Silver Julie K, Raj Vishwa S, Fu Jack B, Wisotzky Eric M, Smith Sean Robinson, Kirch Rebecca A
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA, 02129, USA.
Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA.
Support Care Cancer. 2015 Dec;23(12):3633-43. doi: 10.1007/s00520-015-2916-1. Epub 2015 Aug 28.
Palliative care and rehabilitation practitioners are important collaborative referral sources for each other who can work together to improve the lives of cancer patients, survivors, and caregivers by improving both quality of care and quality of life. Cancer rehabilitation and palliative care involve the delivery of important but underutilized medical services to oncology patients by interdisciplinary teams. These subspecialties are similar in many respects, including their focus on improving cancer-related symptoms or cancer treatment-related side effects, improving health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision-making. They also aim to improve healthcare efficiencies and minimize costs by means such as reducing hospital lengths of stay and unanticipated readmissions. Although their goals are often aligned, different specialized skills and approaches are used in the delivery of care. For example, while each specialty prioritizes goal-concordant care through identification of patient and family preferences and values, palliative care teams typically focus extensively on using patient and family communication to determine their goals of care, while also tending to comfort issues such as symptom management and spiritual concerns. Rehabilitation clinicians may tend to focus more specifically on functional issues such as identifying and treating deficits in physical, psychological, or cognitive impairments and any resulting disability and negative impact on quality of life. Additionally, although palliative care and rehabilitation practitioners are trained to diagnose and treat medically complex patients, rehabilitation clinicians also treat many patients with a single impairment and a low symptom burden. In these cases, the goal is often cure of the underlying neurologic or musculoskeletal condition. This report defines and describes cancer rehabilitation and palliative care, delineates their respective roles in comprehensive oncology care, and highlights how these services can contribute complementary components of essential quality care. An understanding of how cancer rehabilitation and palliative care are aligned in goal setting, but distinct in approach may help facilitate earlier integration of both into the oncology care continuum-supporting efforts to improve physical, psychological, cognitive, functional, and quality of life outcomes in patients and survivors.
姑息治疗和康复治疗从业者是彼此重要的协作转诊来源，他们可以共同努力，通过提高护理质量和生活质量来改善癌症患者、幸存者及其护理人员的生活。癌症康复和姑息治疗涉及跨学科团队为肿瘤患者提供重要但未得到充分利用的医疗服务。这些亚专业在许多方面相似，包括它们专注于改善癌症相关症状或癌症治疗相关副作用、提高健康相关生活质量、减轻护理人员负担，以及重视以患者为中心的护理和共同决策。它们还旨在通过减少住院时间和意外再入院等方式提高医疗效率并降低成本。尽管它们的目标通常一致，但在提供护理时使用了不同的专业技能和方法。例如，虽然每个专业都通过确定患者和家属的偏好及价值观来优先提供目标一致的护理，但姑息治疗团队通常广泛关注利用与患者和家属的沟通来确定他们的护理目标，同时也关注症状管理和精神关怀等舒适问题。康复临床医生可能更具体地关注功能问题，如识别和治疗身体、心理或认知障碍方面的缺陷以及由此导致的残疾和对生活质量的负面影响。此外，虽然姑息治疗和康复治疗从业者接受过诊断和治疗医疗复杂患者的培训，但康复临床医生也治疗许多只有单一损伤且症状负担较轻的患者。在这些情况下，目标通常是治愈潜在的神经或肌肉骨骼疾病。本报告定义并描述了癌症康复和姑息治疗；阐述了它们在综合肿瘤护理中的各自作用；并强调了这些服务如何能成为基本优质护理的互补组成部分。了解癌症康复和姑息治疗在目标设定上如何一致，但在方法上又有所不同，可以帮助促进将两者更早地整合到肿瘤护理连续过程中，以支持改善患者和幸存者身体、心理、认知、功能和生活质量结果的努力
