Melanie Cole, MS (Host): At Weill Cornell Medicine, our Cancer Rehabilitation specialists aim to improve patients quality of life using a holistic, empathetic, and patient-centric approach. These complementary cancer treatments are used in conjunction with conventional treatments to address both the physical and emotional needs of our patients.

Welcome to Back to Health, your source for the latest in health wellness and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole, and joining me today is Dr. Kristen de Vries. She's an Assistant Attending physician at New York-Presbyterian Weill Cornell Medical Center and an Assistant professor of Clinical Rehabilitation Medicine at Weill Cornell Medical College Cornell University. Dr. de Vries, thank you so much for joining us today. Start by telling us a little bit about cancer rehabilitation. What is it and who is it for?

Dr. Kristen de Vries: Yes, I'm happy to talk about it. And thank you so much for having me today. So, rehabilitation medicine, we'll start with that, also known as physiatry, also known as PM&R, a lot of different ways that you may hear it referred to. But really, it's a medical specialty that focuses on the diagnosis, evaluation, and management of physical and functional impairments and disabilities. And this can be caused by various different medical conditions, diseases, or injuries. And really, with each passing year, we have more patients who are diagnosed with and treated for their cancer. And thanks to new advances in surgery, medicine, and radiation treatments, the number of cancer survivors continues to grow.

But with that, we see a whole host of different side effects, which can result from cancer and its treatment. And these are often unique to whatever that treatment might be. Actually in a recent letter published in JAMA, and this was in the summer of 2023, they showed that the number of cancer survivors with self-reported functional limitation has more than doubled in the past 20 years. And there's about a 70% prevalence of functional limitation among survivors, and this was from 2018.

So in more recent years, the field of Cancer Rehabilitation has emerged and really is a distinct field under the umbrella of rehabilitation medicine that focuses on managing or eliminating the side effects of cancer and/or its treatment in an effort to improve function and quality of life for patients.

Melanie Cole, MS: Well, thank you for that. So while you're telling us the basic goals of cancer rehabilitation, I'd like you to speak about the benefits. But before that, doctor, I'd like you to speak about some of those side effects you just mentioned. So if we're looking at the basic goals, what are we trying to do? What are some of those side effects that we're trying to mitigate?

Dr. Kristen de Vries: So, there are a variety of different side effects that I can see. These can range from anything like joint pains or neuropathy, sensory impairments, weakness, deconditioning, range of motion restrictions, lymphedema, radiation fibrosis, cancer-related pain or fatigue. So, there are a whole host of different side effects and I see them to varying degrees, again depending on the treatment that was used.

Melanie Cole, MS: Well, then tell us a little bit about the benefits. How are you helping people?

Dr. Kristen de Vries: When we refer to the goals or what the goals might be of Cancer Rehabilitation, and if we take a step back to around the 1960s, there was a doctor, Dr. Herbert Dietz, who developed a model for cancer rehabilitation and kind of broke it into four different stages.

The first of that being preventative. And really, that's this concept of prehabilitation. And this is really when patients are at that initial diagnosis. And the goals at that point are to educate patients about the potential outcomes or complications and how to mitigate the risk of progression, or mitigate the risk of those complications happening, hoping to stop the problem before it begins.

Then, there's restorative, which is really interventions to alleviate impairments, and this can be throughout treatment and into survivorship. Then, there's supportive, which is really in that survivorship phase and at times when patients have recurrence or progression of their disease. So, it's intervention to optimize function for those patients who maybe have persistent debility after cancer.

And then, finally, there's palliative, which is more end-of-life care, but really helping to maintain function and quality of life when possible. And so, the benefits really depend on what stage we're intervening. When we're talking about preventative care, there's a growing body of evidence that suggests that this proactive approach to functional screening and assessment and really encouraging identification and management of impairment earlier in the cancer continuum. And there's a lot of evidence to show that this can contribute to better outcomes. When we're talking about the benefits during treatment, we're really helping patients to make it through their treatment. So, any side effects that may be coming up throughout their treatments, which are delaying their chemotherapy cycles, for example, trying to help manage their pain or their functional impairment to get them back on track and complete their cycles of treatment. And then, when we're talking about after treatment, it's really the goal and the benefits are really to get people back to their life before cancer.

Melanie Cole, MS: So comprehensive and so important, as you said, as survivorship grows and we're seeing more and more long term survivors in this country. Tell us about the program at Weill Cornell Medicine, your approach, and really the multidisciplinary approach that makes it so comprehensive.

