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Guan M, Gresham G, Shinde A, Lapite I, Gong J, Placencio-Hickok VR, Forrest CB, Hendifar AE. Priority Rankings of Patient-Reported Outcomes for Pancreatic Ductal Adenocarcinoma: A Comparison of Patient and Physician Perspectives. J Natl Compr Canc Netw 2020; 18:1075-1083. [DOI: 10.6004/jnccn.2020.7548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
Abstract
Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with high symptom burden. However, treatment decisions currently depend heavily on physician interpretation of clinical parameters and may not consider patients’ health preferences. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) initiative standardized a set of patient-reported outcomes for use in chronic diseases. This study identifies preference rankings among patients with PDAC and physicians for PROMIS domains and compares the priorities of patients and their providers. Methods: We condensed the 96 NIH PROMIS adult domains into 31 domains and created a Maximum Difference Scaling questionnaire. Domain preference scores were generated from the responses of patients with PDAC and physicians, which were compared using Maximum Difference Scaling software across demographic and clinical variables. Results: Participants included 135 patients with PDAC (53% male; median age, 68 years) and 54 physicians (76% male; median years of experience, 10). Patients selected physical functioning (PF) as their top priority, whereas physicians identified pain as most important. PF, ability to perform activities of daily living, and symptom management were within the top 5 domains for both patients and physicians, and varied only slightly across age, sex, and ethnicity. However, several domains were ranked significantly higher by patients than by physicians, including but not limited to PF; ability to do things for yourself, family, and friends; ability to interact with others to obtain help; and sleep quality. Physicians ranked pain, anxiety, and depression higher than patients did. Conclusions: Our findings suggest that patients with PDAC value PF and engaging in daily and social activities the most, whereas physicians prioritize symptoms such as pain. Patient-reported outcomes need to become more integrated into PDAC care and research to better identify unmet patient needs, inform treatment decisions, and develop therapies that address outcomes valued by patients.
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Affiliation(s)
- Michelle Guan
- 1Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Gillian Gresham
- 1Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Arvind Shinde
- 2Department of Hematology and Oncology, Transplant and Hepatopancreatobiliary Institute, St. Vincent Medical Center, Los Angeles, California; and
| | - Isaac Lapite
- 1Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Jun Gong
- 1Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | | | - Christopher B. Forrest
- 3Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew E. Hendifar
- 1Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
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Yusufov M, Grebstein L, Rossi JS, Redding CA, Ferszt GG, Prochaska JO. Development and Implementation of a Psychological Service for Patients With Cancer. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:290-305. [DOI: 10.1016/j.cbpra.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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53
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Yang J, Choi M, Choi J, Kang M, Jo A, Chung SH, Sim SH, Kim YJ, Yang EJ, Yu SY. Supervised Physical Rehabilitation in the Treatment of Patients with Advanced Cancer: a Systematic Review and Meta-analysis. J Korean Med Sci 2020; 35:e242. [PMID: 32715671 PMCID: PMC7384905 DOI: 10.3346/jkms.2020.35.e242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As the survival rate of cancer patients increases, the clinical importance of rehabilitation provided by healthcare professionals also increases. However, the evidence supporting the relevance of rehabilitation programs is insufficient. This study aimed to review the literature on effectiveness in physical function, quality of life (QOL) or fatigue of supervised physical rehabilitation in patients with advanced cancer. METHODS A systematic review and meta-analysis was conducted following the Cochrane guidelines. We narratively described the results when meta-analysis was not applicable or appropriate. Literature databases including Ovid-MEDLINE, Ovid-EMBASE, and the Cochrane Library, as well as several Korean domestic databases, were searched up to June 2017 for studies that investigated the effectiveness of supervised physical rehabilitation programs on physical function, QOL or fatigue in patients with advanced cancer. The quality of the selected studies was evaluated independently by paired reviewers. RESULTS Eleven studies with 922 participants were finally selected among 2,459 articles. The meta-analysis revealed that after physical exercise, the physical activity level and strength of patients with advanced cancer increased significantly. The QOL showed a statistically significant improvement after physical rehabilitation according to the European Organization for Research and Treatment of Cancer version C30. Though some of measurements about cardiovascular endurance or strength in several studies were not able to be synthesized, each study reported that they were significantly improved after receiving rehabilitation. CONCLUSION Supervised physical rehabilitation for patients with advanced cancer is effective in improving physical activity, strength, and QOL. However, more trials are needed to prove the effectiveness of supervised exercise and to strengthen the evidence.
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Affiliation(s)
- Jangmi Yang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - JinA Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Minjoo Kang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - AeJung Jo
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung Hyun Chung
- Department of Physical Medicine and Rehabilitation, National Cancer Center, Goyang, Korea
| | - Sung Hoon Sim
- Department of Physical Medicine and Rehabilitation, National Cancer Center, Goyang, Korea
| | - Yu Jung Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Joo Yang
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Su Yeon Yu
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
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Barnes CA, Stout NL, Varghese, Jr TK, Ulrich CM, Couriel DR, Lee CJ, Noren CS, LaStayo PC. Clinically Integrated Physical Therapist Practice in Cancer Care: A New Comprehensive Approach. Phys Ther 2020; 100:543-553. [PMID: 32043139 PMCID: PMC8204882 DOI: 10.1093/ptj/pzz169] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/29/2023]
Abstract
Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient's level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure-the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual-and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators.
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Affiliation(s)
- Christopher A Barnes
- Department of Physical Therapy and Athletic Training, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Nicole L Stout
- National Institutes of Health, Clinical Center, Rehabilitation Medicine Department, Bethesda, Maryland
- Department of Hematology Oncology, Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Thomas K Varghese, Jr
- Huntsman Cancer Institute, and School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, and Department of Population Health Sciences, University of Utah
| | - Daniel R Couriel
- Huntsman Cancer Institute, and School of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah
| | - Catherine J Lee
- Huntsman Cancer Institute, and School of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah
| | | | - Paul C LaStayo
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108 (USA), and Huntsman Cancer Institute, University of Utah
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Sewell B, Jones M, Gray H, Wilkes H, Lloyd-Bennett C, Beddow K, Bevan M, Fitzsimmons D. Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study. Br J Gen Pract 2020; 70:e186-e192. [PMID: 31932296 PMCID: PMC6960004 DOI: 10.3399/bjgp20x708077] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/22/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A pilot rapid diagnosis centre (RDC) allows GPs within targeted clusters to refer adults with vague and/or non-specific symptoms suspicious of cancer, who do not meet criteria for referral under an urgent suspected cancer (USC) pathway, to a multidisciplinary RDC clinic where they are seen within 1 week. AIM To explore the cost-effectiveness of the RDC compared with standard clinical practice. DESIGN AND SETTING Cost-effectiveness modelling using routine data from Neath Port Talbot Hospital, Wales. METHOD Discrete-event simulation modelled a cohort of 1000 patients from referral to radiological diagnosis based on routine RDC and hospital data. Control patients were those referred to a USC pathway but then downgraded. Published sources provided estimates of patient quality of life (QoL) and pre-diagnosis anxiety. The model calculates time to diagnosis, costs, and quality-adjusted life years (QALYs), and estimates the probability of the RDC being a cost-effective strategy. RESULTS The RDC reduces mean time to diagnosis from 84.2 days in usual care to 5.9 days if a diagnosis is made at clinic, or 40.8 days if further investigations are booked during RDC. RDC provision is the superior strategy (that is, less costly and more effective) compared with standard clinical practice when run near or at full capacity. However, it is not cost-effective if capacity utilisation drops below 80%. CONCLUSION An RDC for patients presenting with vague or non-specific symptoms suspicious of cancer in primary care reduces time to diagnosis and provides excellent value for money if run at ≥80% capacity.
