Rehabilitation and Pediatric Oncology: Supporting Patients and Families During and After Treatment

Limitations of Current Rehabilitation Practices in Pediatric Oncology: Implications for Improving Comprehensive Clinical Care

OBJECTIVE

To identify the proportion of hospitals/clinics in the United States (US) that have a comprehensive pediatric oncology rehabilitation program and characterize current practices.

DESIGN

Cross-sectional survey of rehabilitation providers in the US and internationally.

SETTING

Electronic or telephone survey.

PARTICIPANTS

Rehabilitation or supportive care practitioners employed at a hospital, outpatient clinic, or medical university.

INTERVENTIONS

Electronic and telephone survey. The full electronic survey contained 39 questions, provided opportunities for open-ended responses, and covered 3 main categories specific to pediatric cancer rehabilitation: service delivery, rehabilitation program practices, and education/training. The short telephone survey included 4 questions from the full survey and was designed to answer the primary study objective.

MAIN OUTCOME MEASURES

Proportion of hospitals/clinics with a comprehensive pediatric oncology rehabilitation program.

RESULTS

This cohort (N=241) includes rehabilitation providers from 191 hospitals/clinics, 49 states within the US, and 5 countries outside of the US. Of hospitals/clinics represented from the full and short survey, 145 (76%) do not have an established pediatric oncology rehabilitation program. Nearly half of full survey respondents reported no knowledge of the prospective surveillance model (PSM) and 65% reported no education was provided to them regarding pediatric cancer rehabilitation. Qualitative survey responses fell into three major themes: variability in approach to rehabilitation service delivery, program gaps, and the need for additional educational opportunities.

CONCLUSIONS

There is evidence of limited comprehensive rehabilitation programming for children with cancer as demonstrated by the lack of programs with coordinated interdisciplinary care, variability in long-term follow-up, and the absence of education and training. Research is needed to support the development and implementation of comprehensive pediatric oncology rehabilitation programs.

Psychological Considerations in Pediatric Chronic Illness: Case Examples

Despite significant gains in survival rates for pediatric patients and adolescents/young adults (AYA) with chronic illness, patients in this vulnerable age group are also at an increased risk for developing one or more adverse effects related to their disease, treatment, or maladaptive health behaviors. Maladaptive health behaviors ultimately increase the risk for developing adverse effects, including: increased rates of morbidity and mortality, impaired physical functioning, increased fatigue, obesity, increased psychological distress, and poor quality of life. With close attention including participation in preventive and therapeutic health promotion interventions, problematic health behaviors can be mitigated and ultimately prevented over time. It is well known that improved psychological functioning and adaptive coping can result in improved health status. The present paper provides four case examples illustrating various psychological interventions in pediatric chronic illness. As evidenced in the four case examples, pediatric psychologists provide comprehensive interventions for patients with acute and chronic medical conditions through the use of health promotion interventions, adherence and self-management promotion, cognitive behavioral therapy, behavioral therapy, medical coping, parent training, and motivational interviewing. Our case series demonstrates that for the most impactful behavior change to occur, a combination of interventions is often the most effective.