Academy of Oncologic Physical Therapy CSM 2023 Platform and Poster Presentations

ONCOLOGY RESEARCH PLATFORM PRESENTATIONS IMPLEMENTATION OF A CANCER REHABILITATION NAVIGATION PROGRAM PART 1: QUALITATIVE ANALYSIS OF PROGRAM IMPLEMENTATION Stout NL, Perry AW, Harrington SE, Alappattu M, Pfab VM, Stewart B, SPT, Bailey C, Manes M PURPOSE/HYPOTHESIS: The purpose of this study is to qualitatively assess the implementation of a Cancer Rehabilitation Navigation (CRNav) program in a community-based cancer center. We assessed the clinical context of the program, barriers and facilitators to program development and sustainment, and program processes. Our goal is to provide a prioritized synopsis of strategies and processes that supported successful implementation. NUMBER OF SUBJECTS: 11 stakeholders from the CRNav program at Halifax/Brooks Cancer Center were interviewed, 6 Halifax/Brooks stakeholders participated in a focus group with 2 stakeholders from another regional CRNav program. All stakeholders participated in a prioritization Delphi exercise. MATERIALS AND METHODS: Using a post-implementation study design, interdisciplinary CRNav program stakeholders were contacted to participate in a one-on-one semi-structured qualitative interview. The interview questionnaire, based on the Consolidated Framework for Implementation Research (CFIR), assessed the clinical context of the CRNav program, barriers and facilitators to program implementation, the individual characteristics of the navigator, and program processes. All interviews were recorded, transcribed and coded using reflexive thematic analysis in NVivo software and a process map of the program workflow was developed using Lucidchart. The focus group reviewed content theme findings, identified missing considerations in program implementation, and participated in an implementation mapping exercise to identify specific strategies to influence the provider, clinic, and system levels. Focus group results are being prioritized through a 2-round Delphi process. RESULTS: Fifteen individuals were recruited and 11 consented to participate in a semi-structured interview including physicians (n=2), oncology nurse navigators (n=2), administrators (n=2), office support staff (n=1), rehabilitation providers (n=3), and a patient (n=1). Content themes identified that contribute to program implementation included; staffing, program justification, process for program development, process for patient throughput, unique characteristics of the navigator, skills and training of the navigator, communication strategies, patient engagement strategies and growth opportunities. Content coverage analysis identified the predominant facilitators of program implementation were co-location of the navigator in the cancer center and an implementation team of diverse stakeholders. Predominant barriers to program implementation were lack of oncologist understanding of rehabilitation services for individuals with cancer and process challenges across multiple health systems. Focus group findings are currently being analyzed and complete Delphi results will be presented. CONCLUSIONS: Multiple strategies that influence the provider, clinic, and system level must be considered in CRNav program implementation. An interdisciplinary implementation team, oncologist education, and co-location of the navigator may enhance program implementation. CLINICAL RELEVANCE: Our findings can inform CRNav program implementation and improve integration of rehabilitation services into cancer care delivery. IMPLEMENTATION OF A CANCER REHABILITATION NAVIGATION PROGRAM PART 2: ANALYSIS OF HEALTH SERVICE UTILIZATION DATA Harrington SE, Perry AW, Stout NL, Alappattu MJ, Horn K, Manes M PURPOSE/HYPOTHESIS: The Brooks/Halifax (B/H) cancer rehabilitation navigation (CRNav) program uses a physical therapist to screen and manage patient physical function. The CR navigator receives consults for functional screening from MDs, nurses, or patient navigators. Screening occurs in-person on via telephone and results in the CR navigator coordinating an appropriate clinical pathway for supportive care. Patients are not billed for this screen. The purpose of this research is to analyze health care service utilization outcomes for patients screened using this model. NUMBER OF SUBJECTS: 405 adults (M=117, F=288, age=67.1 ±11.9 yrs) with cancer, referred to physical therapy (PT), occupational therapy (OT) &/or speech and language pathology (SLP) outpatient services in the B/H system from October 2019-December 2021. MATERIALS AND METHODS: Data from the screening tool, an 18-item form capturing oncology treatment-specific factors and patient self-reported functional limitations, was extracted from electronic health records (EHR). Patients referred to and received rehabilitation in the B/H system were analyzed for this report. Demographic, diagnosis, and impairment data were retrieved from the EHR along with treatment encounter data including start/end date and the number of visits. All data were compiled in Excel. Descriptive analysis of referral rates, time to treatment, and length of the encounter were conducted. RESULTS: The navigator received 1083 consults from Breast (52%) head and neck (15%) and lung (12%) disease teams. 