Cancer rehabilitation 국내외정리
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Transcript of Cancer rehabilitation 국내외정리
CANCER REHABILI-TATION
Past, Present and Future
A history of cancer rehabilita-tion An examination of the history of cancer
rehabilitation will steer us toward future success for our patients.
DeLisa JA.
Cancer. 2001 Aug 15;92(4 Suppl):970-4.
Dr. Howard Rusk (1960) A world to Care
A patient with bladder cancer who required a hemi-corporectomy at New York City’s Memorial Hospital
Able to return home after transferred to the Institute of Rehabilitation Medicine
Partner with Memorial Hospital’s Dr. Herbert Dietz
Dietz (1969) A successful cancer rehabilitation programAcute care hospital + A cancer hospitalNot duplicated in other facilities
Dietz model of cancer rehabilitation (1980)Preventative, Restorative, Supportive, Pal-
liative
The National Cancer Act (1971)National Cancer Institute (NCI), National Institutes of
Health (NIH), The Division of Cancer Control and Rehabilitation
A lack of a specific implementation plana lack of trained personnelFailure to educate referring health care pro-
fessionals
Lehman et al (1978)Assessment of problemsGaps and barriersA model of rehabilitation care
delivery
Arch Phys Med Rehabil 1978;59:410–9
Harvey et al (1982)○ 36 cancer rehabilitation program
○ Patient education, protocols for specific can-cer sites, family involvement, pain control methods
○ Referral patterns, team communications, ef-fective outcomes
JAMA 1982;247:2127–31
1970-1980
• A decline in federal funding and emphasis• Failure to educate oncologists about the po-
tential benefits of rehabilitation • Failure to prioritize cancer rehabilitation as
an important part of education• A shift in physiatric interest
A Review of the Literature since the Survey
O’Toole and Golden (1991)70 cancer patients admitted to a freestand-
ing rehabilitation hospital
West J Med 1991;155:384–7
Yoshioka (1994)A prospective 6-year study involving 301
terminal cancer patients in an inpatient hos-pice in Japan
Barthel mobility index : 12.4 → 19.978% Satisfaction
Am J Phys Med Rehabil 1994;73:199–206
DePompolo (1994)The experience of the cancer rehabilitation
program at the Mayo ClinicNeed of emotional support, pain, and im-
pairments in activity of daily living, and mo-bility
Sabers et al (1999)¾ pain, difficulty rising from chairGetting on and off a toilet, walking, climbing
stairs
Marciniak et al (1996)The Rehabilitation Institute of Chicago 159 consecutive patients admitted to inpa-
tient rehabilitation servicesFIM 42.9 → 56.0 Influencing factors
Metastatic disease (x)Radiation (o)
Arch Phys Med Rehabil 1996;77:54 –7
Stafford and Cyr (1997)Medicare Current Beneficiary Surveyby the Health Care Financing Administration
(HCFA)1647 respondents from 9745 elderly com-
munity-based Medicare beneficiaries○ Difficulty with one or more ADL(47%), Walking
(38%), bathing (20%),transfers (21%)
Cancer 1997;80:1973–80.
Van Harten in the Nertherlands (1998)147 cancer patients¼ need for professional care17% more than one problemsPhysical, psychological and cognitive func-
tions
Winningham (2001)Fatigue and pain are major concerns of
cancer patientsUsefulness and benefits of a variety of pro-
grams including exercises and rehabilitation intervention
Cancer 2001;92:988–997.
Integrating cancer rehabilitation into medical care at a cancer hospital
The University of Texas M. D. Anderson Cancer Center
○ 1960 ~1973 : rehabilitation consultation○ 1973 ~ ○ 1989 ~ Baylor College of Medicine
Lessons learned over 40 years○ Strong administrative commitment○ Strong PM&R department○ Marketing of the program○ Strong, continuing educational courses
Cancer. 2001 Aug 15;92(4 Suppl):1055-7.
