Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis

Priority of the basic and instrumental activities of daily living in older patients with cancer prescribed rehabilitation: a cross-sectional survey

BACKGROUND

There is no information on whether vulnerable older patients with cancer consider basic activities of daily living (BADL) and instrumental activities of daily living (IADL) important outcomes. Our survey aimed to investigate the priority of BADL and IADL in outcomes among vulnerable older patients with cancer.

METHODS

This was a single-center survey in a Japanese cancer center. Eligible patients were ≥ 65 years of age and were prescribed in-hospital rehabilitation while under cancer treatment. Using original self-administered ranking questionnaires, patients were asked to rank outcomes and subdomain of BADL and IADL. High-priority domains were defined as the highest, second-highest, and third-highest priority domains in individuals.

RESULTS

A total of 169 patients were analyzed. The mean age was 74.0 years (standard deviation, 5.1 years) and the number of males was 107 (63%). The order of ranking of high-priority outcomes was BADL and IADL (n = 155), cognitive function (n = 91), mental function (n = 82), nutrition (n = 61), social function (n = 51), comorbidity (n = 39), and life span (n = 28). The top three high-priority independence subdomains of BADL and IADL were toilet use (n = 140), feeding (n = 134), and mobility (n = 69) among the BADL and shopping (n = 93), food preparation (n = 88), and ability to handle finances (n = 85) among the IADL.

CONCLUSIONS

BADL and IADL can be considered the most important health outcomes in clinical trials and in practice among older patients with cancer and physical vulnerabilities.

Effects of an outpatient exercise programme for Australians with cancer-related fatigue: an unmet need

BACKGROUND

Cancer-related fatigue (CRF) is a common debilitating condition. International evidence supports an exercise prescription for CRF. The majority of Australians with cancer do not meet recommended exercise targets.

AIMS

To analyse the effects of a guideline-based supervised exercise programme on CRF among a representative private hospital cancer patient sample (n = 268).

METHODS

We collected data from 268 patients recruited from haematology and oncology over a 5-year period. Participants underwent a 3-month CRF exercise programme based on internationally recognised exercise guidelines. The programme, conducted by a multidisciplinary team, operated twice weekly sessions of 2 h duration comprising aerobic, resistance and balance exercises; hydrotherapy and condition counselling; fatigue management; and dietetic, speech pathology and swallowing education (head and neck cancers). The effect of the programme was measured in relation to the following outcomes: Functional Assessment of Chronic Illness Therapy, Fatigue (self-reported fatigue); Functional Assessment of Cancer Therapy, general quality of life (health-related quality of life in cancer); six-minute walk test; and Lawton's Instrumental Activities of Daily Living Scale.

RESULTS

Multivariate outcomes showed statistically significant improvements in all four major outcome measures, plus a programme effect of greater than 0.7 for each outcome variable. The programme treatment outcomes were consistent over the 5 years of the programme.

CONCLUSIONS

The outcomes of this programme contribute to exercise guidelines in Australia. Currently only position statements exist on the subject, but there are no programme guidelines. An exercise prescription is critical to cancer outcomes. This programme is likely to benefit cancer survivors experiencing CRF across private and public hospitals in Australia.

Outcome Measures and Patient-Reported Metrics in Cancer Rehabilitation

PURPOSE OF REVIEW

The current panorama of measurement tools for use in cancer rehabilitation is reviewed. For rehabilitation purposes, evaluating function is of the highest priority.

RECENT FINDINGS

From a patient-reported outcome (PRO) standpoint, SF-36 and EORTC-QLQ-C30 are in most common use in cancer rehabilitation research; these are quality of life measures that contain functional subdomains. Newer tools which are based on item response theory and have options for both computer assisted or short form (SF) administration, including the Patient-Reported Outcomes Measurement Information System (PROMIS) and Activity Measure for Post-acute Care (AMPAC) instruments, show increasing use, especially PROMIS Physical Function SF, and, recently, PROMIS Cancer Function Brief 3D, which has been validated in the cancer population, with domains of physical function, fatigue, and social participation, to track clinical rehabilitation outcomes. Evaluating objective measures of function in cancer patients is also crucial. Utilization of clinically feasible tools for cancer rehabilitation, to employ for both screening purposes and for monitoring of rehabilitation treatment efficacy, is an evolving area, much needed to promote further research and improved, consistent clinical care for cancer patients and survivors.