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Affiliation(s)
- Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales
| | - Mari Jones
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales
| | | | - Heather Wilkes
- Dr Wilkes & Partners, Briton Ferry Health Centre, Swansea Bay University Health Board, Neath, Wales
| | | | - Kim Beddow
- Neath Port Talbot Hospital, Swansea Bay University Health Board, Neath, Port Talbot, Wales
| | - Martin Bevan
- Neath Port Talbot Hospital, Swansea Bay University Health Board, Neath, Port Talbot, Wales
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Rijpkema C, Duijts SFA, Stuiver MM. Reasons for and outcome of occupational therapy consultation and treatment in the context of multidisciplinary cancer rehabilitation; a historical cohort study. Aust Occup Ther J 2020; 67:260-268. [PMID: 32056221 DOI: 10.1111/1440-1630.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate reasons why people consulted an occupational therapist following cancer treatment, and to examine the outcome of occupational therapy interventions, in the context of multidisciplinary rehabilitation. METHODS Data from 181 patients were collected retrospectively. The International Classification of Human Functioning and Health (ICF) was used to describe the reasons for occupational therapy consultation. Patients had completed the Canadian Occupational Performance Measurement (COPM) before and after the occupational therapy intervention. Change scores were calculated with a 95% confidence interval and a two-sided p-value obtained from a paired t-test. RESULTS The reasons for occupational therapy consultation were predominantly within the ICF domain "Activities and Participation". On average, patients improved 3.0 points (95% CI 2.8-3.2) on the performance scale of the COPM, and 3.4 points (95% CI 3.2-3.7) on the satisfaction scale (both: p = <.001). CONCLUSION The result of this study supports the added value of occupational therapy to cancer rehabilitation, and emphasise the positive effect of occupational therapy on everyday functioning. Controlled clinical studies are needed to strengthen the evidence.
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Affiliation(s)
- Corine Rijpkema
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Saskia F A Duijts
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health research institute, UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martijn M Stuiver
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Raj VS, Pugh TM, Yaguda SI, Mitchell CH, Mullan SS, Garces NS. The Who, What, Why, When, Where, and How of Team-Based Interdisciplinary Cancer Rehabilitation. Semin Oncol Nurs 2020; 36:150974. [PMID: 31955923 DOI: 10.1016/j.soncn.2019.150974] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review the key components necessary for successful application of rehabilitation principles to oncology survivors. DATA SOURCES Validated databases, including PubMed, MEDLINE, and Scopus. CONCLUSION Rehabilitation is an essential component of cancer care that addresses functional needs for oncology survivors and is best accomplished via an interdisciplinary team. Interdisciplinary care, provided by nursing, physiatry, rehabilitation therapy, and exercise physiology, are critical components for comprehensive intervention. Challenges exist in implementing services, but opportunity also exists within the post-acute care sector. IMPLICATIONS FOR NURSING PRACTICE Nurses play an important role in the screening, assessment, and treatment of cancer-related functional impairments.
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Affiliation(s)
- Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, Charlotte, NC; Department of Supportive Care, Levine Cancer Institute, Charlotte, NC.
| | - Terrence M Pugh
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, Charlotte, NC; Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Susan I Yaguda
- Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Charles H Mitchell
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, Charlotte, NC; Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Sarah S Mullan
- Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Natalie S Garces
- Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
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Haussmann A, Ungar N, Tsiouris A, Sieverding M, Wiskemann J, Steindorf K. The Influence of Cancer Patient Characteristics on the Recommendation of Physical Activity by Healthcare Professionals. Int J Behav Med 2019; 27:65-78. [PMID: 31823182 DOI: 10.1007/s12529-019-09833-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although physical activity (PA) is beneficial for patients with cancer, healthcare professionals (HCP) still scarcely recommend it. This study aimed to determine how HCP' sociodemographic and professional characteristics and their subjective assessments of patient characteristics are associated with their PA recommendations to patients with cancer. METHODS A cross-sectional survey (paper-pencil or online) was completed by 929 HCP (159 general practitioners, 382 specialized physicians, and 388 oncology nurses). The survey collected information on HCP' sociodemographic and professional characteristics, PA recommendation frequency, and the likelihood of 13 patient characteristics influencing PA recommendations (on a 7-point Likert scale). RESULTS Descriptive results showed that 37.6% of HCP indicated often recommending PA and 41.7% indicated routinely recommending PA. More professional experience was associated with a higher reported PA recommendation frequency among specialized physicians and oncology nurses. Patient characteristics could be assigned to three higher-level categories. Characteristics from the categories "medical side effects" and "low affinity for PA" were more frequently judged by HCP as reasons for recommending PA and characteristics belonging to "indicators of poor general health" as reasons for not recommending PA. In all professional groups, the inclusion of patient characteristics resulted in additional variance explained in the prediction of a routine PA recommendation. CONCLUSIONS HCP in this study reported that they frequently recommend PA to patients with cancer. However, HCP consider cancer patient characteristics to influence their decision whether to recommend PA. Future research and interventions should aim to enable HCP to provide adequate PA recommendations to patients with cancer having different characteristics.
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Affiliation(s)
- Alexander Haussmann
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.,Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Nadine Ungar
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Angeliki Tsiouris
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz University, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Monika Sieverding
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Shimoda K, Imai H, Tsuji T, Tsuchiya K, Tajima H, Kanemaki H, Tozato F. Factors affecting the performance of activities of daily living in patients with advanced cancer undergoing inpatient rehabilitation: results from a retrospective observational study. J Phys Ther Sci 2019; 31:795-801. [PMID: 31645809 PMCID: PMC6801346 DOI: 10.1589/jpts.31.795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 01/19/2023] Open
Abstract
[Purpose] Many clinicians believe that rehabilitation for patients with advanced cancer
is futile. We determined factors affecting the performance of activities of daily living
in patients with advanced cancer based on age, gender, marital status, living arrangement,
rehabilitation intensity, type of cancer, impairment, metastasis, and active cancer
treatment. [Participants and Methods] We assessed the Barthel Index to evaluate the
performance of activities of daily living. Of the 120 adult patients with cancer who
underwent inpatient rehabilitation, we analyzed the Barthel Index scores, consisting of 10
items, and reviewed the clinical characteristics from the medical records of 48 patients
who completed supportive or palliative rehabilitation according to Dietz and showed an
increased or maintained total Barthel Index score at final evaluation. [Results] The
median total Barthel Index score increased from 45 (5–95) to 72.5 (5–100); the
rehabilitation intensity was 320 (40–1,240) minutes. The analytical results showed that
the increase of total Barthel Index score was positively associated with rehabilitation
intensity (β=0.350) and negatively associated with the initial grooming score (β=−0.277).
[Conclusion] Adequate rehabilitation positively affects performance of activities of daily
living, especially in patients with advanced cancer who lost their grooming ability at the
onset of rehabilitation. Importantly, rehabilitation may be beneficial for patients with
advanced cancer.
