Whole Patient Care

Cristina Kline-Quiroz, DO, is a physiatrist and assistant professor of Physical Medicine and Rehabilitation who specializes in cancer rehabilitation — a specialty many people may not know exists. As the only fellowship-trained cancer rehabilitation physiatrist in Tennessee, she works alongside her colleagues across multiple rehabilitation disciplines to provide highly individualized care for patients at Vanderbilt-Ingram Cancer Center.

The primary focus of Kline-Quiroz’s work as a physiatrist is improving function, quality of life and independence for patients. Her expertise allows her to be involved in every step of care, from educating patients on their condition, evaluating their function, ordering diagnostic testing, and creating a care plan to best serve patients and their unique goals. The care plan can involve targeted therapy referrals, a medication regimen, obtaining assistive devices such as canes or walkers, or recommending additional procedures based on the specific needs of each person. 

This work is highly collaborative, involving physical therapists, occupational therapists and speech language pathologists. 

“I meet with patients from every point of the oncology care spectrum — from the time of diagnosis, during active treatment and to survivorship or toward end-of-life care,” Kline-Quiroz said. “I’m always asking myself how we can partner together to best meet their needs and goals. Our field has tremendous opportunities for growth, and I strive to continually gain an understanding of what our patients, our community and our institution need. How can I, and our entire cancer rehab program, help address those needs?”

Kline-Quiroz often works with individuals who have head and neck cancer and are experiencing functional impairments, which can lead to serious quality-of-life concerns such as difficulty moving the neck or shoulder and not being able to open the mouth wide enough to eat or for oral care. 

When working with patients with head and neck cancer, it is important to address their ability to maintain swallowing function and communication abilities. She coordinates care closely with speech pathologists, who help patients maintain these abilities through one-on-one, guided clinic sessions and at-home treatment programs.

She also frequently sees breast cancer survivors to improve upper body function and provide lymphedema care. Working with these survivors has highlighted the need for a lymphedema prevention program for high-risk patients. Lymphedema is an accumulation of fluid in a limb or body region as a result of disruption/disorder of the body’s lymphatic system. As a result, fluid gets backed up, leading to a swollen body part, and possibly impacting function. 

Research by Sheila Ridner, PhD, RN, FAAN, Martha Rivers Ingram Professor of Nursing at Vanderbilt University, has highlighted the importance of a surveillance or prevention model for lymphedema after breast cancer treatment. Kline-Quiroz and the cancer rehabilitation team have adopted Ridner’s model by taking a pretreatment baseline measurement and monitoring every three months to identify subclinical lymphedema before it is visible externally. This intervention has been shown to significantly reduce the risk of progression into chronic lymphedema. 

 “With the surveillance protocol, we have the opportunity to catch it in a subclinical phase, provide an intervention and prevent its progression to a lifelong condition,” Kline-Quiroz said. “This is a meaningful intervention to decrease the symptom burden and the financial stress from managing chronic lymphedema.”

Through this lymphedema prevention program, she and her colleagues are also expanding “pre-hab”— working with patients to optimize health and well-being before any treatments begin. Thus far, pre-hab programs have been implemented for patients who will be undergoing surgeries for bladder cancer, breast cancer and pancreatic cancer as well as stem cell transplants.

She often becomes close with her patients, serving as an advocate and a listening ear. Although this means her work is complex, she would not have it any other way, Kline-Quiroz said. “The most effective plan varies from person to person, and, also, within the same person over time and changing situations.”

While every care plan is individualized, there are some commonalities. A main cornerstone of treatment is physical therapy followed by a lifelong home exercise program. Movements learned in physical therapy can lessen fatigue and pain, while also boosting energy, mood and overall quality of life, said Jamie Pratt, PT, DPT, a physical therapist at Vanderbilt Dayani Center. 

“Physical therapy is meaningful during every part of the cancer journey. We can help people feel their strongest as they prepare for treatment, safely stay active during treatment, and return to full function after treatment.”

Hearing positive feedback and helping patients move forward with their lives after a cancer diagnosis is what motivates Kline-Quiroz every day. When a patient who overcomes significant life challenges — both mentally and physically — tells her that they feel the best they have felt in a decade, she knows the challenging days are worth it.

An important but difficult part of Kline-Quiroz’s role sometimes involves providing rehabilitation care toward end of life. “Rehabilitation services should be available to all patients across the continuum of a cancer journey, including end of life,” she said. “It is essential to partner with each person and focus on their priorities. If I can optimize someone’s independence at home during their last few months, that is very rewarding. I enjoy learning about their goals, whether it be holding a grandchild, playing golf or gardening/caring for their yard. I am humbled to be allowed this privilege to learn about each person, their lives and their unique goals. These connections bring great joy, but they are also bittersweet, knowing a loss is forthcoming.”

Although the practice of cancer rehabilitation physiatry is often not well known, the role for physiatry and cancer rehabilitation services to optimize and maintain function and quality of life is an indispensable resource for patients at any age and at any stage of care. “I know we can make a meaningful difference in the life of each person we serve,” Kline-Quiroz said.