92% (n=996) were screened (8% unable to contact) and 41% of those screened received outpatient rehabilitation in the B/H system. Navigator in-person or phone screening ranged from 10-40 minutes. Reasons for not receiving rehabilitation included: no functional deficit identified (16%), chose to go outside the health system/insurance not eligible at B/H (13%), or referred to home health (8%). The most common indications for referral were pain (29%), lymphedema (27%), and deconditioning (10%). Of patients referred 74% received PT, 17% OT, 2% SLP & 8% received 2 services. Average visits: PT=10.7 (range:1-62), OT=8.6 (1-54), SLP=1. Average time from navigator screen to rehabilitation evaluation = 15±13 days. Patient satisfaction was excellent for overall experience (94.5%) and expectations (94.2%) for rehabilitation. 94.9% were likely to recommend B/H and 94.9% were likely to return. CONCLUSIONS: A CR navigator can effectively screen adults with cancer and appropriately identify needs for rehabilitation referral for various functional limitations. The screening consultation is efficient, allowing for flexibility in patient contact. B/H is able to support a non-billable CR navigator due to the return on investment (ROI) generated by in-system referrals. Further analysis of cost and cost modeling is indicated. CLINICAL RELEVANCE: Understanding utilization trends of patients screened through a CRNav program provides data to justify ROI. Community-based cancer centers can improve cancer care delivery by implementing this model and may improve revenue generation for their health system. FACILITATORS AND BARRIERS TO USE OF OUTCOME MEASURES WITH PATIENTS WITH BREAST CANCER-RELATED LYMPHEDEMA Doubblestein DA, Spinelli BA, Goldberg A, Larson CAA, Yorke AM PURPOSE/HYPOTHESIS: Outcome measures (OMs) on breast cancer survivors (BCS) and breast cancer-related lymphedema (BCRL) have been established by the Breast Cancer EDGE Task Force and the Dutch Society of Dermatology.1,2 Limits in knowledge of OMs and competence their use are reported as barriers across healthcare disciplines.3,4 Other barriers across disciplines include lack of time implementing, and patient of lack of of the lack of and use from and The purpose of this study was to facilitators and barriers influence lymphedema use of OMs and their NUMBER OF SUBJECTS: physical and occupational MATERIALS AND METHODS: A research was using an electronic to lymphedema from various Descriptive of and were to and and group across multiple Descriptive were to identify barriers to OMs with and to OMs facilitators and barriers and the of facilitators and barriers to use of individual RESULTS: that OMs a of care improve of care and the of on of reported knowledge OMs and reported the to due to in or the of that not the to to use on with = not training in their or on that OMs improve of care. barriers for specific OMs were lack of knowledge and not in and CONCLUSIONS: on the of and to the use of may the use of OMs experience barriers to use of OMs to lack of knowledge and implementation the clinical barriers are to OMs not being and lack of CLINICAL RELEVANCE: barriers the for in OMs for with and the to and in the of A of OMs be for and in the of rehabilitation on and BARRIERS AND FACILITATORS TO IMPLEMENTATION OF BREAST CANCER-RELATED LYMPHEDEMA CLINICAL PURPOSE/HYPOTHESIS: are to improve patient outcomes through implementation of barriers and facilitators to implementation across of health from the to the The purpose of this study was to identify the barriers and facilitators that implementation of the and to the of patients with breast cancer-related lymphedema NUMBER OF SUBJECTS: and MATERIALS AND METHODS: An electronic was to and were of the of and of The to barriers and facilitators from the and and clinical RESULTS: and to the the and the Of those not were not of the and were not of the were likely to to and were likely to the Of those the and have the and that implementation of the were time and not into workflow that of the were reported lack of in implementation from and Patient characteristics were as barriers with most support staff and physical were CONCLUSIONS: to the of have the into their clinical barriers to implementation including characteristics to the and Further research is to strategies to barriers to effectively into clinical strategies are to improve the overall and implementation of CLINICAL RELEVANCE: study identified to implementation of the and for patients with The findings have the to inform the development of strategies to the implementation of to improve of care and outcomes for patients and to improve the workflow of the clinical OF IMPLEMENTATION OF BREAST CANCER-RELATED LYMPHEDEMA CLINICAL ANALYSIS C, PURPOSE/HYPOTHESIS: The of clinical to the and of breast cancer-related lymphedema (BCRL) in and from this research group established that and in the are not to the from and a diverse of barriers and facilitators to implementing the The purpose of this analysis was to identify themes of barriers and facilitators to implementation of the and will be