Rehabilitation in Oncology Care Guidelines: A Gap Analysis.

BACKGROUND: Cancer survivors experience a high prevalence of functional impairments. Rehabilitation interventions include an expansive array of services that can help optimize function, address pain, decrease symptom burden, and improve quality of life. Nonetheless, rehabilitation services remain underutilized. Thus, it is important to enhance the understanding of and establish guidelines for specific rehabilitation disciplines and interventions. METHODS: This is a gap analysis of rehabilitation recommendations in published oncology guidelines from selected nationally recognized organizations. Symptom-specific guidelines and cancer type-specific guidelines were analyzed for inclusion of common functional impairments (fatigue, pain, peripheral neuropathy, cognitive dysfunction, and lymphedema) and the rehabilitation discipline recommendations. RESULTS: The prevalence of recommendations for rehabilitation in cancer type-specific guidelines was 29%, and was higher in symptom-specific guidelines at 60%. However, the frequency of specific rehabilitation disciplines (physiatry, physical therapy, occupational therapy, speech-language pathology, and rehabilitation psychology/neuropsychology) was notably lower. Overall rehabilitation was mentioned in 33% and physiatry in 18%. Nonrehabilitation specialties were recommended in 18% of the guidelines. No specialty referral was endorsed in 53% of guidelines in which 1 of 5 symptoms were discussed. This highlights the relative paucity of recommendations for specific rehabilitation disciplines in oncology guidelines. The more general term "rehabilitation" was included more frequently but lacks critical guidance for oncology providers. Other crucial rehabilitation services may be underrecognized and underutilized. Rehabilitation specialists must work to improve patient access and the presence of indicated specific rehabilitation disciplines and goals within guidelines. CONCLUSIONS: Most oncology guidelines do not include specific recommendations for rehabilitation disciplines. However, including specific rehabilitation disciplines is more common in symptom-specific guidelines. With a stronger evidence base and increased involvement of rehabilitation specialists in guideline development, rehabilitation recommendations in oncologic guidelines may be more precise, leading to improved utilization of rehabilitation services to optimize function and quality of life.

Prophylactic Lymphovenous Bypass at the Time of Axillary Lymph Node Dissection Decreases Rates of Lymphedema.

Background: Breast cancer-related lymphedema impacts 30% to 47% of women who undergo axillary lymph node dissection (ALND). Studies evaluating the effectiveness of prophylactic lymphovenous bypass (LVB) at the time of ALND have had small patient populations and/or short follow-up. The aim of this study is to quantitatively and qualitatively evaluate prophylactic LVB in patients with breast cancer. Methods: A retrospective review of patients who underwent ALND from 2018 to 2022 was performed. Patients were divided into cohorts based on whether they underwent prophylactic LVB at the time of ALND. Primary outcomes included 30-day complications and lymphedema. Lymphedema was quantitatively evaluated by bioimpedance analysis, with L-dex scores >7.1 indicating lymphedema. Results: One-hundred five patients were identified. Sixty-four patients (61.0%) underwent ALND and 41 patients (39.0%) underwent ALND+LVB. Postoperative complications were similar between the cohorts. At a median follow-up of 13.3 months, lymphedema occurred significantly higher in the ALND only group compared with ALND+LVB group (50.0% vs 12.2%; P < 0.001). ALND without LVB was an independent risk factor for lymphedema development (odds ratio, 4.82; P = 0.003). Conclusions: Prophylactic LVB decreases lymphedema and is not associated with increased postoperative complications. A multidisciplinary team approach is imperative to decrease lymphedema development in this patient population.

Translating 2019 ACSM Cancer Exercise Recommendations for a Physiatric Practice: Derived Recommendations from an International Expert Panel.

In 2018, the American College of Sports Medicine (ACSM) reconvened an international, multi-disciplinary group of professionals to review pertinent published literature on exercise for people with cancer. The 2018 roundtable resulted in the publication of three articles in 2019. The three articles serve as an important update to the original ACSM Roundtable on Cancer, which convened in 2010. Although the focus of the three 2019 articles is on exercise, which is only one part of comprehensive cancer rehabilitation, the evidence presented in the 2019 ACSM articles has direct implications for physiatrists and other rehabilitation professionals who care for people with cancer. As such, the narrative review presented here has two primary objectives. First, we summarize the evidence within the three ACSM articles and interpret it within a familiar rehabilitation framework, namely the Dietz model of Cancer Rehabilitation, in order to facilitate implementation broadly within rehabilitation practice. Second, via expert consensus, we have tabulated relevant exercise recommendations for specific cancer populations at different points in the cancer care continuum and translated them into text, tables, and figures for ease of reference. Notably, the authors of this article are members of the Cancer Rehabilitation Physician Consortium (CRPC), a group of physicians who subspecialize in cancer rehabilitation medicine (CRM).

The Role of Physiatry Practice in a Multidisciplinary Breast Tumor Board: A Descriptive Study.

BACKGROUND: Cancer rehabilitation medicine is a growing field in physiatry, but more studies are needed to demonstrate how physiatry can contribute to patient care within the cancer care continuum. OBJECTIVE: To quantify and describe physiatric participation during a multidisciplinary tumor board for breast cancer patients. DESIGN: A prospective descriptive study. SETTING: A multidisciplinary breast tumor board at a large academic medical center. PARTICIPANTS: Five hundred thirty-seven breast cancer cases presented at a multidisciplinary breast tumor board. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The number of times physiatry actively participated in a multidisciplinary breast tumor board in the categories of referral to physiatry, referral to rehabilitation services, referral to other services, advice given on patients/symptom management, and discussion of available services. RESULTS: Out of 537 breast cancer cases presented, 221 cases (41.2%) resulted in a physiatry recommendation for referral to either physiatry, rehabilitation services, other services, or advice on patient and symptom management. CONCLUSION: Physiatry can actively participate in the care of cancer patients during a multidisciplinary breast cancer tumor board.

I feel good, therefore I am real: testing the causal influence of mood on state authenticity.

Although the literature has focused on individual differences in authenticity, recent findings suggest that authenticity is sensitive to context; that is, it is also a state. We extended this perspective by examining whether incidental affect influences authenticity. In three experiments, participants felt more authentic when in a relatively positive than negative mood. The causal role of affect in authenticity was consistent across a diverse set of mood inductions, including explicit (Experiments 1 and 3) and implicit (Experiment 2) methods. The link between incidental affect and state authenticity was not moderated by ability to down-regulate negative affect (Experiments 1 and 3) nor was it explained by negative mood increasing private self-consciousness or decreasing access to the self system (Experiment 3). The results indicate that mood is used as information to assess one's sense of authenticity.