Offering Rehabilitation Care to Oncology Patients (Podcast)

Oncology patients face an array of adverse effects from their cancer and its treatments, including pain, mobility issues and cognitive impairment. Eileen Slavin, DO, a physician in the Department of Physical Medicine and Rehabilitation within Cleveland Clinic’s Neurological Institute, recently launched an oncologic rehabilitation program to help patients maintain and regain function during their cancer treatment and recovery.

“All of us have been affected by cancer in some way — through patients that we treat or family members,” Dr. Slavin says. “That’s why I’m excited about this work — it’s really important. I appreciate the collaboration of the diverse teams that are involved — all of our oncology teams, all our therapy teams, neurology, prosthetics and orthotics, nutrition and others.”

In a recent episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Slavin discusses the emerging field of cancer rehabilitation. The topics she covers include:

• What oncologic rehabilitation entails, and how to refer patients
• The difference between palliative care and rehabilitation
• The role of prehabilitation to prepare patients prior to surgery and other treatments
• Consulting on the care of patients with side effects such as fatigue from chemotherapy and neurotoxicity from immunotherapies

Click the podcast player above to listen to the 25-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.

Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: I suspect that one real growth area for you will be prehabilitation. Can you explain prehabilitation and what your role in it is?

Dr. Slavin: The concept of prehabilitation is for patients to prepare for something like a transplant or a big surgery, particularly when we know the outcomes could be potentially devastating — for instance, that they could end up with lymphedema, could have major mobility issues, could lose a lot of weight or might have a lower functional status. We try to identify patients who have about four to six weeks until their surgery or their transplant. That is better, of course, for solid tumor patients undergoing neoadjuvant chemotherapy because we can buy some time.

Prehabilitation essentially involves optimizing patients from three different perspectives — psychologically, physically and nutritionally. It includes looking at psychological health — referring patients to psychology, making sure they have good psychosocial support, such as ensuring that they have no transportation issues. It also includes helping with physical activity, or the physical function piece. That involves talking about exercise counseling, providing safety recommendations, giving them actual exercise prescriptions using the principle of FITT, or frequency, intensity, time and type. Then the final piece is nutrition, which involves collaborating with our dietician colleagues to prepare for the likelihood that the patient will lose weight and to make plans to help the patient maintain their caloric intake and consume enough protein to reduce loss of muscle mass and avoid sarcopenia.

All these aspects of the patient’s life will be affected. The idea of prehabilitation is to build the patient up before they get beaten up with all these therapies to treat their cancer, so that they have a stronger baseline to start from and will have a better and swifter recovery from treatment.