Cancer rehabilitation: assessment of need, development, and evaluation of a model of care.

A sample of 805 cancer patients, comparable to but not identical with a national study, was screened to identify: rehabilitation problems encountered at different cancer sites; the need for rehabilitation services; and gaps in the delivery of rehabilitation care. Significant numbers of rehabilitation problems were found that could be improved by rehabilitation care. Psychologic problems were commonly encountered and seemed more severe in patients with physical disabilities; these patients have to make adjustments to both life-threatening disease and to a disabling condition. The findings suggest a need for psychosocial support services on any oncology service; where cancer is associated with significant physical disability, a comprehensive rehabilitation team with psychologic management capability is often needed. Primary barriers to optimal delivery of rehabilitation care are the lack of identification of patient problems and/or lack of appropriate referral by physicians unfamiliar with the concept of rehabilitation. Health care financial support for the patients in the sample came primarily from private insurance, Medicare and Medicaid; financial support from the patient's family held up well even in the advanced stages of the disease. A model of rehabilitation care delivery was established and implemented, with the result being that gaps and barriers to rehabilitation service delivery disappeared rapidly.