Physical Therapists as Essential Members of the Cancer Care Team

This blog post is the fifth of an eight-part ACCCBuzz series highlighting the achievements of the 2020 ACCC Innovator Award Winners. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us at the ACCC 37th [Virtual] National Oncology Conference September 14-18, 2020.

Beaumont Health—a nonprofit eight-hospital regional health system in southeast Michigan—operates comprehensive pre-habilitation, rehabilitation, exercise, and survivorship programs that emphasize lifelong health and wellness. An important part of this effort is oncology physical and occupational therapy, a specialty customized for the treatment of individuals across the cancer care continuum.

But Christopher Wilson, PT, DPT, DScPT—program director for the Beaumont Health Oncology Residency and assistant professor at Oakland University—says recruiting therapists certified in oncology can be a challenge. “We had trouble recruiting physical therapists for cancer patients, because oncology specialization is not entry-level for physical and occupational therapists; it requires a lot of advanced training to work with cancer patients,” says Dr. Wilson. “We also observed that oncologists are very protective of their patients—and rightfully so. They don’t want someone to teach their patients potentially inappropriate exercises that could cause a patient more discomfort than they already have with chemotherapy, surgery, or radiation.”

Dr. Wilson and his colleagues set out to develop an in-house solution. “We began to focus on training our current Beaumont therapists to be cancer specialists,” he explains. “We started developing the program in 2015. After researching for a while, we looked at each other and said, ‘Wow, we've got a real curriculum here.’” So Dr. Wilson and his colleagues approached the American Physical Therapy Association—the accrediting body for residency programs for physical therapists—to get accreditation for their own residency in oncology. “We were accredited in 2018,” says Dr. Wilson, “making us the first residency program in the United States for oncology rehabilitation.”

Dr. Wilson says the one-year oncology residency has thus far graduated seven physical therapists and one occupational therapist. The first two graduates of the program were therapists already working at Beaumont, and the remainder began working at Beaumont after graduating from the program. Once participants pass a board exam, they can be certified in oncology.

Dr. Wilson says programs like Beaumont’s residency promote a wider role for physical therapy in cancer care. “This is a cultural shift for rehabilitation professionals—thinking about themselves not just as interventionists,” explains Dr. Wilson. “Physical therapy is not just waiting until something goes wrong and then getting a physical therapist to fix it. It is being proactive to keep people well in the first place.”

Dr. Wilson believes the success of Beaumont’s cancer physical therapy program is not only measured by the efficacy of its outpatient rehabilitation services, but also in being able to reduce hospital length of stay and readmission rates. “This patient population tends to stay in the hospital a bit longer than someone with a heart attack, knee replacement, or stroke,” explains Dr. Wilson. “If cancer patients aren't well-equipped to function in a home setting after being released from the hospital, they end up having to come back. We've been able to demonstrate a link between rehabilitation services and a reduction in admissions for cancer patients.”

Another way Beaumont’s physical therapists are proactive is their involvement in the multidisciplinary care team as care plans are developed. Wilson says his therapists attend tumor boards to provide input on individual therapy needs. Beaumont’s physical therapists work closely with the nurse navigators who run tumor boards to help identify which patients may be appropriate for their services. “The theory is, the more pre-habilitated a patient is, the stronger, more flexible, and more mobile they will be before they receive radiation, surgery, or chemotherapy,” says Dr. Wilson. “Their recovery will be that much shorter, and their side effects less severe.”

Dr. Wilson says that as cancer patients live longer as a result of more effective treatments, the need for oncology rehabilitation is growing. Physical therapists at Beaumont also help create survivorship care plans in which therapists teach patients how to maintain a healthy lifestyle and respond to the long-term side effects that may occur.

 Dr. Wilson says his personal priority is tending to the needs of the patients for whom there is no cure. “Unfortunately, some of our cancer patients are not going to survive their cancer, and they need integrated palliative services,” he says. “That’s the patient population for whom I think the services of physical and occupational therapists are the most important. These folks are getting weaker, but their disease has not yet taken their life; they still have living to do. Ensuring they are able to have the best quality of life for as long as they can is my most important responsibility.”

Dr. Wilson will deliver an in-depth presentation on the creation and integration of Beaumont Health’s oncology rehabilitation services at the ACCC 37th [Virtual] National Oncology Conference, September 14-18. To learn about how Beaumont Health developed and supported its oncology rehabilitation services, be sure to register for the session, “Integration of Pre-Habilitation, Rehabilitation, and Prospective Surveillance Into Cancer Interdisciplinary Teams.”

Be sure to also learn about the accomplishments of the other 2020 ACCC Innovator Award winners on topics ranging from the creation of a 3D educational tool that reduces patient distress to the development of a nurse navigator-led cardio-oncology clinic.