Andrea L. Cheville, MD, MSCE, Editor

This growth has been accompanied by a maturation of our field and a growing presence at national meetings and in the medical literature. In addition, a number of themes/concepts are emerging that are shaping our thinking about how we treat cancer and provide our services. Among these are the potential role of prehabilitation; the complementary natures of rehabilitation and palliative care; the growth of cancer survivorship awareness; and, not least, the impact of governmental policy. Advances outside our field influence, and will continue to influence, our care as well. Notably, patient-reported outcomes (PROs) have gained such acceptance that the systematic collection of patients’ perceptions of the benefits of their care is now required by payers, policymakers, and advocacy groups. Similarly, the mandated and growing presence of electronic health records (EHRs) provides an unmatched opportunity to evaluate the function of cancer populations over time with minimal incremental effort and resources.

Unfortunately, while the last decade has seen a large growth in the provision of cancer rehabilitation services, this growth has not been matched by a comparable intensification of our research activities. As a consequence, uncertainty regarding the effectiveness of different treatment elements impacts an ever-increasing number of patients as well as the acceptance of our efforts by our colleagues. The heart of this problem is that we lack the infrastructure that will allow us to generate, much less effectively translate, findings into routine clinical practice. For example, the evidence base for strength and aerobic training in cancer populations has grown largely through the efforts of exercise physiologists, yet these advances have not spurred their routine availability to the patient. In effect, there are two breakdowns in the process: (1) we lack the research base necessary to further the development of our field, and (2) even when knowledge is available, we lack the means to translate it effectively to clinical care.

Such deficits are no longer tenable in light of the growing impact of cancer and its treatment on the patient, the caregiver, and society. The old adage was, “Care delayed is care denied.” Since we know that function lost in the later stages of cancer is seldom recovered, our new adage might be “care delayed is function lost.”

The limited number of large-scale cancer rehabilitation trials and observational studies underway makes it unlikely that our evidence base will improve markedly over the next five years. The growing importance of PROs and EHRs will be beneficial, but the bulk of their impact will be in the future. As a result, there is a pressing need for an authoritative, interdisciplinary consensus sponsored by the appropriate credentialing bodies, professional societies, consumer groups, and payers that leverages the best of clinical experience with the best available evidence. The consensus should highlight not only which cancer rehabilitation services should be universally available but also the most problematic gaps in evidence and training.

The caliber and diversity of the contributing authors in this issue are extraordinary. The distribution of their thoughts over the gamut of cancer rehabilitation should not only be useful for the reader but it is hoped will also serve as fodder and support for this needed consensus.