Europe The policy framework for commissioning
cancer services review (1995)○ Integration of rehabilitation from diagnosis
NHS Cancer Plan ○ Department of Health (DH), 2000
Services beyond cancer centerRegional cancer networksNorthern Ireland Cancer Network (2006)
- The Cancer Care Workforce Team- AHP (Allied health professions)
Guidance on Cancer Services (2004)○ National Institute for Clinical Excellence (NICE)○ Improving Supportive and Palliative Care for
Adults with Cancer○ Four level version
National Cancer Network AHP Lead Fo-rum (2007)
○ a new model of cancer rehabilitation assess-ment and support
Present
U.SCancer survivorship
○ Mullan, F. (1985)Seasons of survival: reflections of a physician with can-
cer. New England Journal of Medicine. 270-273.
국가기관○ CDC○ NCI (National Cancer Institute)
비영리기관○ American Cancer Society○ National Coalition for Cancer Survivorship○ Cancer Care
Cancer RehabilitationAmerican Cancer Society
○ Physical side effectsChemotherapy, radiation effects, pain, fatigue, lym-
phedemaNCCN Task Force
○ Management of neuropathy in cancer (MD Stubblefield)
○ Bone Health and Cancer Care
M. D. Anderson Cancer Center Four full-time physiatrist
In the Section of Physical medicine and rehabilitation in the Department of Palliative and Rehabilitation Medicine within the Division of Cancer Medicine
Outpatient clinic○ Lymphedema, pain, disability evaluations, general de-
conditioning, gait abnormality, fatigue and spasticityInpatient rehabilitation unit
○ More than 400 patients admitted yearly○ Average length of stay 10days○ Brain and spinal tumor (28%), GU, lung, bone, GI,
breast, head and neck
National Rehabilitation Hospital http://www. nrhrehab.org/
AustraliaAustralian Cancer Survivorship Centre,
ACSC○ Patient-centred care○ Shared care○ Long-term follow-up clinics○ Supported self-management○ Multidisciplinary care
Canada
일본
환자 · 가족→담당의① 진찰
담당의→환자 · 가족② 방문간호지시서
담당의→왕진의② 진료의뢰
왕진의→환자 · 가족③ 왕진
간호사→방문간호스테이션정보제공
방문간호스테이션→환자 · 가족③ 방문
방문간호스테이션↔케어매니저의뢰 실시보고
환자 · 가족↔케어매니저플랜작성 계약
국내현황 _ 진료 림프부종 클리닉
95 년 말 : 최초로 삼성서울 병원 림프부종 클리닉 개설이후 성모병원 , 일산병원 , 분당서울대병원 , 세브란스병원 , 아산병원 등에서 클리닉 개설
포괄적 암재활 서비스 제공 시작
국내현황 _ 연구 2006 년
유방암 삶의 질 연구 ( 분당서울대병원 )암환자 재활요구 , 림프부종의 핵의학 연구 , CDT연구 , lymphangiogenesis 연구 ( 삼성병원 )
2007 년서울대병원 부종 초음파 연구 ( 서울대병원 )
2009 년진행성 암환자 연구 ( 국립암센터 )
2011 년림프부종 측정 도구 (impedence) 연구 ( 아산병원 )
대한 림프부종 학회 2011 년 제 7 차 대한림프부종 연구회 정기학술대회 및 학회창립총회 2004 년 출범 다학제간 , 질환 중심 연구회 삼성암센터
○ 개원시부터 림프부종 클리닉 개설 , ○ 림프부종 진단과 치료 선도
아산재활 심포지엄 2011 년 제 5 회 아산재활 심포지엄 2007 년부터 개최 암센터 내 삶의 질 향상팀 운영 한달 평균 외래 250 명 , 타과 협의진료 150 명
분당서울대병원 암재활 연구 2007 년 , 2010 년
보건복지부 암정복추진개발사업“ 유방암 삶의 질에 상지 기능 장애가 미치는 영향 조사 및 삶의 질 향상을 위한 지속적 상지 재활 프로그램 개발”“ 한국 암 생존자의 기능 장애 실태와 국제 장애 분류 (ICF)의 임상적 적용을 통한 장애 관리 프로그램 개발”
국립암센터 2007 년 재활의학클리닉 진행성암환자 위한 연구 및 진료 암생존자 통합지지 서비스 제공 체계
재활의학과 전문의 암재활 인식도 조사