Cancer Center Spotlights: Increasing Equitable Access to Exercise, Rehabilitation, and Image Recovery Services for Patients with Breast Cancer

This is the second blog post highlighting the Association of Cancer Care Centers Supportive Care Services for Patients with Breast Cancer Quality Improvement Program. You can read the first one here. 

For nearly 4 decades, the United States has recognized October as breast cancer awareness month. Despite advances in treatment and supportive care interventions, barriers to optimal care continue to persist. To increase access to supportive care services for historically underserved populations, the Association of Cancer Care Centers (ACCC) launched a quality improvement initiative in collaboration with Living Beyond Breast Cancer and Cancer Support Community.  

ACCC selected 3 member programs tasked with identifying specific barriers to supportive care faced by patients with breast cancer in their catchment area. Once identified, each site applied evidence-based strategies to improve equitable access to supportive care services for the patients they serve.  

The Queen’s Medical Center 

The largest non-profit hospital in Honolulu, Hawaii opened the doors of The Queen’s Cancer Center in 2007. “It brought the people of Hawaii a comprehensive multidisciplinary cancer treatment and research center with the mission to provide superior cancer care," said Joyce Tokuhara, RN, operations manager, Oncology Navigation Program at The Queen’s Medical Center. This mission inspired the center to enroll in the ACCC supportive care initiative, with their focus dedicated to exercise oncology and rehabilitation services.  

According to Tokuhara, the cancer center’s quality improvement aim was to increase patient and caregiver awareness of exercise oncology services by creating a tailored, comprehensive exercise brochure for patients by the end of September 2024. Their action plan included highlighting resources from the American Cancer Society, local community resources, as well as input from patients and staff. To implement the program, the cancer center collaborated with multidisciplinary stakeholders to understand the insurance landscape, created marketing brochures promoting the exercise and wellness program, and contracted a vendor to update their website. 

“Feedback received from the staff and patients has been great so far,” Tokuhara explained. “A survivorship support group member said the brochure is very informative and explained that many people are unaware of physical therapy and it’s great to get the word out.”  

To build on their early success and engagement, the cancer center plans to obtain feedback from oncologists and rehab teams about the brochure, work to auto-populate the exercise brochure into each patient’s discharge paperwork, and track their hospital referrals.  

Bon Secours St. Francis Cancer Center 

In Greenville, South Carolina, Bon Secours St. Francis Cancer Center recognized a dearth of image recovery services for patients with breast cancer undergoing treatment. “Our approach was fragmented,” said Lara Widener, quality manager, Oncology. “We had some resources and education for patients but desired a more robust offering.”  

To address this issue, the cancer center aimed to equitably increase image recovery services for patients with breast cancer who are receiving or have completed treatment. The process began with an interest survey distributed to patients in September 2024. “This allowed us to understand what patients would like to see and what services would be most valuable to them,” Widener explained.  

Following completion, the center identified 3 areas that patients were eager to learn more about:  

• Mastectomy Supplies  
• Lymphedema Management and Prevention  
• Sexual Health Seminar  

According to Widener, the cancer center hopes to launch this program in December 2024, with a focus on one area of interest each month. “Hopefully we will progress and add more as we go along,” she said. “We have enjoyed working on this program and hope to have updates at a later date of our progress.”  

AtlantiCare Cancer Care Institute  

AtlantiCare Cancer Care Institute in Egg Harbor Township, New Jersey, focused on optimizing processes for early detection and equitable access to cancer rehabilitation and durable medical equipment (DME). Their team analyzed data about referrals to cancer rehabilitation services, engaged in community discussions, and gathered insights from patients and providers to identify gaps in awareness and resource integration. Their aim was to create a navigation-led process that would streamline the identification of supportive service needs and develop a patient risk assessment scorecard to assist navigators in connecting patients with appropriate services in a timely manner. 

“From July to September [2024], we focused on developing an identification tool for cancer rehabilitation, translating an existing process into a new protocol,” said Carolyn Kalpas, PT, MSPT, ReVital Cancer Rehabilitation program director, NovaCare Rehabilitation—a local outpatient physical therapy provider partnered with the cancer institute. This protocol helped to guide referrals at various stages of treatment, ensuring that patients receive support throughout their care journey. “Within 6 months, we plan to advance both the cancer rehabilitation and DME protocols, with hopes to integrate more supportive services within the following 12 months,” Kalpas concluded.  

ACCC President’s Theme  

This year, ACCC president and senior associate dean for Community Engagement and Equity in Research at the Wake Forest University School of Medicine and Atrium Health, Nadine Barrett, PhD, MA, MS, centered her president’s theme on Reimagining Community Engagement and Equity in Cancer. Through innovative and community focused initiatives like these, Dr. Barrett hopes ACCC can be at the forefront of improving equity in cancer care delivery.  

The ACCC Supportive Care Services for Patients with Breast Cancer Quality Improvement Program is supported by Gilead Sciences Inc.