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Affiliation(s)
- Kaori Shimoda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences: 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8514, Japan
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences: 3-39-22 Showa-machi, Maebashi-shi, Gunma 371-8514, Japan
| | - Hiroshi Tajima
- Division of Rehabilitation, Gunma Prefectural Cancer Center, Japan
| | - Hatsumi Kanemaki
- Division of Rehabilitation, Gunma Prefectural Cancer Center, Japan
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Boa S, Duncan E, Haraldsdottir E, Wyke S. Mind the gap: Patients’ experiences and perceptions of goal setting in palliative care. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1672131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sally Boa
- Strathcarron Hospice, Randolph Hill, Denny, Stirlingshire, UK
| | - Edward Duncan
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Erna Haraldsdottir
- Department of Education and Research, St Columba’s Hospice, Edinburgh, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Brassil ME, Cheville A, Zheng JY, Smith SR, Tolchin DW, Wittry SA, Jones CA, Chernack B. Top Ten Tips Palliative Care Clinicians Should Know About Physical Medicine and Rehabilitation. J Palliat Med 2019; 23:129-135. [PMID: 31556786 DOI: 10.1089/jpm.2019.0440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Physical medicine and rehabilitation (PM&R) is a specialty of medicine focused on optimizing function and quality of life for individuals with physical impairments, injuries, or disabling illnesses. Given the sometimes acute nature of the loss of function and even loss of independence, there are significant palliative care (PC) needs within patients seen by PM&R. This article, written by a team of PM&R and PC specialists, aims to help the PC team better understand the world of postacute care, expand their toolkit for treating musculoskeletal and neurological symptoms, improve prognostication for patients with brain and spinal cord injuries, and decide when patients may benefit from PM&R consultation and support. There is significant overlap between the populations treated by PM&R and PC. Better integration between these specialties will help patients to maintain independence as well as advance excellent patient-centered care.
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Affiliation(s)
- Michelle E Brassil
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Palliative Care Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Jasmine Y Zheng
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Dorothy W Tolchin
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | | | - Christopher A Jones
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Betty Chernack
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Palliative Care Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sharma R, Molinares-Mejia D, Khanna A, Maltser S, Ruppert L, Wittry S, Murphy R, Ambrose AF, Silver JK. Training and Practice Patterns in Cancer Rehabilitation: A Survey of Physiatrists Specializing in Oncology Care. PM R 2019; 12:180-185. [PMID: 31140751 DOI: 10.1002/pmrj.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer rehabilitation is an integral part of the continuum of care for survivors. Due to the increasing number of survivors, physiatrists commonly see cancer patients in their general practices. Essential to guiding the field is to understand the current training and practice patterns of cancer rehabilitation physicians. OBJECTIVES To assess current trends in training and practice for cancer rehabilitation physicians, including the level of burnout among providers in this field. DESIGN Cross-sectional descriptive survey study. SETTING Online survey. PARTICIPANTS American physicians who are affiliated with the Cancer Rehabilitation Physician Consortium (CRPC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The CRPC is a group of cancer rehabilitation providers (both fellowship-trained and not fellowship-trained) with the mission of furthering cancer rehabilitation medicine through education, research, and networking. METHODS All CRPC physicians were invited to complete a voluntary and anonymous 43-question online survey. The survey was conceived by a group of eight experts interested in providing additional information to the current literature regarding the training and practice in the cancer rehabilitation field. MAIN OUTCOME MEASUREMENTS Training, practice, opioid prescribing, and professional support. RESULTS Thirty-seven of 50 physicians participated (response rate = 74%). Respondents were from various states, the three most common being New York (16%, n = 6), Texas (16%, n = 6), and Massachusetts (11%, n = 4). About 57% (n = 21) of the respondents were employed in an academic medical center and 73% (n = 27) reported their primary departmental affiliation was Physical Medicine and Rehabilitation (PM&R). Approximately 78% (n = 29) credited mentorship early in training for their interest in the field. More than half (54%, n = 20) either strongly agreed or agreed that cancer rehabilitation fellowship training is necessary for graduating physiatrists who plan to treat oncology patients/survivors. National PM&R meetings were the primary source of continuing education for 86% (n = 31). Sixty-five percent (n = 24), strongly agreed or agreed that cancer rehabilitation physiatrists should know how to prescribe opioids, and 35% (n = 13) reported prescribing them when appropriate. About 54% (n = 20) rated their level of burnout as low or very low, and more than half (51%, n = 19) believed their burnout level was lower than physiatrists treating other rehabilitation populations. CONCLUSIONS Cancer rehabilitation is a growing subspecialty in PM&R, and most physiatrists in general practice will treat many survivors-often for neurologic or musculoskeletal impairments related to cancer or its treatment. Cancer rehabilitation physicians perceive that they have relatively low levels of burnout, and early mentorship and fellowship training is beneficial. Professional conferences and mentorship are a primary source for continuing education. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Raman Sharma
- Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY
| | - Diana Molinares-Mejia
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish Khanna
- Department of Cancer Rehabilitation, Kessler Institute for Rehabilitation & ReVital Program, West Orange, NJ
| | - Susan Maltser
- Department of Cancer Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Lisa Ruppert
- Department of Rehabilitation Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sarah Wittry
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Ryan Murphy
- Physical Medicine & Rehabilitation Services, Valley Hospital & Valley Medical Group, Ridgewood, NJ
| | - Anne Felicia Ambrose
- Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston, MA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Lozano-Lozano M, Martín-Martín L, Galiano-Castillo N, Fernández-Lao C, Cantarero-Villanueva I, López-Barajas IB, Arroyo-Morales M. Mobile health and supervised rehabilitation versus mobile health alone in breast cancer survivors: Randomized controlled trial. Ann Phys Rehabil Med 2019; 63:316-324. [PMID: 31454561 DOI: 10.1016/j.rehab.2019.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Survival rates in cancer are increasing exponentially, with a corresponding increase/influence in disability-adjusted life-years. Efforts should be made to explore the optimal balance between unsupervised/distance-based and supervised/onsite approaches to cancer care. OBJECTIVE This study aimed to compare the clinical efficacy of the BENECA mobile Health (mHealth) lifestyle application combined with a supervised rehabilitation program (BENECA and supervised rehabilitation) versus the BENECA mHealth lifestyle application alone on quality of life (QoL) and functional outcomes of breast cancer survivors. METHODS This randomized controlled trial included 80 survivors of breast cancer diagnosed at stage I-IIIA, who completed adjuvant therapy and were overweight or obese at diagnosis. Participants were randomly allocated (ratio 1:1, 3 waves) to BENECA mHealth and rehabilitation for 2months (n=40) or BENECA mHealth and usual care (BENECA mHealth alone; n=40). Participants completed a questionnaire at baseline (T1), 8-weeks post-intervention (T2) and 6-month follow-up (T3). The primary outcome was QoL assessed with the EORT QLQ-C30. Secondary outcomes included upper-limb functionality and body composition. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention to treat. RESULTS Both groups showed improved outcomes, but global QoL was significantly better with BENECA mHealth and rehabilitation than BENECA mHealth alone (mean difference, 12.76; 95% confidence interval 4.85; 20.67; P=0.004), with a moderate-to-large effect size (d=72). The proportion of participants reporting reliable clinical improvement on global QoL at T2 was higher with BENECA mHealth and rehabilitation than BENECA mHealth alone (57.5% vs 26.3%, P=0.008). Improvement in subjective and objective upper-limb functionality was also higher with BENECA mHealth and rehabilitation. CONCLUSIONS The BENECA mHealth lifestyle application with a supervised rehabilitation program had a statistically and clinically significant effect on QoL and upper-limb functionality in breast cancer survivors and is a unique and important promising new approach.
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Affiliation(s)
- Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain; "Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain
| | - Lydia Martín-Martín
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain; "Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain; "Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain.
| | - Carolina Fernández-Lao
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain; "Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain; "Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain
| | | | - Manuel Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda. de la Ilustración, 60, 18016 Granada, Spain; Sport and Health Joint University Institute (iMUDS), Granada, Spain; Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain; "Cuídate" Support Unit for Oncology Patients (UAPO-Cuídate), Granada, Spain
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Custodio CM, Wisotzky EM. Is Cancer Rehabilitation Fellowship Training Necessary for Graduating Physiatrists Who Wish to Enter the Field of Cancer Rehabilitation? PM R 2019; 9:S429-S433. [PMID: 28942914 DOI: 10.1016/j.pmrj.2017.07.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 10/18/2022]
Affiliation(s)
- Christian M Custodio
- Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10022(∗).