Function in Cancer Patients: Disease and Clinical Determinants

Patients with cancer often experience changes in function during and after treatment but it is not clear what cancer types, and associated clinical factors, affect function. This study evaluated patient-reported functional impairments between specific cancer types and risk factors related to disease status and non-cancer factors. A cross-sectional study evaluating 332 individuals referred to cancer rehabilitation clinics was performed at six U.S. hospitals. The PROMIS Cancer Function Brief 3D Profile was used to assess functional outcomes across the domains of physical function, fatigue, and social participation. Multivariable modeling showed an interaction between cancer type and cancer status on the physical function and social participation scales. Subset analyses in the active cancer group showed an effect by cancer type for physical function (p < 0.001) and social participation (p = 0.008), but no effect was found within the non-active cancer subset analyses. Brain, sarcoma, prostate, and lymphoma were the cancers associated with lower function when disease was active. Premorbid neurologic or musculoskeletal impairments were found to be predictors of lower physical function and social participation in those with non-active cancer; cancer type did not predict low function in patients with no evidence of disease. There was no differential effect of cancer type on fatigue, but increased fatigue was significantly associated with lower age (0.027), increased body mass index (p < 0.001), premorbid musculoskeletal impairment (p < 0.015), and active cancer status (p < 0.001). Anticipatory guidance and education on the common impairments observed with specific cancer types and during specific stages of cancer care may help improve/support patients and their caregivers as they receive impairment-driven cancer rehabilitation care.

Preferences on Delivery of Cancer Rehabilitation Services for Cancer-Related Disability Among Older Individuals Surviving Breast Cancer: A Qualitative Study

Background

Older individuals surviving breast cancer often encounter cancer-related disability as a short-term or long-term effect of cancer and related treatment. Cancer rehabilitation interventions have the potential to prevent, mitigate, or remediate cancer-related disability. However, use of these services remains limited. Understanding the priorities and perspectives of older individuals surviving breast cancer is key to developing effective and implementable cancer rehabilitation interventions. This qualitative descriptive study examined individuals' preferred and valued methods of cancer rehabilitation intervention delivery.

Methods

Using a qualitative descriptive design, older individuals surviving breast cancer (n=14) completed a single telephone-based semi-structure interview. Interviews explored survivors' preferences for cancer rehabilitation service delivery. Interview transcriptions were thematically analyzed. Open codes were inductively generated and reviewed for agreement by an independent reviewer. The codes were deductively organized. Differences were resolved through consensus meetings.

Results

Findings revealed preferred intervention delivery characteristics for intervention setting, mode of delivery, format, and timing. Participants predominantly preferred interventions delivered in community-based settings, with both in-person and remote components. Participants also appeared to value one-on-one interventions and those delivered post-treatment. Survivors' overarching preferences were based on desire for patient-centric care, one-on-one therapist time, complex medical schedules, and financial concerns.

Discussion

Study findings provide guidance on the modification of existing and creation of new cancer rehabilitation interventions addressing cancer-related disability in older individuals surviving breast cancer. Adoption of stakeholder-driven intervention delivery characteristics may improve value and acceptability of interventions. Future intervention research should incorporate and test these characteristics to ensure their effectiveness in real-world settings.

Contributions of a Rehabilitation Nursing Program in the Self-Care of Women Undergoing Breast Surgery

BACKGROUND

Although surgical treatments for breast cancer have exhibited advanced interventions, axillary lymph node dissection can limit functionality and compromise women's self-care. This study aims to assess the effectiveness of a rehabilitation nursing program in improving self-care performance in women undergoing breast surgery with axillary lymph node dissection.

