Chicago rehab facility formalizes treatment of oncology patients

New program provides rehab and extra services

Many rehab providers have at least some oncology patients, including brain injury and spinal cord injury patients whose disabilities stem from tumors. Actively recruiting referrals from oncologists for these and other cancer patients, however, may take a shift in rehab philosophy.

Schwab Rehabilitation Hospital & Care Network in Chicago made such a shift this year. The hospital developed a more formal program to treat cancer patients. Schwab has 125 beds, including 30 subacute beds, and is affiliated with Sinai Health System in Chicago.

"I think the best way to think about oncology rehab is that it’s rehab with a different ideology of impairment," says David Weiss, MD, director of outpatient care and attending physician at Schwab. He’s also an assistant professor at the University of Chicago. "Instead of a stroke giving us the weakness, it’s a brain tumor," he says. "Instead of a traumatic spinal cord injury, it’s a metastatic spinal cord lesion leading to paraparesis."

Improves quality of life

The new oncology rehab program is available for all cancer patients, even those who are in the terminal stage of the disease and are ready for hospice care; those patients benefit from brief rehabilitation that helps them improve their quality of life during the end stage, Weiss says.

The inpatient program consists of a team made up of physical therapists and other therapists, psychologists, social workers, pastoral care, oncologists, dietitians, rehab nurses, and a physiatrist. Outpatient therapy is an equally important component, and a major part of the outpatient program involves lymphedema management, Weiss says.

Lymphedema experts work with cancer patients and other patients experiencing a backup of fluids in their limbs. Physical and occupational therapists undergo special two-week certification training programs to learn lymphedema management.

"We want to look at patients who have had some kind of oncology surgery that results in lymphedema as a complication," explains Claudette Richards, PT, director of physical therapy. "These include breast cancer and mastectomy, prostate surgery after prostate cancer, surgery after urethra cancer, or possibly cervi-cal cancer, or any kind of cancer where they remove lymph nodes."

The lymphedema program involves having therapists provide soft-tissue mobilization, which is called decongestive therapy. "This is where they go in and do the soft-tissue manipulation to decongest the lymphatic system to improve drainage," Richards says.

"Each therapy session is at least an hour, and the treatment is daily in order for it to be effective," Richards adds. "This could last for four to six weeks, with a goal of getting the swelling decreased to close to or near normal so that a patient can perform functional activities without any problems."

Although the cancer rehab program is new, the hospital has begun to receive referrals strictly for the lymphedema management portion. Some patients are not cancer patients but can benefit from this type of therapy, including stroke patients with upper or lower extremity swelling. Chronic venous insufficiency patients and congestive heart failure (CHF) patients also may benefit, although CHF patient referrals need to be made cautiously.

The cancer rehab program’s general goals, including the lymphedema program, include the following:

• expanding a continuum of services for oncology patients within the health care system;

• providing comprehensive interdisciplinary services to improve patients’ overall quality of life;

• expanding the hospital’s referral base to serve patients who are not currently served;

• providing an opportunity for revenue enhancement;

• establishing a specialized interdisciplinary team to manage the cancer patient population.

Weiss acknowledges that cancer rehab still is a new concept both to oncologists and insurance companies. However, there have been changes in how people view cancer in recent years, particularly as the number of survivors grows.

"It used to be that cancer meant death, so you didn’t rehab these patients," Weiss says. "Now it’s a disease stage, a disease process, and the question becomes whether there is a need for rehab and does this patient population benefit from rehab?"

Studies show need for rehab

Several studies show there is a definite need for cancer rehabilitation, Weiss adds. "Because if you look at survivors, there’s a significant percent who have problems with ambulation and activities of daily living, and pain, and weight loss, and difficulties with working."

Rehab therapists can help cancer patients improve in all of those areas. Plus, there’s evidence that rehab treatment can help cancer patients and their families improve their quality of life, even when the patient is dying, Weiss says.

"Families are very anxious at the end, and if you can calm them down by empowering them and giving them knowledge on how to take care of their loved one, they’re less likely to want them to be readmitted into an acute care institution," he explains.

While the program is too new to judge reimbursement success, hospital officials anticipate little difficulty with reimbursement, which mainly will come from Medicare and Medicaid.

"They cover our routine services, but as far as getting into specifics, it depends on the individual patient and what the patient’s needs are," says Nancy Cutler, MS, CRRN, vice president of inpatient services at Schwab. Medicare will cover costs associated with rehab staff because many cancer patients experience functional limitations as a result of their disease. "Then we have patients who have had less of functional gains, but we’ve done a lot of teaching with the family so they can return home," she adds.

Schwab also has been building a relationship with hospice providers so referrals can work in both directions. The hospice might refer patients to the rehab facility, and the rehab facility might refer cancer patients to hospice. "We’re looking for hospice to provide us with education, and we’re also looking for them to complete our continuum of care," Cutler says. "In rehab, traditionally, we have the idea of making patients better functionally and cognitively, but death and dying is not an area that rehab folks do well because it’s not part of our philosophy."

Hospice professionals could help educate the oncology rehab team about death and dying issues, she says.

Designed for three cancer stages

Likewise, Schwab will work with oncologists to improve their cancer rehab program and to encourage them to make referrals to the program. Weiss has met with oncologists at lecture meetings to present the program’s benefits and services.

Basically, the program is designed to offer services to patients with three different stages of cancer. (See story on three stages of cancer and rehab, at right.)

Those services include education, psychology and psychiatry, nutrition, pain management related to function, rehab services and therapies, lymphedema management, case management and discharge planning, female oncological management, chemotherapy, and oncology management.

Need More Information?

Nancy Cutler, MS, CRRN, Vice President of Inpatient Services, Schwab Rehabilitation Hospital & Care Network, 1401 South California Blvd., Chicago, IL 60608. Phone: (773) 522-2010, ext. 5859. Fax: (773) 522-4839.

Claudette Richards, PT, Director of Physical Therapy, Schwab Rehabilitation & Care Network, 1401 South California Blvd., Chicago, IL 60608. Phone: (773) 522-2010, ext. 5125.

David Weiss, MD, Director of Outpatient Care, Schwab Rehabilitation Hospital & Care Network, 1401 South California Blvd., Chicago, IL 60608. Phone: (773) 522-2010, ext. 5051.