The three stages of cancer
Cancer rehab services need to be adjusted according to each patient’s stage of cancer, and that division of stages also is helpful in marketing the program to referral sources and payers.
David Weiss, MD, director of outpatient care and attending physician at Schwab Rehabilitation Hospital & Care Network in Chicago, describes the three cancer stages this way:
• First: Patients in the first stage are in remission, and the rehab goal is to help them achieve maximum function. For example, a patient may have gone through chemotherapy and have peripheral neuropathy as a result of treatment. The patient needs to learn strengthening skills and how to use assistive devices for activities of daily living. An average length of stay (LOS), depending on what the patient’s impairment is, could be two to three weeks. A patient who has had a brain tumor, resulting in a disability that’s similar to a stroke, may need 21 days, for instance.
• Second: Cancer patients in the second stage need supportive therapy as their cancer progresses. The goals are to help patients use adaptive equipment and do therapeutic exercises to prevent their impairment from becoming a disability. Patients may include those who have a metastatic lesion to the spinal cord and are paraperetic. Rehab care of such patients will take longer because the goal is for them to be independent at the wheelchair level. They’ll need help with strengthening their upper extremities, learning how to transfer, and learning how to take care of their bowels and bladder. "Basically, they have a new body, and they need to learn how to deal with it," Weiss says. So the average LOS might be in the four-week range.
• Third: These patients are in the palliative, terminal stage of cancer. The goals are to help them improve or maintain comfort and function. The rehab care enables the family and patient to work together toward a goal of enhancing quality of life. For example, a rehab therapist may teach the family how to safely transfer a patient from the bed to a wheelchair. "It’s very empowering to the family to help the person at the end of life to get out and enjoy the sun, so they’re not just sitting in the bedroom, looking at each other," Weiss says. While this type of rehab therapy and education can be done by a home health agency, it may be done faster in a brief rehab stay before the person is referred to hospice care, he adds. The average LOS might be three days to a week.