METHODS

This quantitative, quasi-experimental study involved 48 women recruited from a main hospital between 2018 and 2019. The participants completed a three-month rehabilitation program at home. The evaluation instrument used was the DASH questionnaire. This study was not registered.

RESULTS

The functionality of the upper limb ipsilateral to the surgery improved significantly (p < 0.001) after the implementation of the program, influencing the participants' capacity for self-care, including washing/drying their hair, washing their back, and wearing a shirt. The average DASH total score increased from 54.4 to 8.1 after the program.

CONCLUSIONS

The rehabilitation nursing program positively influenced the participants' self-care ability. Incorporating rehabilitation nursing programs into breast cancer treatment can improve self-care performance and the overall quality of patients' lives. This study was not registered.

Eribulin mesylate induces bone mass loss by promoting osteoclastic bone resorption in mice

Over the past few decades, the clinical outcomes of patients with cancer have significantly improved mostly owing to the development of effective chemotherapeutic treatments. However, chronic health conditions such as bone mass loss and risk of fragility fractures caused by chemotherapy have also emerged as crucial issues in patients treated for cancer. In this study, we aimed to understand the effect of eribulin mesylate (ERI), a microtubule-targeting agent currently used to treat metastatic breast cancer and certain subtypes of advanced sarcomas, on bone metabolism in mice. The administration of ERI reduced bone mass in mice, mainly by promoting osteoclast activity. Gene expression analysis of skeletal tissues revealed no change in the expression levels of the transcripts for RANK ligand, one of the master regulators of osteoclastogenesis; however, the transcript levels of osteoprotegerin, which neutralizes RANK ligand, were significantly reduced in ERI-treated mice compared with those in vehicle-treated controls, indicating a relative increase in RANK ligand availability after ERI treatment. In line with the increased bone resorption in ERI-treated mice, we found that zoledronate administration effectively suppressed bone loss in these mice. These results reveal a previously unrecognized effect of ERI on bone metabolism and suggest the application of bisphosphonates for patients with cancer undergoing treatment with ERI.

Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective

BACKGROUND

The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice.

METHODS

The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described.

RESULTS

PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows.

CONCLUSION

Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.

IMPLICATIONS FOR CANCER SURVIVORS

Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.

Factors That Influence Occupational Engagement of Young Adults Who Are Cancer Survivors: A Pilot Study

Cancer and its treatment can impact occupational engagement. However, occupational therapy-specific research studying young adult cancer survivors remains limited. The objective of this study to identify the type of occupations that young adult cancer survivors choose to engage in and to understand their decision-making process when choosing these occupations. A mixed-methods explanatory sequential design was used. Eleven participants, nine females and two males, between the ages of 18 and 35, were included. Several occupations were identified for engagement such as activities of daily living, leisure, work, sleep and rest, and health management. The predominant factor that influenced why occupations were chosen was that individuals purposefully selected occupations that allowed them to choose a path toward a more meaningful life. Information gained from this pilot study can be used to inform occupational therapy practitioners regarding services and interventions that promote occupational engagement for young adult cancer survivors.

Caregivers’ contribution to self-care for patients treated with oral anticancer agents: A qualitative descriptive study

PURPOSE

To adequately manage oral anticancer agents (OAAs) therapy, appropriate self-care behaviours must be implemented. Informal caregivers could support and contribute to patient self-care. This study aimed to explore and describe the caregiver contribution to self-care and their related experience of caring among informal caregivers of patients on OAAs.

METHODS

Qualitative descriptive design. We conducted semi-structured interviews, which were transcribed, read in depth, and analysed with deductive and inductive content analysis, according to Mayring. Adult informal caregivers (>18 years) of elderly patients (>65 years) with solid malignancies undergoing OAAs therapy for at least 3 months were included.