Dr. Kristen de Vries: Sure, so, my approach is very holistic. So I really like to get to know my patients as a whole person, mind, body, spirit, really to better understand how their dysfunction or impairment impacts their daily life. And this allows for me to have a more comprehensive treatment approach. So, this may include medication management, therapeutic interventions, but also lifestyle modifications. I really like to include family members when I am seeing patients, to see how they can be helpful or even trained in the rehabilitation process to support their family member. And then, when we're talking about a multidisciplinary approach, it's not for me just treating a patient in isolation. And many times our cancer patients have many providers and many people kind of working together to direct their treatment. And cancer rehab is not to be in isolation, it's to be a part of that team. So when making treatment decisions or medication changes or therapeutic interventions, I often loop in the full oncology team to let them know what I found, what we're evaluating and what our treatment approach is going to be, so that we're all on the same page.

Melanie Cole, MS: And now, speak about some of those therapies. And you were mentioning that you do more complementary and holistic treatments. What does that look like for patients?

Dr. Kristen de Vries: So, Weill Cornell is unique in that it has a very robust therapy program, and I try to utilize all the resources that we have to really support our patients as best as possible. So we have physical therapists, occupational therapists, speech therapists. And within those realms are therapists who specialize in a variety of conditions. Some of them may be neurologic or spine. Some of them may be pelvic floor. We have training in adaptive equipment or activities of daily living. We have brace evaluations. So, we have a wide number of resources that can be used. We also have an integrative health department, which is something that's very unique. And oftentimes complementary treatments such as acupuncture or medical massage or nutrition counseling is all kind of part of that very comprehensive approach, and multimodal approach. So, in that regard, we're very, again, unique and it's a special place in that we can offer these other modalities to our patients. in addition to that, we have neuropsychologists. So for patients who have brain injuries or other cognitive needs, we have that available as well, so really trying to make this a whole comprehensive treatment plan, not just from a medical perspective, but also, a complementary approach as well.

Melanie Cole, MS: One of the interesting things that I've noticed as a cancer survivor myself is the followup appointments, the things can get dizzying. What kind of support can you help with for patients as far as getting them those followup care that they need, helping them to coordinate, because it can be really confusing.

Dr. Kristen de Vries: So, I do try my best with my patients to offer follow up care, and we try to coordinate it with their other appointments. I would say we are working on a number of different fronts to try to come up with a more multidisciplinary clinic approach, where it's kind of you're able to have your comprehensive care in one place. That has not happened yet, but it is a goal that we have because we do understand that these appointments can be very overwhelming. For many of my patients when possible, we do offer telehealth, which is convenient in that, you know, it mitigates or eliminates that need to come in in person. I would say that's not always appropriate to use, but is something that can be very, very helpful, especially when these appointments can be very overwhelming.

Melanie Cole, MS: And what about the families, Dr. de Vries, how are they involved?

Dr. Kristen de Vries: So, patient's significant others play a vital role, I think, in rehabilitation in general, but specifically in cancer rehabilitation. I'd say I often and very frequently have family members accompany patients to their point appointments to help provide information, take notes, coordinate care. As we alluded to earlier, this can be a very overwhelming process and a lot of information coming at patients.

So, I encourage family members to come along. I think it's incredibly helpful. And I really try to incorporate family members into the patient's care, and trying to offer education to them and how they can assist the patient, how they can be involved in the overall health and care for their family member and loved one.

Melanie Cole, MS: What a great program. As we wrap up, I'd like you to tell the listeners what you want them to know about cancer rehabilitation and survivorship at Weill Cornell Medicine and how someone with cancer can access this program.

Dr. Kristen de Vries: So, I want to emphasize that despite the need for rehab, there's really an underutilization of cancer rehabilitation and survivorship resources. And there's some data to show that over 90% of cancer survivors have at least one physical impairment, and only one-third of those patients will receive rehabilitation treatment. And some of this is due to lack of knowledge and some of this is due to lack of access to services. And I do want to emphasize that, you know, part of what we're trying to do here is really advertise, but also advocate for our patients. And the hope is that by continuing to spread this knowledge of the field, patients are more aware of our specialty, can ask more questions and can really find those resources that they need.

So, you know, for patients who are seeking care from our Cancer Rehabilitation Program, they can feel free to speak to their oncologist. We have been working a lot to advocate with our Oncology teams to make them aware of our services. So if it's not being brought up in the conversation, the patient can advocate for themselves and ask for a referral, or they can self-refer as well and schedule an appointment with our rehabilitation department.

Melanie Cole, MS: Thank you so much, Dr. de Vries, for joining us today and really telling us about the key goals and the benefits of cancer rehabilitation. It's so important. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, iHeart, and Pandora. And for more health tips, go to weillcornell.org and search podcasts and parents. Don't forget to check out our kids health cast. So many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

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