Introduction

Survivors of cancer may face a complex combination of physical, psychological and social issues following the completion of active treatment.1 2 While for some people, primary care support is sufficient, others may have more complex needs that require specialist input.3 4 The Centre for Cancer Rehabilitation in Stockholm offers multidisciplinary and person-centred programmes for survivors of cancer that typically include counselling to manage the psychological and physical impact of cancer, support to return to work, and physical exercise programmes.5 6 Every year, the centre receives more than 1,000 referrals and conducts more than 9,000 consultations.4 The impact of the service is assessed on a case-by-case basis, but there are plans to implement a structured evaluation programme in 2021.

Challenge

The impact of cancer extends beyond active treatment. Survivors of cancer report a range of physical issues, including fatigue, pain, cognitive dysfunction and swelling.1 2 In addition, they may experience anxiety and fear about potential relapses, and issues with self-esteem and body image following surgery or other physical changes due to their cancer.7 Time away from work and social activities can also affect a person’s relationships and sense of self.7 8

Sweden has a National Care Plan for Cancer Rehabilitation, which offers extensive support for survivors of cancer and their families.3 While primary care support is sufficient for some people, others may have more complex needs that require specialist input.3 As issues may emerge long after the completion of treatment, it can be difficult for healthcare professionals to recognise or predict who might need more intensive support.4

Solution

Since 2016, the Centre for Cancer Rehabilitation in Stockholm has offered comprehensive rehabilitation programmes for cancer survivors in the region.4 It has a multidisciplinary team, currently led by a physiotherapist specialising in oncology, which includes physicians, nurses, occupational therapists, physiotherapists, dietitians and psychological specialists.9 Most people are referred to the centre by healthcare professionals in primary care or specialist cancer centres, but it is also possible to access the centre through self-referral.10 4 The national public health system funds the rehabilitation programme, meaning that people do not have to pay out-of-pocket to use the service.4

Rehabilitation programmes offered by the centre are tailored to the concerns, needs and goals of each individual.9 These goals are often focused on everyday activities that may have become difficult owing to the impact of cancer and its treatment.4 People are encouraged to be active partners in the development and implementation of their programme,9 which typically includes counselling to manage the psychological and physical impact of cancer, support to return to work, and physical exercise programmes such as medical yoga.5 Following completion of this initial programme, participants receive a final rehabilitation plan with recommendations for self-management and, if needed, follow-up care with other healthcare professionals.11 The centre also hosts support groups for survivors, their families and caregivers.12

What has been achieved

In 2019, the centre received 1,100 referrals and offered 9,300 appointments to survivors of cancer.4 The impact of the service is assessed on a case-by-case basis, as people set unique goals in their rehabilitation programmes. The centre’s team is currently exploring tools to assess patient-reported outcomes.4

In response to the COVID-19 pandemic, appointments, consultations and group meetings were moved online using videoconferencing software.4 Rehabilitation programmes were integrated into a national online healthcare platform, which enabled people to access self-care modules and contact members of their care team.4

Next steps

In the future, staff at the centre hope to:

  • monitor patient outcomes with appropriate data-collection protocols to evaluate and communicate the centre’s impact over time
  • expand the multidisciplinary team and collaborate with primary care professionals to increase the centre’s capacity and portfolio of services
  • encourage further research in the field of cancer rehabilitation.4

Further information

Contact

Ylva Svahn (Head of Unit, The Centre for Cancer Rehabilitation, Stockholm)

Ylva.svahn@sll.se

References:

  1. Alfano CM, Cheville AL, Mustian K. 2016. Developing High-Quality Cancer Rehabilitation Programs: A Timely Need. American Society of Clinical Oncology Educational Book, : 10.1200/edbk_156164 (36): 241-49
  2. Scott DA, Mills M, Black A, et al. 2013. Multidimensional rehabilitation programmes for adult cancer survivors. Cochrane Database of Systematic Reviews: 10.1002/14651858.CD007730.pub2:
  3. Regionala Cancercentrum I Samverken. 2019. National care program cancer rehabilitation. Available from: Available here: https://kunskapsbanken.cancercentrum.se/diagnoser/cancerrehabilitering/vardprogram/
  4. Svahn Y. 2020. Interview with Catherine Hodge at The Health Policy Partnership [Video Call].
  5. Center for Cancer Rehabilitation. 2020. Rehabilitering. Available from: Available here: https://www.rehabcancer.se/for-dig-som-patient/det-har-hander-hos-oss/rehabilitering/
  6. Center for Cancer Rehabilitation. 2020. Start. Available from: Available here: https://www.rehabcancer.se/
  7. European Society for Medical Oncology. Patient Guide on Survivorship. Available from: Available here: https://www.esmo.org/Patients/Patient-Guides/Patient-Guide-on-Survivorship
  8. Park CL, Zlateva I, Blank TO. 2009. Self-identity after cancer: "survivor", "victim", "patient", and "person with cancer". J Gen Intern Med 24 Suppl 2(Suppl 2): S430-S35
  9. Center for Cancer Rehabilitation. 2020. Kartlaggning. Available from: Available here: https://www.rehabcancer.se/for-dig-som-patient/det-har-hander-hos-oss/kartlaggning/
  10. The Swedish National Board of Health and Welfare. 2017. The development of regional cancer centres: An overall assessment of a four-year follow-up. Stockholm: Socialstyrelsen
  11. Center for Cancer Rehabilitation. 2020. Avslutning. Available from: Available here: https://www.rehabcancer.se/for-dig-som-patient/det-har-hander-hos-oss/avslutning/
  12. Center for Cancer Rehabilitation. 2020. Gruppsamtal. Available from: Available here: https://www.rehabcancer.se/for-dig-som-patient/det-har-hander-hos-oss/gruppsamtal/