Recently, the open-access journal, Cancer, included a special issue: Supplement: A Prospective Surveillance Model for Rehabilitation for Women With Breast Cancer. This model has been described by researcher, Nicole Stout, as a “proactive approach to periodically examining patients and providing ongoing assessment during and after disease treatment, often in the absence of impairment, in an effort to enable early detection of and intervention for physical impairments known to be associated with cancer treatment(1).” In other words, checking early and often so that issues can be dealt with at a mangeable stage and not in a catastrophic end-stage presentation. Theoretically, this model of approach can mitigate many of the known poor related outcomes for patients following cancer treatment.
The model of prospective surveillance has been developed over the last decade at the National Naval Medical Center in Bethesda-now part of the Walter Reed National Military Medical Center. It’s the standard of care for all patients there and serves as a great base for research into the clinical effectiveness of this approach. While bottom-line cost savings numbers aren’t apparent yet, this seems a likely outcome, as overall, patients consume less care when issues are dealt with in early stages when their prognosis is still strong. Regardless, it’s a cool phrase!
The prospective surveillance model attempts to cover many aspects of cancer treatment, including awareness of known side-effects to the sometimes persistent upper extremity pain and dysfunction that so many women share following treatment for breast cancer. Describing and quantifying the séquelle of post-treatment effects that are common following treatment that can be ameliorated through rehabilitation are part in parcel in studying this model, and are dealt with as well in the supplemental Cancer issue. Check it out and get smart!
This issue hits close to home for me. My mother is a breast cancer survivor. As she recovered, I was well aware of the musculoskeletal dysfunction in her upper extremity, yet was confounded at the lack of attention that received from her care providers. Research into this area is a critical, emerging field of physical therapy and one that makes me proud.
As an aside, Nicole Stout is a member of the APTA Board of Directors (Scroll to Bottom). She is in candidate status this year and I’m sure would appreciate any support one could be in the position to be in as elections approach in June. She does important work.
1. Stout NL. Cancer prevention in physical therapist practice. Phys Ther. 2009; 89( 11): 1119-1122.
Eric,
Excellent post, and an intriguing concept that is likely not on the radar of the global health care system nor PT. I relate this to strongly to acute care and some of the potential effects of an acute illness or hospitalization. Our folks in ICU’s display persistent neuro-cognitive and neuro-musculoskeletal impairments as well as impaired health quality of life. Prospective surveillance could likely assist in preventing and appropriately managing.
Thank you Eric for the post and for recognizing that this is groundbreaking for patients with cancer. I love Kyle’s comment! And from the 30,000 foot level, there are so many areas of PT practice that could better serve the needs of patients by working in a secondary prevention model. It is a better approch to care, especially for those with chronic conditions which will have a deleterious impact on function. Rather than being impairment-based in our approach to care it is time to shift the paradigm of PT practice towards prospective surveillance for early identification and treatment of impairment.
I agree. I think we sometimes become TOO bogged down in identifying impairments, regardless of setting. Imagine the health impact if EVERY outpatient physical therapist took resting HR and BP of their patients and designed a prevention or wellness adjunct exercise program targeted to that person’s vitals, body type, weight, AND individual goals. PT’s have the capability to be one of the primary players in the treatment of obesity, hypertension, COPD, CAD/CVD, and other chronic medical conditions.
We need to broaden our perspective and begin to understand how we can actually affect chronic medical conditions (the best thing these folks can do is improve their fitness!!). We need to know and identify what people are at risk for, and begin to study if we can intervene to prevent it.
Interesting, interesting concept both clinically and scientifically.