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Rehabilitation, Quality of Life, and Symptom Management

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INTRODUCTION

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According to the American Cancer Society (ACS), almost one-third of women in the United States will develop cancer. Most of these women will survive their cancer diagnosis yet face an uphill battle of maintaining their health as well as to reduce the risk of cancer recurrence. To help women in coordinate, there is a shift toward patient-centered approaches to survivorship with Clinical Integrated Networks (CIMs), Patient-Centered Medical Homes (PCMHs), Accountable Care Organizations (ACOs), and the Patient-Centered Outcomes Research Institute (PCORI; Figure 21-1). The focus of these emerging concepts is to help women make informed health care decisions, improve health care delivery, and implement plans of care using evidence-based information. Ultimately, survivorship is guided by patients, caregivers, and the broader health care community.1 Ideally, patients as well as members of the public have the information they need to make decisions with their health care professional that reflect desired health outcomes. As health care professionals, we must hear the call of our patients’ desires to improve survivorship through rehabilitation, quality of life (QOL), and symptom management. As the nation moves from physician-centric care to a patient-centered team approach, our patients deserve more active roles in their survivorship.

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Fig. 21-1.

Approach to patient care with the dawn of health care reform.

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Cancer survivorship can be improved by participating in rehabilitation, improving QOL, and managing symptoms. With new national guidelines putting the patient at the center of communication between oncologists and primary care providers, we need to ensure all survivorship options are available to them.

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REHABILITATION

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Definitions

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Gynecologic cancer diagnosis can play havoc on a woman’s body. Oncologists typically use various conventional therapies for treating gynecologic cancers to facilitate a positive prognosis. Unfortunately, these therapies along with a list of comorbidities can reduce the functional ability and QOL of women in survivorship. Rehabilitation is defined as restoring the body for use in life. Oncology rehabilitation specifically addresses a patient’s debilitating adverse events as a result of the therapeutic interventions.2 Evidenced-based oncology rehabilitation includes physical strengthening, flexibility, functional assessments, QOL improvement strategies, stress management, lifestyle changes, and nutrition/dietary interventions. While still fairly new, oncology rehabilitation is still underutilized as a tool in survivorship, even as we face a future of patient-centered health care.

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Although the potential benefits of oncology rehabilitation are obvious, the optimal frequency, intensity, type, and timing of rehabilitation for patients undergoing treatment or in survivorship still remain unclear.3,4,5,6 Clinicians struggle to find the balance of challenging gynecologic cancer ­survivorship and encouraging one to make lifestyle changes all at once. However, can patients really afford to be inactive? Encouraging patients to be physically active can improve glucose metabolism, digestive function, immune function, ...

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