FINDINGS

Twenty-three caregivers were interviewed with mean age of 57,2 (SD ± 15,8). A total of 18 codes from the qualitative content analysis were found, of which ten were referred to caregiver contribution and classified into the three dimensions of self-care maintenance (i.e. behaviours to maintain illness stable), self-care monitoring (i.e., tracking symptoms and side effects), and self-care management (i.e., management of worsening symptoms), according to the Middle Range Theory of Self-Care of Chronic Illnesses. The eight codes on caregiver experience were aggregated into two main themes: negative aspects (i.e., burden, emotional state, self-denial, social isolation) and positive aspects of caregiving.

CONCLUSION

Healthcare professionals should consider the importance of caregiver role in supporting their loved one treated with OAAs, also taking into account their needs to prevent burdensome situations. A holistic view in which a patient-centred approach is established should be encouraged through the communication and education of the dyad.

Global retrospective analysis of clinician- and patient-reported clinical characteristics and humanistic burden of patients with gastroesophageal cancers on first-line treatment

BACKGROUND

Gastric cancer (GC), gastroesophageal junction cancer (GEJC), and esophageal adenocarcinoma (EAC), together, are leading causes of cancer deaths worldwide. Patient health-related quality of life (HRQoL) and well-being has become increasingly important alongside traditional oncologic outcomes for both patients and clinicians and may aid treatment decisions. We conducted a survey to examine the clinical characteristics, humanistic burden, and the effects of first-line (1L) treatment in patients with GC/GEJC/EAC, across different geographic regions, to address the paucity of real-world data.

METHODS

Clinicians treating patients with unresectable advanced or metastatic GC/GEJC/EAC in China, France, Germany, Japan, the United Kingdom, and the United States, during April-October 2019, were invited to provide data on their patients' demographics, clinical characteristics, treatment, and HRQoL via medical chart reviews, clinician surveys, and patient questionnaires. Data were analyzed using descriptive statistics, regression analyses comparing active treatment and best supportive care. Patients were also stratified into subgroups that were identified either as human epidermal growth factor receptor 2 (HER2) positive, HER2 negative (which has a higher prevalence but for whom there are limited treatment options), or unknown HER2 status.

RESULTS

Survey data were analyzed for 995 patients, 87% of whom were on active treatment, most commonly dual or triple chemotherapy. Demographics and clinical characteristics were similar across countries with most patients having GC and the lowest incidence of GEJC and EAC in China. Overall, most patients had de novo disease with good response to 1L treatment, while their HRQoL and well-being was significantly worse than the general population. In 682 patients on active treatment with HER2 negative or unknown status, HRQoL also appeared to be worse in those with recurrent disease. Regression analysis identified several drivers of treatment decisions and factors impacting patients' HRQoL, including stage of disease and comorbidities.

CONCLUSIONS

In patients with advanced GC/GEJC/EAC, screening and assessment of HER2 status as well as patient-reported HRQoL outcomes are invaluable in aiding treatment decisions. The introduction of appropriate therapy soon after diagnosis has the prospect of achieving improved HRQoL and survival in these patients.

Men's Lived Experiences of Breast Cancer and Changes in Occupation

Introduction

Male breast cancer is rare and frequently diagnosed at later stages of disease with low survival rates. There is a lack of knowledge of how breast cancer impacts men's occupations.

Objectives

This study is aimed at understanding the lived experiences of men with breast cancer and their changes in occupation. Methodology. Twenty-four men with breast cancer participated in semistructured phone interviews. Data was open-coded and analyzed for themes. Findings. The six major themes are as follows: (1) death as a reality, (2) unique personal insights, (3) social environment, (4) interactions with the healthcare system, (5) decreased engagement in occupations, and (6) finding meaning in new occupations.

Conclusion

The healthcare team can improve the patient experience by discussing and responding to the client's experience throughout the diagnosis, intervention, and survival continuum. The scope of occupational therapy is well suited to address the needs of men with breast cancer to maintain optimal levels of functioning.

Mental Adjustment, Functional Status, and Depression in Advanced Cancer Patients

Depressive symptoms are common in individuals with advanced cancer.

OBJECTIVES

This study sought to analyze the relationship between physical and functional status and depressive symptoms, and to assess the role of mental adjustment across these variables in people with advanced cancer.

