LEXINGTON Saint Joseph Hospital (SJH) Rehabilitation Manager Vickie Heierman, a 34 year veteran of Saint Joseph, wanted to expand and improve the rehabilitation services for cancer survivors by having her clinicians better trained and better prepared. In October 2012, under Heierman’s leadership, SJH initiated the STAR® Program and Certification (Survivorship Training and Rehabilitation), an evidence-based, reimbursable training program from Oncology Rehab Partners (ORP).
According to ORP’s website, STAR® was developed by Julie Silver, MD, an assistant professor at Harvard Medical School, a cancer survivor and author of several books on cancer rehabilitation. Heierman says that “rehabilitation and pre-habilitation for cancer patients are often overlooked and people think they have to live with the full side effects of chemotherapy and surgery. But rehabilitation and pre-habilitation can really improve the quality and quantity of a patient’s life.”
Scarring from mastectomies, for example, takes an enormous toll on breast cancer survivors, both physically and psychologically. Scar tissue can prevent simple tasks such as brushing hair, dressing or doing simple daily tasks. Heierman says that Saint Joseph physical and occupational therapists employ the ASTYM® (advanced soft tissue mobilization) treatment system for rejuvenating damaged soft tissue, using ergonomically designed tools designed to increase blood flow.
Breast cancer surgery patients make up the majority of SJH STAR® outpatient rehab clients, but are not the totality. Heierman lists patients with esophageal, brain, rectal, stomach, ovarian cancer and all types of cancer who can benefit from the STAR® and ASTYM® rehab protocols. ASTYM® treatments range from 6 to 12 sessions and patients are typically discharged with greatly improved functionality, decreased pain, and the skill and knowledge to manage their physical stresses.
Twenty five SJH staff members consisting of PT’s, OT’s, Speech Therapists, Nurse Navigators, social workers and even chaplains received certification after a 20 hour multi-discipline online course. STAR® for cancer survivors is offered at four central Kentucky locations: Saint Joseph Park Physical Therapy in the SJH Medical Office Building; Saint Joseph East; Saint Joseph Jessamine and the Beaumont Center YMCA in Lexington.
Pre-Habilitation: The Next Great Thing
Heierman is particularly enthused about the advent of a “pre-habilitation program for cancer patients” which she projects to begin before the end of 2013. Pre-habilitation is the process on the continuum of care that occurs “anywhere from two to six weeks after diagnosis and before surgery or treatment begins,” says Heierman.
The benefits to pre-habilitation are multiple, including establishing a pre-treatment baseline status of a patient’s mobility and function; identifying pre-treatment impairments; and improving the physical and mental health of the patient prior to treatment. These, in turn, can result in reduced morbidity or mortality from treatment and decreased hospital stay or readmissions.
To gauge the effectiveness of the STAR® program, SJH Rehab uses a “Distress Management” questionnaire for patient satisfaction and staff evaluation. (See Chart) The Distress Management questionnaire from the National Comprehensive Cancer Network provides Heierman and her staff with “an objective, evidence-based tracking of a patient’s progress towards recovery with functional outcome measures,” she states.
Heierman stresses that doctors and patients need to know that pre-habilitation and rehabilitation services are beneficial and available to cancer patients who have just been told, “You have cancer.”