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65
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Badr H, Bakhshaie J, Chhabria K. Dyadic Interventions for Cancer Survivors and Caregivers: State of the Science and New Directions. Semin Oncol Nurs 2019; 35:337-341. [PMID: 31248677 DOI: 10.1016/j.soncn.2019.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe caregiving and relationship challenges in cancer and the state of the science of dyadic interventions that target survivors and caregivers. DATA SOURCES Narrative review. CONCLUSION Viewing the survivor-caregiver dyad as the unit of care may improve multiple aspects of survivor and caregiver quality of life. However, several questions remain regarding how, why, and for whom dyadic interventions are effective. IMPLICATIONS FOR NURSING PRACTICE Nurses should consider survivor, caregiver, and relationship needs when formulating supportive care protocols. Screening for survivor distress and extending distress screening to caregivers is an important first step in providing comprehensive psychosocial care.
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Affiliation(s)
- Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Jafar Bakhshaie
- Department of Medicine, Baylor College of Medicine, Houston, TX
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66
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Alexander JH, Jordan SW, West JM, Compston A, Fugitt J, Bowen JB, Dumanian GA, Pollock R, Mayerson JL, Scharschmidt TJ, Valerio IL. Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol. J Surg Oncol 2019; 120:348-358. [PMID: 31197851 DOI: 10.1002/jso.25586] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/14/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P = .015), 5.896 (95%CI 0.492-11.30; P = .033), and 7.435 (95%CI 1.797-13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P = .031), 6.195 (95%CI 0.705-11.69; P = .028), and 6.816 (95%CI 1.438-12.2; P = .014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.
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Affiliation(s)
- John H Alexander
- Department of Orthopaedics, The Ohio State University James Wexner Medical Center, Columbus, Ohio
| | - Sumanas W Jordan
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julie M West
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amy Compston
- Department of Oncologic Rehabilitation, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Jennifer Fugitt
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J Byers Bowen
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gregory A Dumanian
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raphael Pollock
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joel L Mayerson
- Department of Orthopaedics, The Ohio State University James Wexner Medical Center, Columbus, Ohio
| | - Thomas J Scharschmidt
- Department of Orthopaedics, The Ohio State University James Wexner Medical Center, Columbus, Ohio
| | - Ian L Valerio
- Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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67
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Bouleuc C, Burnod A, Angellier E, Massiani MA, Robin ML, Copel L, Chvetzoff G, Frasie V, Fogliarini A, Vinant P. [Early palliative care in oncology]. Bull Cancer 2019; 106:796-804. [PMID: 31174856 DOI: 10.1016/j.bulcan.2019.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
Early palliative care is now recommended in international guidelines. A meta-analyze combining seven randomized studies has been published in 2007. It confirms that early palliative care improves patient's quality of life and reduces symptom burden. There is also a trend for the reduction of depressive disorder and the increase of overall survival. Other studies show that early palliative care improves quality of life of patient's relatives and reduces end of life care aggressiveness. Most of the time, early palliative care is introduced as soon as the diagnosis of advanced cancer is made, and the precise referral criteria need to be addressed. Other studies have assessed the palliative care consultation; patient-centered care, focusing on symptom management, filling information and education needs about illness and prognosis, helping psychologic adaptation and coping.
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Affiliation(s)
- Carole Bouleuc
- Institut Curie, département de soins de support, 26, rue d'Ulm, 75248 Paris cedex 05, France.
| | - Alexis Burnod
- Institut Curie, département de soins de support, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - Elisabeth Angellier
- Institut Curie, département de soins de support, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Marie-Ange Massiani
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Marie-Luce Robin
- SSR de la clinique du Pont de Sèvres, 76, rue de Silly, 92100 Boulogne-Billancourt, France
| | - Laure Copel
- Centre hospitalier Diaconesses, service de soins palliatifs, 125, rue d'Avron, 75020 Paris, France
| | - Gisèle Chvetzoff
- Centre Leon-Berard, département de soins de support, 28, rue Laennec, 69008 Lyon, France
| | - Véronique Frasie
- Centre Paul-Strauss, département de soins de support, 3, rue de la Porte de l'Hôpital, 67065 Strasbourg cedex, France
| | - Anne Fogliarini
- Centre Lacassagne, service de soins palliatifs, 227, avenue de la Lanterne, 06000 Nice, France
| | - Pascale Vinant
- CHU de Cochin, services de soins palliatifs, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Hall CC, Cook J, Maddocks M, Skipworth RJE, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer 2019; 27:2371-2384. [PMID: 30944994 PMCID: PMC6541700 DOI: 10.1007/s00520-019-04749-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/15/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The optimal components for rehabilitation in patients with incurable cancer are unclear. However, principles of exercise and nutrition-based interventions used in cancer cachexia may be applied usefully to this population of cancer patients. This systematic review examines current evidence for rehabilitation combining exercise and nutritional support in patients with incurable cancer. METHODS MEDLINE, EMBASE and Cochrane databases were searched. Eligible studies included patients with incurable cancer and rehabilitation programmes combining exercise and nutritional interventions. Studies of cancer survivors, curative treatments, reviews, case note reviews, protocols and abstracts were excluded. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied to patient-important outcomes. RESULTS Of the 2424 search results, 67 abstracts were reviewed and 24 full texts examined. Eight studies (n = 685) were included comprising two randomised control trials, three prospective, one exploratory and two secondary analyses. All examined multi-modal outpatient programmes. GRADE analysis revealed moderate evidence (B) for improvements in depression and physical endurance, low-quality evidence (C) for quality of life and fatigue and very low-quality evidence (D) for overall function and nutritional status. CONCLUSION There are limited data for multi-modal rehabilitation programmes combining exercise and nutritional interventions in patients with incurable cancer. However, studies to date report improvements in multiple domains, most notably physical endurance and depression scores. This supports the concept that multi-modal rehabilitation incorporating principles of cachexia management may be appropriate for the wider group of patients with incurable cancer. Further, high-quality studies are needed to define the optimal approach and outcome measures.
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Affiliation(s)
- Charlie C Hall
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK. .,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
| | - Jane Cook
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, London, UK
| | | | - Marie Fallon
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Barry J Laird
- St Columba's Hospice, 15 Boswall Road, Edinburgh, EH5 3RW, UK.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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69
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Stout NL, Sleight A, Pfeiffer D, Galantino ML, deSouza B. Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care. Support Care Cancer 2019; 27:4497-4505. [DOI: 10.1007/s00520-019-04741-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022]
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70
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Lie NEK, Solvang PK, Hauken MA. "A limited focus on cancer rehabilitation"-A qualitative study of the experiences from Norwegian Cancer Coordinators in Primary Health Care. Eur J Cancer Care (Engl) 2019; 28:e13030. [PMID: 30848034 DOI: 10.1111/ecc.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/12/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The facilitation of complex cancer rehabilitation interventions in primary health care has become of growing importance to meet the bio-psycho-social needs of cancer survivors. However, the delivery of cancer rehabilitation is debated and services are underutilised. Cancer coordinators (CCs) provide patients with coordinated services throughout the trajectory. Little is known about CCs' rehabilitation-focused tasks. This study's objective was to explore Norwegian CCs' experiences with cancer rehabilitation interventions in primary health care. METHODS Data were obtained via two focus group interviews with 12 participants, analysed using thematic analysis and discussed using Salutogenesis, a theory for health promotion. RESULTS The analysis revealed three themes: (a) "A missing link" to cancer rehabilitation in primary health care, (b) Aiming to put cancer rehabilitation "in the spotlight," (c) The need to build a system for rehabilitation service delivery. CONCLUSION CCs experience a lacking focus on and missing systems for cancer rehabilitation in primary health care. CCs aim to improve local practices by advocating patients' needs and educating professionals. CCs must be supported via education and training in system-level work, an increased policy focus and resources for cancer rehabilitation. More research is required into how CCs may facilitate cancer rehabilitation in primary health care.