to a to support the development of strategies to improve implementation. NUMBER OF SUBJECTS: and MATERIALS AND METHODS: An electronic based on the and was developed to identify the barriers and facilitators to implementation of the and to the of patients with An analysis was to identify and the factors to implementation of the RESULTS: and to the the and the analysis of the for by for and for that barriers and facilitators for 1: and and of stakeholders 2: characteristics Patient analysis of the for by for and 41% for that barriers and facilitators for 1: and and of stakeholders 2: characteristics and physical Patient and characteristics CONCLUSIONS: factors were identified for that as barriers and facilitators to implementation. factors individual physical and as as characteristics of the patient and research that on factors support or barriers to implementation of will healthcare providers in clinical and the delivery of CLINICAL RELEVANCE: findings can inform the development of strategies that can implementation of into clinical and the development of outcomes to of implementation. TO TO BREAST CANCER REHABILITATION M, M to cancer rehabilitation care for individuals of and in the research is that in outcomes and and in the barriers to rehabilitation care and exercise. The will the and outcomes of the established to to breast cancer rehabilitation for in the is a of the Breast Cancer to Rehabilitation and the The of health patient and care. The provides breast cancer physical therapy and in a in with the Center for in Patients have to support and exercise barriers to care. A with knowledge of breast cancer treatment and rehabilitation the to healthcare and support and to the through as health and A that of and the for and the The development and challenges of the will be presented. Patient including functional and will be presented. An clinical will be presented. OF is that treatment breast cancer survivors and barriers to rehabilitation. The is a community-based that to experience and the to in breast cancer outcomes in the The model can be for and are barriers to oncology rehabilitation. TO is that physical and to the barriers to oncology rehabilitation care. The is an of a successful community-based model to in outcomes AND UTILIZATION ONCOLOGY A PURPOSE/HYPOTHESIS: and are that contribute to physical therapy services can by physical through to pain and improve a is a to understanding the of on functional outcomes in the in the oncology study to measures of and utilization of services the in the oncology The was that study or be likely to a NUMBER OF SUBJECTS: were screened from a as of an to have a with an or and be at in a of study MATERIALS AND METHODS: was a were from the and were a of or not based on the data of and were from the and for were reviewed to utilization and length of The the were assessed with using and RESULTS: were and were likely to a evaluation those not and those were likely those not to a evaluation those with and were likely to a CONCLUSIONS: The results of this study a and utilization the in the oncology CLINICAL RELEVANCE: findings is a for screening to identify patients may from services. research is to the of on functional to services for and to the of on oncology OF AND ONCOLOGY REHABILITATION PURPOSE/HYPOTHESIS: The purpose of this study is to the by with cancer reported oncology rehabilitation screening and analyze referral to group exercise program, or to their NUMBER OF SUBJECTS: MATERIALS AND METHODS: for cancer, and referred by provider, cancer or to were screened by a at a based outpatient study data was extracted from screening from electronic records and and into an through a electronic Data was analyzed using for were on a and were for of lymphedema and lymphedema by and by were for diagnosis, RESULTS: of were were of received treatment of and received and received and to pain at reported to pain with reported to Other reported of and reported to of and to Of of or and not an for at of of were in and head and neck and to were an or was by to by the screening were referred for physical therapy for to a group exercise program at the physical therapy and received CONCLUSIONS: study the of that referral for and with and to this service is to identify and provide to functional and improve of CLINICAL RELEVANCE: are to provide screening and the treatment to improve and or manage to screening is to and manage cancer treatment and patients with the education, knowledge and to rehabilitation OF ONCOLOGY PURPOSE/HYPOTHESIS: The purpose of this is to the of of adults to a care for oncology measures are in to date not with cancer in the and the of by physical in the NUMBER OF SUBJECTS: to a with cancer and referred to PT, including cancer and MATERIALS AND METHODS: The for Research and of Cancer of was due to and in provides a health functional and from to with of or of on the the at time of evaluation or as as able in from to RESULTS: patients were with a of and The most common cancer were and and and head and neck The group the were a a health of Patients in the and and in the The most were pain and and the were and The group the overall health and with the and