & Infants Hospital, Kent Hospital, South County Hospital, Newport Hospital, Rehabilitation Hospital of Rhode Island, and Rhode Island Rehabilitation Centers. Within a few months, these programs (which will be covered in the state by health insurance) will complete accreditation and be available to patients.

"Once fully established, this collaboration of hospitals and medical centers in Rhode Island will put various health care professionals on the same page to ultimately assist our patients who are suffering from the remnants of cancer," said Marc Houlé, PT, CLT, Women & Infants Hospital of Rhode Island.

Members of each institution involved in the Rhode Island initiative agree that there is a void that needs to be filled after cancer has been diagnosed and treated. Cancer patients may experience some life-changing treatments including colostomies, neuropathies, chronic pain and decreased range of motion, and rehabilitation services can help restore these patients to a more "normal" state, according to Dr. Dyer.

"This is the rehabilitation which brings the patient back to the fullest life possible with maximum function. And this life may be even better, more healthful, than the pre-cancerous lifestyle," shared John R. Carbon, DO, MS, Physical Medicine and Rehabilitation, Kent Hospital.

Twenty-five clinical staff therapists in Rhode Island Rehabilitation Center's seven outpatient rehab offices throughout Rhode Island are in the process of completing the STAR program training. "This speaks to the seriousness of RI Rehab's commitment to cancer patients and cancer survivors in Rhode Island who deserve to receive the most effective care available," said Sisun.

As a national provider of temporary and permanent physician and allied health staffing, CompHealth has made a commitment to be a part of advancing cancer survivorship care and the first step in this initiative was to make the STAR Certification accessible to all of its rehab providers. "This will be an ongoing opportunity for our providers that will put them ahead of the curve in cancer rehab knowledge and preparing them to provide cancer rehab services in any setting," said Ptak.

"Our part in the initiative has been to ensure we have a pool of STAR Clinician Certified therapists who are available and licensed in the state of Rhode Island to support any staffing needs a facility may encounter during the implementation and/or growth of their cancer rehab program," shared Ptak.

According to Alan Dunn, program director at Kent Hospital Rehabilitation, adoption of the STAR Program is an opportunity for cancer patients and survivors to receive the gold standard level of care for the symptoms of their illness, regardless of where they live in the state of Rhode Island.

"This team of professionals will have the opportunity to share resources and knowledge across the state," he said. "The networking opportunities greatly enhance the quality of care for the people of Rhode Island to receive the most current services possible."

For the Patient

"If we can help minimize or prevent pain, disability and psychosocial distress for the cancer patient and the cancer survivor; if we can help prevent secondary cancers and the recurrence of cancer; and if we can promote appropriate independent self-care management to maximize years of healthy living, then we have succeeded in filling an extraordinary need indeed," observed Sisun.

The STAR Program stands apart as offering an excellent means of evidence-based resource knowledge and training to help clinicians offer oncology rehabilitation services that can improve the health and well-being of cancer survivors.

By the beginning of 2012, residents of Rhode Island will have access to reimbursable rehabilitation services post-cancer. "The collaboration of so many constituents behind the Rhode Island initiative reinforces the fact that there is a need, a desire, and most of all, a commitment to continue this mission across the nation," shared Ptak. 

Rebecca Mayer is senior regional editor of ADVANCE and can be reached at rmayer@advanceweb.com