When teams fumble: cancer rehabilitation and the problem of the "handoff"

Cancer Rehabilitation Providers and Oncology Patient Expectations for Functional Outcomes after Inpatient Rehabilitation

BACKGROUND

Cancer rehabilitation is a valued resource for patients and oncologists. Cancer rehabilitation providers are seeing increasing numbers of referrals for inpatient rehabilitation as the number of cancer survivors grows. However, cancer rehabilitation providers, oncologists, therapists, patients, and caregivers may not always clearly communicate the goals of care, which can lead to different expectations for inpatient rehabilitation.

OBJECTIVE

To determine the difference in expectations of function after an acute inpatient rehabilitation stay between cancer patients and cancer rehabilitation providers and how they align with achieved goals after treatment.

DESIGN

Prospective survey study.

SETTING

Quaternary academic medical center inpatient rehabilitation unit.

PARTICIPANTS

Out of 194 eligible patients, 132 were enrolled and completed admission surveys, and 110 completed the discharge survey. Twelve cancer rehabilitation providers completed the surveys.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Barthel Index.

RESULTS

Patients estimated their expected functional status as a median (interquartile range) score of 19 points (18, 20) using the Barthel Index, compared to cancer rehabilitation providers, who estimated a median score of 17 points (15, 19) (P < .001). Actual functional status upon discharge was a median score of 16 points (13, 18) using the Barthel Index, which was three points lower than expected by patients (P < .001).

CONCLUSIONS

Oncology patients and cancer rehabilitation providers significantly overestimate functional goals for acute inpatient rehabilitation. This overestimation was clinically significant for oncology patients and statistically but not clinically significant for cancer rehabilitation providers. Increased communication may allow for a more realistic expectation of functional status upon discharge.

A Case Report on the Communication between Oncologists and Physiatrists in the Establishment of Functional Prognosis while Undergoing Chimeric Antigen Receptor T-cell Therapy

Chimeric Antigen Receptor (CAR) T-cell therapy can have severe toxicities, which include CAR-T-cell-related encephalopathy syndrome (CRES). The patient may present with altered mental status, encephalopathy, seizures, and cerebral edema. Depending on the severity, the recovery process will require rehabilitation.

We present a case and explain how communication between cancer physiatrists, oncologists, and patients can affect the expectations for functional recovery, and the importance of setting goals for recovery in a medically complex population.

We present a patient who underwent aggressive chimeric antigen receptor T cell therapy, causing encephalopathy and complications. He initially required total assistance for mobility and activities of daily living. Physiatry was consulted to assist with the rehabilitation plan of care and disposition. Initially, the oncologist conveyed to the patient he would be walking in two weeks, which was unrealistically optimistic. The patient's physiatrist intervened and discussed these expectations with him, alleviating his emotional distress. His condition improved with inpatient rehabilitation, and he was able to ambulate short distances with modified independence in four weeks.

The involvement of a cancer physiatrist allows for recognition and treatment of complications related to cancer and aggressive therapies, along with an accurate functional prognosis assessment. With improved communication and patient involvement, the patient underwent a successful rehabilitation.