May 2, 2008

Rehab oncology gives life back

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Physical therapist Ann Marie Flores, Ph.D., works with patient Darryl Robertson, who is taking part in the Rehabilitation Oncology Program. (photo by Neil Brake)

Rehab oncology gives life back

After Darryl Robertson completed his nearly yearlong treatment for throat cancer in 2007, there was one thing he longed to do — lift his son.

Fifty-six pounds lighter, his neck and shoulder muscles had limited motion and strength after treatment and surgery. But all of that changed this year when he enrolled in the Rehabilitation Oncology Program at Vanderbilt Medical Center.

Today, lifting 3-year-old Darrion is again possible.

“I'm getting my life back,” said Robertson, 44. “I decided to enlist the help of the physical therapist after my doctor recommended it. The rehab was sometimes painful, but it was good. I know without it, I would have only gotten worse.

“I was so stiff and very limited in what I could do. I can do things now that I had struggled with in the past.”

The program, created in 2006, is located in Medical Center East in the Vanderbilt Orthopaedic Institute and Rehabilitation Services. It offers both outpatient and inpatient services that also include caretakers to ensure patients a better quality of life.

“At the heart of the program is our commitment to cancer survivorship and improving quality of life as they relate to the physical and functional needs of the survivor,” said Ann Marie Flores, Ph.D., physical therapist and team leader of the program.

“There was an unmet need here. Patients, doctors, nurses, therapists, administration — we all rolled up our sleeves and got to work. Our interdisciplinary group really works together.

“There is no standard for rehabilitation services for cancer survivors. We asked other centers and experts and consulted the literature. We found no standard model for the delivery of care. So based on the information we gathered, we developed our own model and hope that within five years we will see our model replicated.”

This novel approach to care began two years ago with a quality improvement project that targeted the inpatient population of stem cell transplant recipients. The staff began working on programming and protocols that would best serve these patients. As time went on, the group saw an increasing need for such services for the entire oncology population.

“Cancer can be conceptualized as a chronic disease with potential life-threatening episodes in between that can lead to physical impairment if not treated early enough,” said Flores, assistant professor of Orthopaedics and Rehabilitation. “It makes it very difficult for a patient to go elsewhere for help. We have created a program dedicated to the importance of exercise and physical activity.”

Flores' research focuses on cancer survivorship and providing the highest evidence-based quality of care.

Through the Rehabilitation Oncology Program, her dream is being realized. Flores' interest in cancer survivorship first began when friends were diagnosed with breast cancer — one being a 42-year-old with stage III breast cancer. With a toddler at home, she was experiencing major physical impairments with no resources for help.

“It was then that I made it my mission in life,” Flores said. “There was almost no literature that considered the issues of quality of life as they relate to physical function for the cancer survivor. The bulk of the literature focused on psychological adjustment. And if there was information on exercise, it focused on physical activity and patients who were far out from the treatment phase.

“There was little research that looked at the disablement process that can come with cancer and treatment. The literature that existed was outdated and focused on breast cancer.”

With a growing number of patients and “graduates” of the program, Flores and her group are now able to document the process of program development and have begun developing standards that can be used nationally.

Robertson, a a U.S. Postal Service supervisor, is grateful for Flores' drive to create such a program.

His one-hour sessions, held two to three times a week, changed his life.

“Before I was diagnosed with cancer, I was a distance runner. Then I stopped,” Robertson said. “With Ann Marie's help I got back on the treadmill. Now I am near my goal of running to the next town — it's eight miles away.”

His therapy and determination assisted Robertson in preparing to run 13.1 miles in the Country Music Marathon’s Half-Marathon last week.

“Going to rehab is one of the first things I would recommend to folks. I am able to do things I know I would not be doing today…I have Ann Marie to thank for that.”