were most and health reported across in was a in health CONCLUSIONS: of patients a and are most and with the to their care and to an oncology service that the unique needs of this The to use the across from and and in to and to provide the care CLINICAL RELEVANCE: with patients for oncology care be of the of their patients and can of the most and and physical and referral to be to OF OF ONCOLOGY REHABILITATION delivery of and study outcomes as by in oncology rehabilitation cancer and in the to physical therapy referral through in of physical therapy cancer survivors are in the by The level of knowledge for as an in in the not been The of the to to cancer content in have content as an was developed by a and to of with cancer by the for cancer were considerations on of a was assessed via and and were and for and of Descriptive and qualitative themes were OF and as were a to with reported with with patients with breast cancer, on of clinical reported no reported that the their to in the most or that identify of cancer treatment and that to of in the most for into study with group and by content with use of clinical for to was in or of specific content cancer time a of content for and and TO to of content to the are as and A, A, PURPOSE/HYPOTHESIS: outcomes of cancer and the adults can of survivors from of exercise as for that & centers use analysis to a of to cancer, can oncology physical use to and of care. We to from a study of no for will use data from a NUMBER OF SUBJECTS: patients with data were adults in were MATERIALS AND METHODS: data were from & of and We and with & and by or using We by as RESULTS: was and at & for & was not to with not to to & CONCLUSIONS: to at of not and by are for Other include and use of from are and specific to We to the of & by and CLINICAL RELEVANCE: may to and exercise use to identify cancer survivors for A CANCER Bailey PURPOSE/HYPOTHESIS: adults cancer may be at for are by cancer or in the is the to of and of been to in cancer have been to exercise measures in lung cancer The purpose of this study was to a exercise program in lung cancer NUMBER OF SUBJECTS: lung cancer survivors participated in the program with of the MATERIALS AND METHODS: to the were be of and were to of physical and included: for time to and and the was of to and were and the a A was using the measures as A was conducted. RESULTS: The and in adults The physical and not CONCLUSIONS: The exercise in physical measures as and and in CLINICAL RELEVANCE: have cancer experience and have is for lung cancer the use of exercise using of physical therapy with and of in lung cancer a been to and training Our results in and in lung cancer survivors that participated in a exercise with and exercise to be to of OF REHABILITATION UTILIZATION WITH ONCOLOGY PATIENTS A PURPOSE/HYPOTHESIS: been with of the cancer and are with length of and The from cancer, and treatment can a physical with and their of physical therapy services can be to and improve functional The purpose of this study was to services functional outcomes and in patients treatment for is a of research in this The was patients with and NUMBER OF SUBJECTS: A of patients were screened from a as of an Patients were at and to the for oncology and A of patients the MATERIALS AND METHODS: study and from a Data utilization and the for and encounter were extracted from an electronic system. The were analyzed with RESULTS: Patients received overall time and patients with and received time therapy The for and were and Patients were and received to patients CONCLUSIONS: patients received were level of and to patients not that patients received from to Of the patients those received those CLINICAL RELEVANCE: findings and can in screening patients with level of may from services. research can the utilization of with a and patients with cancer OF & PATIENTS K, PURPOSE/HYPOTHESIS: Of patients a for is the most common in of patients along with physical and of of the and of exercise is a lack of data on and Patient reported outcomes the of exercise The to therapy be to improve understanding of and physical measures can for for NUMBER OF SUBJECTS: through patients the and consented to MATERIALS AND METHODS: Patients were to group or that a Outcome measures were at time a and outcomes to physical and and time a Data were analyzed using and of with for and RESULTS: was no in and or to was an in and an in the of the on the was was no for and the and for or in and by was The of the on length of was a for CONCLUSIONS: The results of this study patients participated in a and for to and those in the program. was no on or for or for patients or CLINICAL RELEVANCE: physical measures and exercise be in the to and for patients C, B, AND Patients receiving for may experience in as as and contribute to and of Rehabilitation the care can have on and of to and a of patients multiple to and patients with use of a support system time to and length of The purpose of this study was to a as of rehabilitation program to improve The study a for with a The patient developed lung and and was to the for and and was as a for on the of the and was not appropriate for or due to and and for for was