A hallmark of Silver’s program is prehabilitation, a physical therapy regimen that prepares patients physically as well as emotionally for their cancer treatments. As Silver learned through her own cancer experience, oncology treatment can deplete and age a patient. The prehabilitation goal of the STAR Program is to strengthen and condition, so when the onslaught of treatment occurs, the damage is reduced. Targeted exercises and psychological counseling can go a long way towards faster recovery from treatment.


The effectiveness of prehabilitation and rehabilitation is limited by patient access, and some patients will experience barriers to this care. For example, insurance coverage can be an issue. Although most insurance plans cover cancer rehabilitation, policies may have caps on how much they cover. Patients should be screened early for physical impairments, and the impairments should be addressed before they can progress too far. Therefore, oncology clinicians should consider routinely referring their patients for rehabilitation. That is getting better: the American College of Surgeons’ Commission on Cancer recently published new program standards for survivor care that include recommendations for improved access to cancer rehabilitation.6 For more information about the STAR Program, visit

Continue Reading

Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.


1. Silver JK, Baima J, Mayer RS. Impairmentdriven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin. 2013;63(5):295-317. 2. Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatmentrelated morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013;92(8):715-727.

3. Gotbaum R. Cancer rehab begins to bridge a gap to reach patients. Shots: NPR Health News from NPR Web site. http://www.npr. org/blogs/health/2013/02/18/172099043/ cancer-rehab-begins-to-bridge-a-gap-toreach- patients. Published February 18, 2013. Accessed November 13, 2013.

4. Weaver KE, Forsythe LP, Reeve BB, et al. Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2012;21(11):2108-2117.

5. Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008;26(16):2621-2629.

6. American College of Surgeons. Cancer Program Standards 2012, Version 1.2: Ensuring Patient-Centered Care. American College of Surgeons Cancer Programs Web site. programstandards2012.html. Accessed November 13, 2013.