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Affiliation(s)
| | - Per Koren Solvang
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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71
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Shallwani SM, Brosseau L, Thomas R, Poitras S, Sikora L, Ranger MC, King J. Leisure physical activity in people with advanced cancer: a scoping review protocol. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1582201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - Lucie Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | | | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
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Lyons KD, Padgett LS, Marshall TF, Greer JA, Silver JK, Raj VS, Zucker DS, Fu JB, Pergolotti M, Sleight AG, Alfano CM. Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation. CA Cancer J Clin 2019; 69:113-126. [PMID: 30457670 DOI: 10.3322/caac.21549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.
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Affiliation(s)
- Kathleen D Lyons
- Scientist, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Assistant Professor of Psychiatry, Department of Psychiatry, Dartmouth College, Hanover, NH
| | - Lynne S Padgett
- Health Psychologist, Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Timothy F Marshall
- Assistant Professor, School of Physical Therapy, Kean University, Union, NJ
| | - Joseph A Greer
- Program Director, Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital, Boston, MA
- Assistant Professor of Psychology, Harvard Medical School, Boston, MA
| | - Julie K Silver
- Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
- Associate in Physiatry, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA
| | - Vishwa S Raj
- Associate Professor, Director of Oncology Rehabilitation, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Department of Supportive Care, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - David S Zucker
- Medical Director & Program Leader, Cancer Rehabilitation Services, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Jack B Fu
- Associate Professor, Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mackenzi Pergolotti
- Director of Research, ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA
| | - Alix G Sleight
- Postdoctoral Fellow, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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Mugele H, Freitag N, Wilhelmi J, Yang Y, Cheng S, Bloch W, Schumann M. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. J Cancer Surviv 2019; 13:205-223. [PMID: 30806875 DOI: 10.1007/s11764-019-00743-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE This review and meta-analysis aimed to evaluate the effects of high-intensity interval training (HIIT) compared to usual care (UC) or moderate-intensity training (MIE) on physical fitness and health-related outcomes in cancer patients across all stages of therapy and aftercare. METHODS Databases were systematically searched in accordance with the PRISMA guidelines until October 4th, 2018. Eligibility criteria included adult patients of various cancer types, performing HIIT vs. UC or MIE. Outcomes of interest included physical fitness (cardiorespiratory fitness [VO2peak] and functional capacity) and health-related outcomes (body composition, quality of life, cancer-related fatigue, and blood-borne biomarkers). Mean differences (MD) were calculated and pooled to generate effect sizes for VO2peak. RESULTS The search identified 1453 studies, out of which 12 articles were included. The average duration of interventions was 6.7 ± 3.0 weeks, with 2.8 ± 0.5 sessions per week. The meta-analysis for VO2peak showed superiority of HIIT compared to UC (MD 3.73; 95% CI 2.07, 5.39; p < 0.001) but not MIE (MD 1.36; 95% CI - 1.62, 4.35; p = 0.370). Similarly, no superior effects of HIIT compared to MIE were found for quality of life or changes in lean mass, while evidence was provided for a larger reduction in fat mass. CONCLUSION This systematic review showed that short-term HIIT induces similar positive effects on physical fitness and health-related outcomes as MIE but seems to be superior compared to UC. Thus, HIIT might be a time-efficient intervention for cancer patients across all stages of therapy and aftercare. IMPLICATIONS FOR CANCER SURVIVORS High-intensity interval training (HIIT) is superior compared to usucal care in improving physical fitness and health-related outcomes in cancer patients across all stages of therapy and aftercare. Currently, there is no evidence for the benefits of HIIT compared to aerobic training of moderate intensity (MIE) for changes in cardiorespiratory fitness, lean mass and patient-reported outcomes. Reductions in fat mass may be more pronounced in HIIT compared to MIE when training is performed in aftercare.
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Affiliation(s)
- Hendrik Mugele
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Nils Freitag
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Jannik Wilhelmi
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Yanxiang Yang
- Department of Physical Education, Exercise, Health and Technology Centre, Shanghai Jiao Tong University, Shanghai, China
| | - Sulin Cheng
- Department of Physical Education, Exercise, Health and Technology Centre, Shanghai Jiao Tong University, Shanghai, China.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,The Exercise Translational Medicine Centre, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Moritz Schumann
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany. .,Department of Physical Education, Exercise, Health and Technology Centre, Shanghai Jiao Tong University, Shanghai, China. .,The Exercise Translational Medicine Centre, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, China.
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74
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Cha S, Kim I, Lee SU, Seo KS. Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy. Ann Rehabil Med 2019; 42:838-845. [PMID: 30613077 PMCID: PMC6325318 DOI: 10.5535/arm.2018.42.6.838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/02/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy. METHODS Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy. RESULTS There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9-14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly. CONCLUSION In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Division of Hematology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Kwan Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Abstract
PURPOSE The aim of the study was to review the current state of cancer rehabilitation evidence and practice and delineate an agenda for building the future of cancer rehabilitation care. FINDINGS Despite the benefits of cancer rehabilitation interventions and the unmet needs among patients with cancer, very few patients receive these services. CONCLUSIONS Interdisciplinary cancer rehabilitation should be implemented from diagnosis forward. Building this care involves coordinating efforts in four critical areas: innovating cancer rehabilitation care delivery, expanding the team of providers, creating precision medicine cancer rehabilitation, and demonstrating the value of cancer rehabilitation to drive referrals and reimbursement. CLINICAL RELEVANCE Creating next-generation cancer rehabilitation care has the potential to improve the lives of the growing population of cancer survivors.
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76
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Human Immunodeficiency Virus in Southern and East Africa the Pandemic and Interface with Rehabilitation. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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77
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Crevenna R. Physical medicine in cancer rehabilitation: A narrative review. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil 2018; 42:8-13. [PMID: 30574818 DOI: 10.1080/09638288.2018.1514662] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: There has recently been an emphasis on improving cancer care globally, including access to lifesaving treatment and earlier identification of disease. This will lead to more survivors stricken by impairments related to the early and late effects of cancer treatment. An unintended consequence of the noble plan to improve oncology care worldwide is demand on health care systems that may be unable to accommodate increased patient care needs for myriad reasons. As a result, those with disabilities may suffer.Methods: Literature search and input from experts in the field were used to evaluate the growing need for cancer rehabilitation and survivorship care to reduce morbidity associated with cancer treatment.Results: Many governmental and non-governmental organizations have started initiatives to improve cancer care across the continuum, and reduce the symptom burden of those living with cancer. While the start is promising, many barriers must be overcome to ensure high-quality care that would reduce cost and improve patient access, including a lack of trained rehabilitation specialists, poor coordination of efforts, and funding restrictions. Furthermore, global efforts to improve rehabilitation care often do not emphasize cancer rehabilitation, potentially leaving a gap and increasing physical and economic costs of disability. Finally, low-resource countries face unique challenges in improving cancer rehabilitation care.Conclusion: Cancer rehabilitation and survivorship care are needed to improve health care quality, as there is an expected influx of cancer patients with new global efforts to improve oncology care. To accomplish this, rehabilitation initiatives must emphasize cancer rehabilitation as a component of any program, and oncology endeavors should include a plan for the rehabilitation of cancer survivors to reduce morbidity and health care cost.Implications for RehabilitationCancer rehabilitation has the potential to reduce morbidity and health care costs associated with cancer and disability worldwideAdvocacy from international organizations regarding cancer rehabilitation is increasing, but has been disjointed and incompleteLow-resource countries in particular face several barriers to providing cancer rehabilitation and survivorship care.
