The STAR program has faded away, but specialized rehabilitation for cancer patients at UCHealth shines on.

It was not quite a year ago that UCHealth began rolling out STAR (Survivorship Training and Rehab) across the system. Rehabilitation and oncology providers from UCHealth Metro Denver and UCHealth Colorado Springs began forming teams and providers began receiving STAR certification training last summer, joining some 125 colleagues at UCH Health Northern Colorado, where the program launched in 2013.

The goal was to develop a cadre of physical and occupational therapists and speech-language pathologists trained in addressing the many disease- and treatment-related problems cancer patients face. In turn, the training would also increase oncology providers’ understanding of the physical challenges cancer imposes – among them, sleeplessness, fatigue, pain, joint swelling, loss of range of motion and mobility, and swallowing problems – and give them a ready referral source to improve their care.

Dozens of participants completed the certification training at UCHealth Metro Denver and Colorado Springs. They completed 10 online modules covering different types of cancer and various evidence-based rehabilitation treatments and attended in-services to reinforce the information.

Stay the course

The process hit a bump in the road with the announcement that Oncology Rehab Partners, which administered STAR, announced it would close its doors Aug. 18. The company continued to provide support to its partners, including UCHealth, through Dec. 1. The demise of Oncology Rehab Partners doesn’t derail the oncology-rehabilitation partnership at UCHealth, said Erin Erickson, OT, OTD/OTR/L an inpatient occupational therapist at University of Colorado Hospital and co-coordinator of the Oncology Rehabilitation Program.

“We are motivated and still meeting with oncology groups,” Erickson said. Ongoing education will also continue, with sessions for urologic oncology, radiation oncology, and breast cancer on tap, she said. Another will target oncology leadership.

“We were concerned with the announcement of STAR closing that people would think we are fizzling out and not putting our energy into the program,” added Erin Wicken, PT, DPT, a physical therapist at UCHealth’s Boulder Health Center who co-coordinates the Oncology Rehabilitation Program with Erickson. “We are still 100 percent moving forward.”

The pieces are in place to continue the work of expanding UCHealth’s oncology rehabilitation services, emphasized Kathleen Michie, PT, MT, CLT, program manager for Oncology Rehabilitation and Integrative Therapies at UCHealth Northern Colorado. Michie, Wicken and Erickson are members of a system-wide steering committee (see box) that has met twice a month to ensure that providers completed their training and certification before the Dec. 1 deadline. They also work on developing systems and procedures to screen cancer patients for physical impairments.

Michie noted that the committee also includes senior service line directors from all three regions: Jamie Bachman (Metro Denver), Chris Bianca (Colorado Springs) and JoAnn Lovins (North). Their presence signals UCHealth’s ongoing commitment to oncology rehabilitation, she said.

“[The directors] have said that we have a solid foundation and this is something that is important. We are going to continue on our journey of making sure that we have this available for our patients,” Michie said.

Toward the future

The STAR fundamentals focused on integrating rehabilitation services with the overall plan of care to improve cancer patients’ quality of life while managing costs. It took root at UCHealth hospitals in northern Colorado, which then helped to spread the principles across the system. Northern Colorado began screening patients in its Multidisciplinary Survivorship Clinic early in 2014. Of 102 patients initially screened, 80 received referrals to certified rehabilitation specialists, demonstrating the need for consistent evaluation, Michie said.

The Northern Colorado program enters a new phase Dec. 1, with medical oncology patients getting screened by advanced practice providers after their second or third chemotherapy treatment. In April, the process will expand to radiation oncology patients, Michie said.

UCHealth Colorado Springs already provides a variety of oncology rehabilitation services, including lymphedema therapy, said Lisa Allison, RN, MS, OCN, manager of the Comprehensive Breast Cancer Program. She said STAR-trained providers will initially focus on providing screenings and targeted, specialized rehabilitation services for patients in the survivorship program, starting Jan. 1. The plan is to expand the program to patients in active treatment by the middle of 2017, she added.

UCHealth Metro Denver will also launch a pilot Jan. 1, focusing on screening head and neck cancer patients. These patients need a range of rehabilitation services, noted Ryan Roberts, RT, clinical operations manager for the University of Colorado Cancer Center’s GI, Phase One and Surgical Oncology programs. Many, for example, need help from speech-language pathologists with chewing and swallowing problems. Physical and occupational therapists can address collateral damage to bones, ligaments, tendons, muscles, nerves, and lymphatic vessels caused by radiation treatments, Roberts said.

“Our goal is to help the patients return to the state that they were in prior to diagnosis and not to accept their current state as the ‘new norm,’” he said.

Tweaking the system

Along the way, work will continue to fine-tune processes that are necessary across the entire UCHealth system for meeting those goals, such as entering orders and referrals in Epic and scheduling appointments promptly.

“As a large cancer center, we have to learn as a whole how to absorb all of our patients and get workflows in place from a referral standpoint,” Wicken said. “When we do that consistently and promptly with head and neck cancer patients, then we can branch out.”

To that end, Roberts said he brought together staff spanning the head and neck cancer practice to ensure there are no “holes in the workflow.” He also noted that rehabilitation is only one piece of a much broader range of services cancer patients need to live more satisfying lives during and after treatment. These include, for example, counseling, nutrition assistance and help from social workers. Marianne Pearson, director of the Cancer Center’s Supportive Services Program, also a member of the Oncology Rehab steering committee, plays an important role in meeting that broader goal of integrated support, Roberts said.

It’s vital, Erickson concluded, that providers across the system know that despite the dimming of STAR, the Oncology Rehab program at UCHealth is alive and well.

“We have laid the groundwork to show providers the face of rehabilitation services and to tell our oncologists that we are moving full steam ahead to be their partner,” she said.

Oncology Rehabilitation Steering Committee

Colorado Springs

• Lisa Allison
• Christopher Bianca
• Brad Chewakin
• Kimberly Duncan
• Joseph Foecking
• Ann Mellott, MD
• Karen Valentine

Metro Denver

• Jamie Bachman
• Regina Brown, MD
• Hillary Duffy
• Erin Erickson
• Laura Melton
• Marianne Pearson
• Brian Shields
• Amy Walde
• Erin Wicken
• Jennifer Zaccone

Northern Colorado

• JoAnn Arabasz
• Joanne Beasley
• JoAnn Lovins
• Kathleen Michie