a for and was in the outpatient a received from support for in the to with a with and no treatment, from a to a to a and to a the to with a outside of the 6 and to a of with a and home was with and with a for and a in outpatient clinic, can be as of an rehabilitation program. of the to and in a patient that as a the for a to use of a will improve time to and length of WITH A AND Multiple is the most common cancer in those of have in with the Patients with a at of are at of can treatment and functional study the of on and of an with and of A with pain to the a a and in and with of was not a as on of for for and was on and that was and was in a with and exercise to The and were the to oncology treatment functional and a on the and was as and patient to improve to complete the with in and to in the an in was home with was able to complete outpatient to and the in or been established for the in those with The patient the of and of in those The is a in cancer this patient a on by clinical of in those with treatment for and to and is a for this patient study the have in those with and the and on this the patient not received this level of PT, likely not have home or been a for ONCOLOGY PRESENTATIONS AND A WITH AND AM AND is a form of for of Patients that therapy for are at for due to to and The purpose of this is to the of physical therapy in the and of and in a patient The patient was a referred to for on the of for the of from to based on level of impairment to treatment and patient education, and home exercise program The patient in measures home from the The for to to and to that a on and as as patient and were to this patient and Further research needs to be on the implementation of and for patients therapy for A WITH A A AND is an that in the most in an of of patients with to to the outcomes of patients are with from 2 to been research on rehabilitation into the rehabilitation of patients with not been The purpose of this was to a program with an on and training for a patient and The patient was a received of physical therapy at an outpatient The and and functional was using the in The patient in from to for to via including and functional were for this patient as to in and for research is into the of and for patients with BREAST CANCER AND PURPOSE/HYPOTHESIS: The purpose of this study is to the functional of therapy on and and in breast cancer We that the to the will that at of and and of the We that and pain breast cancer survivors to NUMBER OF SUBJECTS: with MATERIALS AND METHODS: is a are at of for the treatment of breast is from a cancer center a oncology The data will be to and of the an analysis of the using and a to and and and RESULTS: Data data by CONCLUSIONS: Data data by CLINICAL RELEVANCE: to of breast cancer survivors have functional and have or been as a for research that the are to breast cancer treatment, and is to may and function. is to the of pain in and this been a common by the in clinical this breast cancer study was to be We to is at for and for breast cancer that can referral and treatment a understanding of and that may rehabilitation to identify and most ONCOLOGY PURPOSE/HYPOTHESIS: NUMBER OF SUBJECTS: clinical pathway in with be MATERIALS AND METHODS: was to and breast cancer along with the Patient to an will to breast cancer patient evaluation and can be a to in the of improve of not patient be able to experience this by the for as RESULTS: on the is for patients in is functional patients were in program to patients were for and treatment or CONCLUSIONS: healthcare lack the appropriate to lymphedema is on patient of or to and lymphedema not for the for lymphedema and into clinical a most are to and cancer program not as to lymphedema CLINICAL RELEVANCE: Our goal at The is to improve patient of lymphedema rates, and with Our been to a lymphedema program and to based on with is a and to in the of improve of not patient allowing for patients to be are and of to the of clinical due to the the to patients at for breast cancer CANCER-RELATED A C, SPT, C, PURPOSE/HYPOTHESIS: is a common cancer with as as individuals the care including and into that on functional and overall of The purpose of this was to the of and in-person exercise in and NUMBER OF SUBJECTS: MATERIALS AND METHODS: A for the of exercise or to by a rehabilitation was using AND exercise AND AND AND of AND via and of of exercise for was and screening was by 2 by to be be in in include with a of cancer and be at in the care and include exercise at was assessed for by 2 were unable to a the study was RESULTS: The in an were and were for and were the of exercise on reported exercise levels. study the of training and training was to overall and with physical in to the of a of exercise and training on of a in of the were and study exercise and reported and physical function. an program to a in-person program. CONCLUSIONS: and exercise improve those with and exercise improve and of cancer is for CLINICAL RELEVANCE: include exercise as a treatment for and in-person or via delivery can have a on and A AND is a disease in is an of in the and treatment for a to in the

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