How to Meet the Commission on Cancer's New Accreditation Requirements in Survivorship Care

The American College of Surgeons' Commission on Cancer has mandated that accredited institutions provide rehabilitation services to cancer patients and that the institution's cancer committee include a rehabilitation specialist. This requirement is part of CoC's new, patient-centered approach described in its updated standards of care. Until now, there has been a lack of emphasis on reimbursable, evidence-based oncology rehab programs at hospitals. Julie Silver, MD, assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation and a breast cancer survivor, co-founded Oncology Rehab Partners to promote the need for quality rehabilitation. Through ORP, she created the STAR (Survivorship Training and Rehabilitation) certifications including the STAR Program to help hospitals create best practices programs.

The problem
Most hospitals already have robust rehab programs for cardiac, stroke and orthopedic patients but lack adequate care for cancer survivors. Current oncology rehab programs are often not reimbursable by third party payor and are not based on best practices, according to Dr. Silver. "What is generally accepted now as cancer rehabilitation in many institutions is simply not a best practices model and not a reimbursable model," she says. "People have to realign their thinking and understand that cancer rehab is similar to stroke rehab, spinal cord rehab, or any other rehabilitation for people with serious medical issues. It needs to be based on research and offered by healthcare professionals who are trained and reimbursed for their care." Furthermore, current cancer rehab programs only serve a fraction of survivors. "Survivorship programs need to be sustainable and be able to grow with the growing needs of survivors," Dr. Silver says.

The solution
1. Define cancer rehabilitation. "A really important part of implementing [rehabilitation] care is to define what cancer rehabilitation is, who should be providing that care and how it's reimbursed," Dr. Silver says. One of the reasons for hospitals' lagging survivorship programs is a lack of understanding of the needs of cancer survivors. "I think that there's been confusion [about] what constitutes cancer rehab in a best practices model," she says. She recommends an oncology rehabilitation team include physiatrists, physical therapists, occupational therapists, speech-language pathologists, rehab nurses and mental health professionals.

"There are many different issues that may arise in cancer survivors that are amenable to rehabilitation," Dr. Silver says. She gives an example of head and neck cancer survivors, many of whom have to stop driving because of their limited cervical range of motion. These survivors would benefit from a rehab program that provided physical therapy to increase neck motion, mental health services for possible depression related to an inability to drive and occupational therapy to work towards driving again. "Understanding what problems cancer survivors might face and how they are related to their ability to function is critical," Dr. Silver says.

Another example of problems cancer survivors face is "chemo-brain" — fatigue and reduced memory and concentration — according to Dr. Silver. "Chemo-brain is really mild cognitive impairment, and a comprehensive rehab program that provides physiatry, speech-language therapy and other appropriate services are necessary for cancer survivors just as they are for stroke patients, head trauma patients and others with similar symptoms," Dr. Silver says.  

2. Facilitate the partnership of administrators, oncologists and rehab professionals. When implementing rehabilitation care for cancer survivors, three key groups need to work together and support each other: the administration, oncology professionals and rehabilitation professionals, according to Dr. Silver. Support from executive leadership is critical for attaining the necessary resources to start the program. Gaining this support is not difficult after the administration learns what an evidence-based cancer rehab program is, Dr. Silver says. "Once people understand how this care can help their hospital financially and can help their patients, both physically and emotionally, it is quite a seamless process to implement the program."

The other two key groups are oncology and rehabilitation professionals, who are essential for implementing best practices. All three groups need to agree on the need for a best practices cancer rehabilitation program, so they can work collaboratively toward a common goal.

3. Train a multidisciplinary team. Once hospital leaders define their cancer rehab program and collaborate with care providers, they need to develop and train a multidisciplinary team that includes physiatrists, therapists of different specialties and nurses, as mentioned above. Providing care from board-certified and licensed rehabilitation healthcare professionals ensures that care will be reimbursed, which is crucial for building a sustainable program.

4. Implement best practices based on research. Dr. Silver says most hospitals already have the resources to create an oncology rehabilitation program but until now have not applied them in a structured, best-practices model. Hospitals can implement best practices by coordinating resources such as trained healthcare providers, equipment and education materials. Providing a multidisciplinary team for comprehensive services and performing evidence-based interventions form the foundation of a reimbursable, best practices rehab program.

5. Track outcomes and provide continuing education. Hospitals should track outcomes of the best practices to identify successes and areas that need improvement. Rehabilitation professionals also need to stay up to date on the research and participate in continuing education in oncology rehab and cancer survivorship, Dr. Silver says.

Learn more about the STAR Program and Oncology Rehab Partners.

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