METHODS

A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed self-report measures: Brief Symptom Inventory (BSI), Mini-Mental Adjustment to Cancer (Mini-MAC) scale, and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire.

RESULTS

Depression was present in 44.3% of the participants and was more common among women, patients <65 years old, non-partnered, and those with recurrent cancer. Results revealed a negative correlation with functional status, and functional status was negatively associated with depressive symptoms. Mental adjustment affected functional status and depression. Patients having a positive attitude displayed fewer depressive symptoms, while the presence of negative attitudes increased depressive symptoms in this population.

CONCLUSIONS

Functional status and mental adjustment are key factors in the presence of depressive symptoms among people with advanced cancer. Assessment of functional status and mental adjustment should be considered when planning treatment and rehabilitation in this population.

Physical, Leisure, and Daily Living Activities in Patients Before, During, and After Radiotherapy for Cancer: Which Patients Need Support in Activities?

BACKGROUND

Avoiding inactivity and staying active during cancer therapy have great health effects.

OBJECTIVE

The aims of this study were to describe level of daily, leisure, and physical activities before, during, and after radiotherapy and to investigate whether patients who had not restored activity level after radiotherapy differed from patients who had restored activity level regarding different characteristics.

METHODS

In this descriptive longitudinal study, 196 patients undergoing pelvic-abdominal radiotherapy reported their activity level at baseline, weekly during radiotherapy, and at 1 month after radiotherapy.

RESULTS

Patients decreased activity level during radiotherapy (P < .001 for all activities): physical activity (34% of patients decreased level), walking (26%), leisure activities (44%), social activities (15%), housework (34%), shopping (28%), and activities in general (28%). Almost half (47%) had not restored activity level after radiotherapy. Patients with colorectal cancer, older than 65 years, who had less education than university, and high capacity in overall daily activities at baseline were more likely than other patients not to restore activity level after radiotherapy. The patients not restoring their activity level after radiotherapy were more likely than others to experience anxious mood (P = .016), depressed mood (P = .003), and poor quality of life (P = .003) after radiotherapy.

CONCLUSION

Patients' activity level decreased during radiotherapy, and almost half of patients did not restore activity level after radiotherapy.

IMPLICATIONS FOR PRACTICE

Given that restored activity level after radiotherapy was less common in certain subgroups and that patients who restored activity level experienced better quality of life and less frequent anxious and depressed mood, cancer nursing professionals should consider supporting these subgroups of patients in performing activities.

Patient Willingness to Use Digital Health Technologies: A Quantitative and Qualitative Survey in Patients with Cancer Cachexia

Purpose

The objective of this study was to gain insights into the patients' perspectives on the impact of cancer cachexia on physical activity and their willingness to wear digital health technology (DHT) devices in clinical trials.

Patients and Methods

We administered a quantitative 20-minute online survey on aspects of physical activity (on a 0-100 scale) to 50 patients with cancer cachexia recruited through Rare Patient Voice, LLC. A subset of 10 patients took part in qualitative 45-minute web-based interviews with a demonstration of DHT devices. Survey questions related to the impact of weight loss (a key characteristic in Fearon's cachexia definition) on physical activity, patients' expectations regarding desired improvements and their level of meaningful activities, as well as preferences for DHT.

Results

Seventy-eight percent of patients reported that their physical activity was impacted by cachexia, and for 77% of them, such impact was consistent over time. Patients perceived most impact of weight loss on walking distance, time and speed, and on level of activity during the day. Sleep, activity level, walking quality and distance were identified as the most meaningful activities to improve. Patients would like to see a moderate improvement of activity levels and consider it meaningful to perform physical activity of moderate intensity (eg, walk at normal pace) on a regular basis. The wrist was the preferred location for wearing a DHT device, followed by arm, ankle, and waist.

Conclusion

Most patients reported physical activity limitations since the occurrence of weight loss compatible with cancer-associated cachexia. Walking distance, sleep and quality of walk were the most meaningful activities to moderately improve, and patients consider moderate physical activity as meaningful. Finally, this study population found the proposed wear of DHT devices on the wrist and around the waist acceptable for the duration of clinical studies.