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Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Jasmine Y Zheng
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
| | - Julie Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, MA, USA
| | - Andrew J Haig
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, The Mayo Clinic, Rochester, Minnesota, MN, USA
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Noruzi Zamenjani M, Masmouei B, Harorani M, Ghafarzadegan R, Davodabady F, Zahedi S, Davodabady Z. The effect of progressive muscle relaxation on cancer patients' self-efficacy. Complement Ther Clin Pract 2018; 34:70-75. [PMID: 30712748 DOI: 10.1016/j.ctcp.2018.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Self-efficacy is considered as one of the influential parameters affecting the health of patients. This study aimed to investigate the effect of relaxation techniques on self-efficacy of patients suffering from cancer. MATERIALS AND METHODS This study was a clinical trial in which 80 patients suffering from cancer were randomly assigned to two groups of experimental and control. Data collection instruments consisted of demographic information and Strategies Used by People to Promote Health questionnaires. In the experimental group, the patients performed relaxation techniques once a day for 30 min over two months. In the control group, the patients received the routine care. RESULTS A statistically significant difference was observed between the mean self-efficacy indices in the experimental group (p = 0.001). There was no significant difference in the control group (p = 0.3). CONCLUSION Muscle relaxation can enhance self-efficacy of cancer patients. Therefore, it can be used as an alternative method for patients who are willing to use this technique.
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Affiliation(s)
| | - Behnam Masmouei
- Department of Nursing, Abadeh Branch, Islamic Azad University, Abadeh, Iran
| | - Mehdi Harorani
- Department of Nursing and Midwifery, Arak University of Medical Sciences: Basij Square, Arak, IR, Iran.
| | - Rezvan Ghafarzadegan
- Instructor, Department of Nursing, Faculty of Nursing & Midwifery, Khomein University of Medical Sciences, Khomein, Iran
| | - Fahimeh Davodabady
- Department of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Sima Zahedi
- Department of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Zakie Davodabady
- Master of Nursing, Valiasr Hospital Arak, Arak University of Medical Sciences, Arak, Iran
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80
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Stein Duker LI, Sleight AG. Occupational therapy practice in oncology care: Results from a survey. Nurs Health Sci 2018; 21:164-170. [PMID: 30345585 DOI: 10.1111/nhs.12576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/10/2018] [Accepted: 08/31/2018] [Indexed: 01/01/2023]
Abstract
The everyday landscape of occupational therapy (OT) in oncology is underexplored, hindering targeted improvements. The purpose of the present study was to identify the OT interventions commonly provided and reimbursed in oncology. A survey utilizing snowball sampling was disseminated online to OT working in oncology care; 167 surveys were received from 21 states in the United States. Results found that over 90% of therapists reported focusing on physical impairment, weakness, fatigue, and activities of daily living. Interventions for emotional/social support, self-advocacy, quality of life, lifestyle management, and cognitive impairment were not directly billed. More than 90% of therapists reported that, in the absence of barriers, they would address quality of life, emotional difficulties, lifestyle management, and home safety. Overall, the findings suggested that OT in the United States primarily provide physical interventions for oncology patients. However, they also provide psychosocial services and client/caregiver education, but often do not bill directly for this care. Reimbursement structures should be modified to allow for the direct billing of mental/psychosocial and educational interventions in OT for cancer care.
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Affiliation(s)
- Leah I Stein Duker
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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81
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Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M. Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center. Disabil Rehabil 2018; 42:2-7. [PMID: 30328719 DOI: 10.1080/09638288.2018.1514665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Wiltschke
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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82
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Dennett AM, Shields N, Peiris CL, Prendergast LA, O'Halloran PD, Parente P, Taylor NF. Motivational interviewing added to oncology rehabilitation did not improve moderate-intensity physical activity in cancer survivors: a randomised trial. J Physiother 2018; 64:255-263. [PMID: 30217412 DOI: 10.1016/j.jphys.2018.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
QUESTION Does adding weekly, physiotherapist-delivered motivational interviewing to outpatient oncology rehabilitation for cancer survivors increase physical activity levels and improve physical and psychosocial outcomes that are typically impaired in this cohort? DESIGN Randomised controlled trial with blinded outcome assessment, concealed allocation and intention-to-treat analysis. PARTICIPANTS A heterogeneous sample of 46 cancer survivors (n=29 female; mean age 59 years) participating in a public outpatient oncology rehabilitation program. INTERVENTION Participants were randomly allocated to receive oncology rehabilitation (n=24) or oncology rehabilitation with motivational interviewing delivered once weekly for 7 weeks via telephone by a physiotherapist (n=22). OUTCOME MEASURES The primary outcome was amount of physical activity of at least moderate intensity completed in 10-minute bouts, measured by an accelerometer worn continuously for 1 week. Secondary outcomes included other measures of physical activity, sedentary behaviour, physical function, psychosocial function, and quality of life. RESULTS When added to oncology rehabilitation, motivational interviewing caused no appreciable increase in the amount of moderate-intensity physical activity (MD -1.2 minutes/day, 95% CI -2.5 to 0.02). Among many secondary outcomes, the only statistically significant result was a small effect on nausea, which probably represents a Type I error. However, several secondary outcomes related to lower-intensity physical activity had non-significant confidence intervals that included large effects such as: sedentary time (SMD -0.67, 95% CI -1.32 to 0.02), light-intensity physical activity (SMD 0.56, 95% CI -0.12 to 1.21) and daily step count (SMD 0.37, 95% CI -0.30 to 1.02). CONCLUSION Adding motivational interviewing to oncology rehabilitation did not increase moderate-intensity physical activity. Favourable trends on measures of lower-intensity physical activity suggest that motivational interviewing should be further investigated for its effects on reducing sedentary time and improving light-intensity physical activity for cancer survivors participating in rehabilitation. TRIAL REGISTRATION ANZCTR 12616001079437. [Dennett AM, Shields N, Peiris CL, Prendergast LA, O'Halloran PD, Parente P, Taylor NF (2018) Motivational interviewing added to oncology rehabilitation did not improve moderate-intensity physical activity in cancer survivors: a randomised trial. Journal of Physiotherapy 64: 255-263].
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health
| | | | | | | | | | - Phillip Parente
- Department of Medical Oncology and Clinical Haematology, Eastern Health, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health
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83
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Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Knowlton SE, Silver AJ. Most National Cancer Institute-Designated Cancer Center Websites Do Not Provide Survivors with Information About Cancer Rehabilitation Services. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:947-953. [PMID: 28064402 DOI: 10.1007/s13187-016-1157-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study is the first to evaluate the existence and quality of patient-related cancer rehabilitation content on the websites of National Cancer Institute (NCI)-Designated Cancer Centers. In 2016, a team of cancer rehabilitation physicians (physiatrists) conducted an analysis of the patient-related rehabilitation content on the websites of all NCI-Designated Cancer Centers that provide clinical care (N = 62 of 69). The main outcome measures included qualitative rating of the ease of locating descriptions of cancer rehabilitation services on each website, followed by quantitative rating of the quality of the cancer rehabilitation descriptions found. More than 90% of NCI-Designated Cancer Centers providing clinical care did not have an easily identifiable patient-focused description of or link to cancer rehabilitation services on their website. Use of a website's search box and predetermined terms yielded an additional 13 descriptions (21%). Therefore, designers of nearly 70% of the websites evaluated overlooked an opportunity to present a description of cancer rehabilitation services. Moreover, only 8% of the websites included accurate and detailed information that referenced four core rehabilitation services (physiatry and physical, occupational and speech therapy). Further research is needed to confirm the presence of cancer rehabilitation services and evaluate access to these types of services at NCI-Designated Cancer Centers providing clinical care.
