The intersection of rehabilitation and palliative care: patients with advanced cancer in the inpatient rehabilitation setting

CITATION:

Padgett, L.S., Asher, A., & Cheville, A. (2018). The intersection of rehabilitation and palliative care: patients with advanced cancer in the inpatient rehabilitation setting. Rehabilitation Nursing, 43(4), 219-228. doi: 10.1097/rnj.0000000000000171


SUMMARY:

This article reviews the literature related to common functional losses experienced by patients with advanced cancer, and discusses the commonalities and complementarities of palliative care and rehabilitation in the treatment of these patients in rehabilitation settings. In particular, this article explores how the care for advanced cancer patients in a rehabilitation setting may differ from the treatment of traditional rehabilitation populations, and highlights opportunities to enhance services to this population through the involvement of palliative care professionals, as well as the use of primary palliative care skills by rehabilitation team members. Notably, the article seeks to educate about the role of palliative care, the benefits of early involvement of palliative care after diagnosis of advanced cancer, and the alignment of the philosophical approaches of palliative care and rehabilitation, as both focus on management of symptoms and improvement of quality of life.

 A number of components that are important and unique to the rehabilitation treatment of patients with advanced cancer are discussed and literature reviewed (e.g., the importance of addressing future functional deterioration, the impact of cancer-related treatment on function, etc.). It also focuses on the concept of “palliative rehabilitation,” and provides a valuable primer on how members of a rehabilitation treatment team can and should pick up and apply palliative care skills and knowledge when working with this population of patients and their family members. The authors highlight resources and provide a review of the literature for how each member of the team may be able to better assess and manage common symptoms addressed in palliative care planning (pain, nausea and vomiting, anorexia/cachexia, cancer related fatigue, delirium, depression and anxiety). Additionally, the importance of discussing of goals and advanced care planning is featured. As the authors note: “knowing the goals patients have for their care allows for a context in which all other medical decisions can be made, including rehabilitation goals. It is important to begin by getting an idea of the patient’s own understanding of their illness and its course, as well as the understanding of their family or caregiver.” The rehabilitation psychologist can play a vital role in assessing this understanding and alerting the treatment team when additional engagement of palliative care or oncology team may be warranted to facilitate communication with the patient and family and ensure treatment goals are realistic and aligned between the patient and the treatment team.

 I chose this article because as a staff member at an acute inpatient rehabilitation hospital with an oncology rehabilitation program, I have seen the team struggle to transition to serving oncology patients with advanced diagnoses. Sometimes, fear of saying the wrong thing leads to failure to address the cancer diagnosis directly – and patients and families may leave without having received the full benefit of the interdisciplinary team approach to education and functional optimization in the context of their specific case. I appreciated the practical applications in this article and the reference to accessible resources to ensure provision of high quality care in a population where the decision of where to spend time and energy is often of paramount importance to the patient and family.

 THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Casey Dawson, PhD, a Rehabilitation Psychologist and co-lead of the Inpatient Oncology Rehabilitation Council at Memorial Rehabilitation Institute at Memorial Regional Hospital South in Hollywood, Florida, and a member of the Division 22 Science Committee.