Protocol for a randomised controlled trial on impact of comprehensive geriatric and supportive assessment versus standard care in older adults with cancer undergoing curative treatment: The Geriatric Oncology SuPportive clinic for ELderly (GOSPEL) study

Cancer affects older adults with varying levels of frailty, but cancer treatment is extrapolated from clinical trials involving predominantly young and robust subjects. Recent geriatric oncology randomised controlled trials (RCT) report that geriatric assessment leading to frailty-guided intervention reduces treatment-related toxicity whilst maintaining survival and improving quality of life (QoL). However, these positive results have not have been consistently reported in the literature. We postulate that the impact of geriatric interventions has been underestimated in these studies with the inclusion of subjects receiving palliative-intent chemotherapy in whom dose reduction is common. Integrating supportive care with current geriatric oncology models may improve the QoL of older adults undergoing treatment. However, no studies as yet have examined such integrated geriatric and supportive models of care. The Geriatric Oncology SuPportive clinic for Elderly (GOSPEL) study is a single-centre, open-label, analyst-blinded RCT evaluating the impact of comprehensive geriatric and supportive care on QoL of older adults with cancer undergoing curative treatment. Older adults aged above 65, with a Geriatric-8 score ≤ 14, with plans for high dose radiotherapy and/or curative chemotherapy will be recruited. The primary QoL outcome is measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD14 mobility scale at 12 weeks. Secondary outcomes include overall and disease-free survival, treatment-related adverse events, and hospital admissions. We pre-powered this study to recruit 200 subjects based on the minimally clinically important difference for EORTC QLQ-ELD14 to achieve 80% statistical power (alpha 0.05), assuming 25% attrition. Outcomes will be analysed using intention-to-treat. Intervention consists of multi-domain comprehensive geriatric and supportive care assessments from a multidisciplinary team targeting unmet needs. These include functional decline, falls, incontinence, cognitive impairment, multi-morbidity, polypharmacy, and symptom relief, as well as social and psycho-spiritual concerns. Standard care entails routine oncological management with referral to geriatrics based on the discretion of the primary oncologist. Recruitment has been ongoing since August 2020. Results from the GOSPEL study will increase understanding of the impact of integrated geriatric and supportive care programs in older adults with cancer receiving curative treatment. Trial registration: This study is registered under ClinicalTrials.gov (ID NCT04513977).

What information can we gain from the quality appraisal of guidelines with physical activity recommendations for cancer patients?A systematic review using the AGREE II and AGREE-REX tools

PURPOSE

There has been growing amount of evidence supporting the benefits of physical activity (PA) on oncological patients' cancer-related health outcomes. Although guidelines on cancer rehabilitation are widely available, the varying quality and practical applicability limited the clinical application of PA recommendations. To assist the future development of guidelines, in this systematic review, we evaluated the quality and applicability of current cancer rehabilitation guidelines with PA recommendations and synthesized PA recommendations for the oncological population.

METHODS

A systematic search was conducted in PubMed, CINAHL, PEDro, EMBASE, and guideline repositories to identify guidelines with PA recommendations for cancer patients from 1 May 2016 to 1 June 2022. The quality of included guidelines was appraised using the tools "Appraisal of Guidelines for Research and Evaluation II" (AGREE II) and AGREE-REX (Recommendation Excellence). PA recommendations were synthesized from the guidelines.

RESULTS

Sixteen guidelines were extracted. The AGREE II domain "clarity of presentation" obtained the highest score, while "applicability" received the lowest, ranging from 33.33% to 98.58%. The AGREE-REX domains "values and preferences" and "implementability" generally scored lower and ranged from 45.83% to 74.17% and 55% to 88.33%, respectively. Eight high-quality guidelines were identified, and the included PA recommendations were extracted.