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Affiliation(s)
- Julie K Silver
- Harvard Medical School, Department of Physical Medicine and Rehabilitation & Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Brigham and Women's Hospital, 300 1st Avenue, Charlestown, MA, 02025, USA.
| | - Vishwa S Raj
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, 1100 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1414, Houston, TX, 77030, USA
| | - Eric M Wisotzky
- MedStar National Rehabilitation Network, 102 Irving Street, NW, Washington, DC, 20010, USA
| | - Sean Robinson Smith
- University of Michigan Department of Physical Medicine & Rehabilitation, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI, 48108, USA
| | - Sasha E Knowlton
- Harvard Medical School, Department of Physical Medicine and Rehabilitation & Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Brigham and Women's Hospital, 300 1st Avenue, Charlestown, MA, 02025, USA
| | - Alexander J Silver
- Department of Hematology, Brigham and Women's Hospital, Karp Family Research Building, 5th Floor, 1 Blackfan Circle, Boston, MA, 02115, USA
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84
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Cancer Survivors Awaiting Rehabilitation Rarely Meet Recommended Physical Activity Levels: An Observational Study. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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85
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Dennett AM, Peiris CL, Taylor NF, Reed MS, Shields N. 'A good stepping stone to normality': a qualitative study of cancer survivors' experiences of an exercise-based rehabilitation program. Support Care Cancer 2018; 27:1729-1736. [PMID: 30136023 DOI: 10.1007/s00520-018-4429-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/15/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Exercise-based rehabilitation is not routinely offered to patients. We explored the experience of cancer survivors completing an exercise-based cancer rehabilitation program with and without motivational interviewing. METHOD A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 26 cancer survivors (n = 17 female, n = 18 post-treatment) participating in cancer rehabilitation at a tertiary hospital. Interviews were recorded and transcribed verbatim. Coding was completed by two reviewers independently and confirmed by a third reviewer. RESULTS The main theme that emerged was exercise-based rehabilitation facilitated a return to normality after diagnosis which included positive changes in physical activity behaviour. Sub-themes were that rehabilitation is person-centred, challenges expectations, empowering and facilitated by expert staff. Common themes emerged whether participants received additional motivational interviewing or not. However, participants who received motivational interviewing were more likely to report feeling accountable for their physical activity levels. Transition to ongoing independent physical activity remained a challenge for some people who did not feel empowered or socially supported. CONCLUSION Exercise-based cancer rehabilitation is important in facilitating 'return to normal' including increased participation in physical activity. To challenge expectations and to empower cancer survivors, rehabilitation programs should be person-centred and led by expert staff.
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Affiliation(s)
- Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3128, Australia.
- School of Allied Health, La Trobe University, Bundoora, Australia.
| | - Casey L Peiris
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3128, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3128, Australia
- School of Allied Health, La Trobe University, Bundoora, Australia
| | - Melissa S Reed
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3128, Australia
| | - Nora Shields
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3128, Australia
- Allied Health, Northern Health, Epping, Australia
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87
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Collaboration in an Oncology Rehabilitation Clinic. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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88
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Padgett LS, Asher A, Cheville A. The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting. Rehabil Nurs 2018; 43:219-228. [DOI: 10.1097/rnj.0000000000000171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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89
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Collaboration Between Cancer Survivorship and Rehabilitation Programs With Head and Neck Patients. Rehabil Nurs 2018; 43:214-218. [PMID: 29957698 DOI: 10.1097/rnj.0000000000000172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to present an example of collaboration between a cancer survivorship and cancer rehabilitation program at an academic-affiliated hospital. FINDINGS The article demonstrates the process of identifying and treating the surgical and radiation effects experienced by a head and neck cancer survivor. The specific roles of the advanced practice nurse and the physical therapist in assessing, identifying and treating cancer treatment-effects such as lymphedema and orthopedic problems are highlighted. CONCLUSION The survivorship visit is an opportunity to identify treatment-related effects amenable to rehabilitation and to refer head and neck cancer survivors to physical therapy for further evaluation and treatment. CLINICAL IMPLICATION Collaboration between nurses and physical therapists engaged in survivorship care can provide an effective and efficient pathway to improved functional outcomes for cancer survivors.
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90
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Gerber LH, Hodsdon B, Comis LE, Chan L, Gallin JI, McGarvey CL. A Brief Historical Perspective of Cancer Rehabilitation and Contributions From the National Institutes of Health. PM R 2018; 9:S297-S304. [PMID: 28942904 DOI: 10.1016/j.pmrj.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
People who have cancer diagnoses often need care throughout their lives through all stages of their illness. These stages include diagnosis, primary treatment, survivorship, and end of life. The management of people with cancer, now a common and chronic illness with long-term survival improving, is complex, challenging, and rapidly changing. Rehabilitation for people with cancer diagnoses is a new specialty and is charged with providing care throughout the trajectory of illness and wellness to maximize potential for function and mitigate disability. Rehabilitation interventions include the application of physical and occupational therapeutics, speech and language interventions, and physical medicine in order to help patients reach their individual goals and to promote life satisfaction. The Department of Rehabilitation in the Clinical Center of the National Institutes of Health has pioneered this field through research and clinical care models over the past 40 years. Staff of this department has supported clinical research investigators at the National Institutes of Health in their exploration of new treatments using chemotherapies, surgery, radiation, and psychosocial interventions. They have also engaged in research specific to rehabilitation to devise and improve functional outcome measures, design exercise interventions, devise orthotics, and prosthetic devices for adaptation to functional loss. Collectively, the staff has published widely in oncology textbooks and professional journals in order to share findings and improve the quality of cancer rehabilitation treatment across the continuum of care.
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Affiliation(s)
- Lynn H Gerber
- Department of Medicine, Inova Fairfax Medical Campus, Inova Health System, Fairfax, VA; 4400 University Dr., MS 2G7, George Mason University, Fairfax, VA 22030(∗).
| | - Bonnie Hodsdon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(†)
| | - Leora Ellen Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD(‡)
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD(§)
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91
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Pettit SD, Kirch R. Do current approaches to assessing therapy related adverse events align with the needs of long-term cancer patients and survivors? CARDIO-ONCOLOGY (LONDON, ENGLAND) 2018; 4:5. [PMID: 32154005 PMCID: PMC7048033 DOI: 10.1186/s40959-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 01/29/2023]
Abstract
The increasing efficacy of cancer therapeutics means that the timespan of cancer therapy administration is undergoing a transition to increasingly long-term settings. Unfortunately, chronic therapy-related adverse health events are an unintended, but not infrequent, outcome of these life-saving therapies. Historically, the cardio-oncology field has evolved as retrospective effort to understand the scope, mechanisms, and impact of treatment-related toxicities that were already impacting patients. This review explores whether current systemic approaches to detecting, reporting, tracking, and communicating AEs are better positioned to provide more proactive or concurrent information to mitigate the impact of AE's on patient health and quality of life. Because the existing tools and frameworks for capturing these effects are not specific to cardiology, this study looks broadly at the landscape of approaches and assumptions. This review finds evidence of increasing focus on the provision of actionable information to support long-term health and quality of life for survivors and those on chronic therapy. However, the current means to assess and support the impact of this burden on patients and the healthcare system are often of limited relevance for an increasingly long-lived survivor and patient population.
