• Nicole D Agaronnik, Areej El-Jawahri, Kristi Kirschner, and Lisa I Iezzoni.
• From the Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts (NDA, LII); Department of Medicine, Harvard Medical School, Boston, Massachusetts (AE-J, LII); Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts (AE-J); Departments of Medical Education, and Neurology and Rehabilitation, University of Illinois College of Medicine, Champaign, Illinois (KK); and Department of Disability and Human Development, College of Allied Health Sciences, University of Illinois, Chicago, Illinois (KK).
• Am J Phys Med Rehabil. 2021 Feb 1; 100 (2): 113-119.

ObjectiveWe explored the process of cancer care for patients with preexisting mobility disability, focusing on treatment decisions and experiences.DesignWe recruited 20 participants with preexisting mobility disability, requiring use of an assistive device or assistance with activities of daily living, subsequently diagnosed with cancer (excluding skin cancers). We conducted open-ended individual interviews, which reached data saturation and were transcribed verbatim for conventional content analysis.ResultsConcerns coalesced around 4 themes: disability-related healthcare experiences affect cancer treatment decisions; concerns about cancer treatment worsening functional impairments; access barriers; and limited provider awareness and biases about treating people with disability. Residual fear from previous medical interventions and concerns about exacerbating functional impairments influenced cancer treatment preferences. Participants also raised concerns that their underlying disability may be used to justify less aggressive treatment. Nevertheless, cancer treatment did exacerbate mobility difficulties for some participants. Inaccessible hospital rooms, lack of accessible medical equipment, and attitudinal barriers complicated treatments.ConclusionsPeople with preexisting mobility disability experience barriers to cancer treatment, compromising quality of care and potentially outcomes. Further training and proactive planning for accommodating disability during cancer treatment and rehabilitation are warranted.To Claim Cme CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.Cme ObjectivesUpon completion of the article, the reader should be able to: (1) Recognize inadequate accommodations that compromise the diagnosis and treatment of a new cancer in patients with preexisting disability; (2) Recommend involving rehabilitation specialists in the process of care and clinical decision making from the time of cancer diagnosis for patients with preexisting disability newly diagnosed with malignancy; and (3) In the setting of accessibility barriers, facilitate efforts to accommodate patients with preexisting disability to improve quality of care in diagnosing and treating cancer.LevelAdvanced.AccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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