Mary Washington Healthcare is a regional medical system in Virginia that provides inpatient and outpatient care through more than 40 facilities and services, including Mary Washington Hospital, a 437-bed regional medical center, and Stafford Hospital, a 100-bed community hospital. Mary Washington Healthcare recently adopted the STAR Program, a best practices cancer rehabilitation model of care.
Rehabilitation Director and STAR Program Coordinator Kathy Duval, MS, reported that she and her team were getting many referrals for newly diagnosed patients with lung cancer from Timothy Sherwood, MD, a thoracic surgeon at Mary Washington Healthcare, and having impressive outcomes, including decreasing the hospital length of stay from an average of 5 to 3 days, and improving patient functioning from their baseline status at diagnosis.1
In a recent interview, Dr Sherwood explained why he is referring patients to the STAR Program Prehab.Q: What do you like about the STAR Program Prehab better than the cardiopulmonary rehabilitation you used for your patients in the past?
Timothy Sherwood, MD: The STAR Program team gets my patients in much faster, within 2 to 3 days, or sometimes on the same day. This increases the patient’s confidence in me and my care. It used to take 3 to 4 weeks to get my patients into the conventional cardiopulmonary rehab.
Q: Why did it take so long to get them in?
Dr Sherwood: They were not set up for patients going to surgery. That is not their model. The cardiopulmonary rehab is not designed to improve surgical outcomes in patients with lung cancer but rather to treat patients who have serious cardiac and/or pulmonary disease.
Q: Are there other reasons why the STAR Program is better and/or easier?
Dr Sherwood: Yes. With the STAR Program, the care is generally covered by insurers. With the other model, my patients would have to qualify by having a reduced cardiac ejection fraction or a cardiac valvular disease. Even if I could get my patients seen by the program, they would not always be covered for it, because they weren’t sick enough based on cardiac and pulmonary criteria.
Q: Are you concerned with delays in surgery with the STAR Prehab?
Dr Sherwood: No. My patients go through the STAR Program lung cancer prehab for 4 to 8 weeks. These are my mid- and high-risk patients. I would rather have them get through surgery safely than have a horrific postoperative outcome.
Q: What else happens during this 4- to 8-week period?
Dr Sherwood: Usually I do the cancer staging, and I see the patients for several visits and monitor their progress. I have them climb 2 flights of stairs every time I see them. As a thoracic surgeon, I have been trained to be very concerned with “performance status,” and not just the ECOG status or the pulmonary function tests. I make notes about how well they climb stairs during every visit to see their progress.
Q: What postoperative issues are you concerned about?
Dr Sherwood: Pneumonia is one of the major complications. The targeted exercise of the STAR Program helps to improve the patients’ respiratory muscles, so that after surgery they can breathe better (Figure). They will have pain from their incision, and if they cough they have more pain. This means that they may take very shallow breaths and get atelectasis, which puts them at risk for pneumonia. The targeted exercises are very important in addition to the general fitness exercise component.
Q: We have just added a nutrition component to the STAR Program Prehab protocol. What do you think about the protein supplementation?
Dr Sherwood: I like it a lot, and I want to add that.
Q: You currently send some of your patients for mental health counseling. What do you think about the coping skills component of STAR Program Prehab that recommends a specific stress reduction strategy approach for all patients (eg, progressive muscle relaxation, guided imagery)?
Dr Sherwood: I like that a lot, and I think it removes the stigma of a mental health referral, which is a barrier for some patients who don’t want to be labeled with a mental health problem but clearly need help with their stress and distress.
Q: What do you think about the STAR Program Prehab approach overall?
Dr Sherwood: I like it, because it provides objective goals, with checklists and protocols.
Reference
- Hunt E, VanderWijst K, Stokes B, et al. Prehabilitation improves the physical functioning of a newly diagnosed lung cancer patient before and after surgery to allow for a safe surgical resection and decreased hospital length of stay: a case report. J Oncol Navig Surviv. 2014;5:34-35.