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Affiliation(s)
- Syril D. Pettit
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Health and Environmental Sciences Institute, Washington DC, USA
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington DC, USA
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92
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Raj VS, Pugh TM. Inpatient cancer rehabilitation: past, present, and future perspectives. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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93
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Palliative Care and Physiatry in the Oncology Care Spectrum: An Opportunity for Distinct and Collaborative Approaches. Phys Med Rehabil Clin N Am 2018; 28:35-47. [PMID: 27912999 DOI: 10.1016/j.pmr.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As cancer evolves from a terminal illness to a chronic medical condition, so too does the view of clinical services. Palliative care and physical medicine and rehabilitation (PM&R) will increase in acceptance because they provide a valuable resource. The overarching theme is improving cancer-related symptoms or treatment-related side effects, improving patient health-related quality of life, lessening caregiver burden, and valuing patient-centered care and shared decision making. Managing symptom burden may improve therapy participation/performance. PM&R and palliative care departments are well-equipped to develop patient-centered care protocols, and could play an important role in developing a universal measure of performance status.
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94
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Best Practices for Public Policies for Palliative Care Physical Therapy: A Critical Review of the Literature. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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95
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96
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Garmy P, Jakobsson L. Experiences of cancer rehabilitation: A cross-sectional study. J Clin Nurs 2018; 27:2014-2021. [PMID: 29493832 DOI: 10.1111/jocn.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To investigate the cancer rehabilitation experiences of working-age cancer survivors. BACKGROUND Cancer survivors have extremely complex needs, spanning physical, vocational and sexual domains. Although cancer rehabilitation services have been found to eliminate or reduce these strains, these services are often underutilised. DESIGN A cross-sectional study design was employed. METHODS A survey of persons over the age of 18 with a cancer diagnosis, enrolled in the Social Insurance Agency in a municipality in southern Sweden (n = 168, 68% women), was conducted. RESULTS Patients who used the cancer rehabilitation service (57%) were generally satisfied with it. Of participants, 26% reported not having received an offer of rehabilitation. Of those who reported that they received information about cancer rehabilitation services, most also reported that they received this information from a healthcare service professional (69%); for example, from the oncology nurse or the oncologist, whereas 20% claimed they received the information from the administrator of the Swedish Social Insurance Agency. A minority of children and family members of patients received support from the healthcare system. CONCLUSIONS More efforts should be taken to reach patients in need of cancer rehabilitation. Additionally, more attention should be directed towards family members and young children. RELEVANCE TO CLINICAL PRACTICE More than one in four patients claimed to not have received an offer of cancer rehabilitation, and an even greater number of patients claimed that their spouses and children had never received an offer for this service either. Hence, there is a communication barrier that needs to be overcome. Health providers should be aware that information needs to be repeated several times, and presented both orally and in writing.
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Affiliation(s)
- Pernilla Garmy
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Clinical Health Promotion Centre, Lund University, Lund, Sweden
| | - Liselotte Jakobsson
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden
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97
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Morgan DD, Marston C, Garner J, Currow DC. Subacute Rehabilitation Does Have Benefits for Patients With Advanced Cancer. J Pain Symptom Manage 2018; 55:e1-e2. [PMID: 29111378 DOI: 10.1016/j.jpainsymman.2017.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Deidre D Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Celia Marston
- Victorian Comprehensive Cancer Centre-Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jill Garner
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - David C Currow
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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98
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Kristiansen M, Adamsen L, Piil K, Halvorsen I, Nyholm N, Hendriksen C. A three-year national follow-up study on the development of community-level cancer rehabilitation in Denmark. Scand J Public Health 2017; 47:511-518. [PMID: 29212431 DOI: 10.1177/1403494817746535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Scandinavian cancer care policies emphasise community-level rehabilitation services, but little is known about changes in service provision over time. This follow-up study explores development in these services in Danish municipalities, focusing on availability, utilisation and organisation of services, including existing opportunities and challenges. Methods: A national survey among all 98 Danish municipalities was conducted in 2013 (baseline) and repeated in 2016 (follow-up). The electronic questionnaire comprised closed- and open-ended questions. Data were analysed using descriptive statistics and content analysis. Results: A total of 93 municipalities responded (95% response rate) and the services offered primarily comprised group physical activity, dietary advice, smoking cessation and individual counselling on physical activity. The number of patients enrolled was below the estimated number needing rehabilitation in Denmark. Inequality in utilisation by ethnicity, age and gender was reported. Key challenges for the delivery of services were: inadequate referral and recruitment procedures; lack of needs assessment tools; obstacles to ensuring collaboration and referral of patients between hospitals and municipalities; and inadequate evidence on the rehabilitation's effect. Key recommendations include ensuring collaboration between municipalities; provision of diagnosis-specific group-based activities; services focusing on physical activity; and gender-specific activities directed particularly at men. Conclusions: This study, which highlights improvements in the provision of community-level cancer rehabilitation, recommends that more effort be made to ensure equality in utilisation across patient groups, improved integration of municipal-level services into cancer care trajectories, more uniform documentation of service delivery and the enforcement of patient outcomes to gradually build a more robust evidence base for community-level cancer rehabilitation.
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Affiliation(s)
| | - Lis Adamsen
- 1 Department of Public Health, University of Copenhagen, Denmark.,2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karin Piil
- 2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ida Halvorsen
- 1 Department of Public Health, University of Copenhagen, Denmark
| | - Nanna Nyholm
- 1 Department of Public Health, University of Copenhagen, Denmark
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99
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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100
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Loughran K, Rice S, Robinson L. Living with incurable cancer: what are the rehabilitation needs in a palliative setting? Disabil Rehabil 2017; 41:770-778. [PMID: 29185362 DOI: 10.1080/09638288.2017.1408709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increasing numbers of people are living with incurable cancers. Symptoms, side effects, and treatment burdens impact on physical functioning, yet little is known about the impact on people's lives and how best to provide rehabilitation. MATERIALS AND METHODS A qualitative study employing a phenomenological approach explored the lived experience of incurable cancer. A purposive sample of six people participated in semi-structured interviews. The data were analysed thematically at a semantic level to identify the functional difficulties experienced by people living with incurable cancer, the meanings of those difficulties, and participants perceived rehabilitation needs. RESULTS People living with incurable cancer described cancer-related issues spanning all five domains of the International Classification of Functioning, Disability and Health (ICF). Although highly valued amongst study participants, rehabilitation services were difficult to access, poorly utilised, and referrals were sporadic and consequential; indicative of poor awareness of rehabilitation for people with incurable cancer amongst potential referrers. DISCUSSION Participants valued a change in terminology away from "palliative" towards more positive language in line with enhanced supportive care movements. Validated tools such as the Palliative Care Therapy Outcome Measure, which align with the ICF, would allow rehabilitation professionals to demonstrate maintenance or improvement in participation and wellbeing. Implications for Rehabilitation Incurable cancer leads to a fluctuating multifactorial disability. People living with incurable cancer can benefit from rehabilitation input throughout their illness. Offering flexible and varied rehabilitation options for people living with incurable cancer will increase physical and emotional well-being, function, and coping. Allied health professionals should take and create opportunities to promote rehabilitation for people living with incurable cancer and their services to other potentially referring healthcare professionals to increase understanding of benefits and utilisation of available services for people living with incurable cancer.
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Affiliation(s)
- Kirsti Loughran
- a School of Health and Social Care , Teesside University , Middlesbrough , UK.,b Specialist Palliative Care Team , Newcastle upon Tyne NHS Foundation Trust, Arthur's Hill Clinic , Newcastle upon Tyne , UK
| | - Sarah Rice
- b Specialist Palliative Care Team , Newcastle upon Tyne NHS Foundation Trust, Arthur's Hill Clinic , Newcastle upon Tyne , UK
| | - Lisa Robinson
- c Rehabilitation Department , The Newcastle upon Tyne NHS Foundation Trust, Royal Victoria Infirmary , Newcastle upon Tyne , UK.,d Newcastle University Faculty of Medical Sciences Graduate School , Newcastle University , Newcastle upon Tyne , UK
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