CONCLUSION

There were some disparities in the quality of the included guidelines. Methodological weaknesses were commonly observed in domains "applicability," "values and preferences," and "implementability"; particular attention should be given to these domains when developing future guidelines. Furthermore, this analysis indicated that more rigorous, high-quality studies are needed to generate evidence for supporting PA recommendations and provide guidance on research gaps in the field of cancer rehabilitation.

A broad perspective on breast cancer: Participation, quality of life and return to work throughout the recovery process

BACKGROUND

Studies found that women with breast cancer struggle with significant physical and mental challenges that affect their participation in daily living, social and work activities. Although women express their need for rehabilitation, in Israel there has been scant research on the nature of these needs.

OBJECTIVE

To examine the implications of breast cancer for Israeli women in terms of their quality of life, body function, activities and participation in all facets of life, including work.

METHODS

The sample was composed of women diagnosed with breast cancer. The data were collected through: (a) an online electronic survey assessing cancer-related quality of life (QoL), function and disability, fatigue and sensory-motor functions, (n = 201) followed by (b) face-to-face interviews and assessments (n = 20), and a healthy control group (n = 61).

RESULTS

Women with breast cancer reported significantly lower QoL compared to the healthy control group. They reported higher levels of disability in areas such as, cognition, mobility, upper extremity, as well as overall difficulties in self-care, doing routine household activities and return to work. Roughly one-third of the women did not return to work. Interestingly, our sample did not perceive a decline in terms of their social support or networks, the women stated that family and social support were major enabling factors.

CONCLUSION

The results show that breast cancer has short and long-term functional effects on most facets of these women's life. The women's social support system served as an enabling factor. Many women expressed their frustration at the lack of rehabilitation services for their condition and needs in Israel.

Medial Branch Radiofrequency Treatment for Low-Back Pain in Cancer Patients: A Case Series

Cancer patients are increasing in number, with an increased lifespan and advances in cancer treatment. Palliative care physicians often encounter difficulties in caring for patients with pain. In addition to cancer-related pain, patients with cancer may suffer from various musculoskeletal diseases, resulting in significant functional limitations of physical activities of daily living. We present three cases illustrating methods to deal with nonspecific mechanical low-back pain in patients with advanced cancer. We provide our therapeutic experiences, focusing on the usefulness of radiofrequency treatment in palliative care in patients with cancer.

Assessment of locomotive syndrome in patients with visceral cancer, the comparison with non-cancer patients using propensity score matching

BACKGROUND

When treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association.

METHODS

Locomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N).

RESULTS

The average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function.

CONCLUSIONS

Even in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis.

Oral cancer screening prevalence in low-income adults before and after the ACA

BACKGROUND

Detecting oral cancer early is associated with higher probability of survival, reduced treatment costs, and improved quality of life. Unfortunately, <30% of oral cancers are detected early. Recent health insurance expansions from the Affordable Care Act (ACA) could improve outcomes by increasing access to screening. However, due to the differences in screening practices by physicians and dentists, the impact of expanded access to insurance on oral cancer screenings remains unknown.

METHODS

Self-reported oral cancer screening data were obtained from The National Health and Nutrition Examination Survey (NHANES) for years 2011-2017. NHANES questionnaires ask respondents if they have received an oral cancer screen from a physician or dentist in the past year. Along with adjusting for demographic characteristics, this study accounts for unobserved heterogeneity by comparing "Differences-in-Differences" estimates of low-income adults (<200 % FPL) with high-income adults, before and after the ACA (2014), for adults most exposed (<age 65) to insurance expansion.

RESULTS

Before and after the ACA, low-income adults had the lowest prevalence of oral cancer screenings. However, relative to high-income adults, the ACA was associated with a 5-6%-point increase in oral cancer screenings for low-income adults under age 65, but only for screenings performed by dentists.

CONCLUSIONS

Overall, oral cancer screening rates have been declining across the population, but the ACA may have slowed the decline in low-income adults. Understanding why oral cancer screenings are declining could inform cancer control policies. Research evaluating the impact of access to oral cancer screenings remains warranted.

Factors influencing cancer survivors' experiences with follow-up cancer care: results from the pan-Canadian Experiences of Cancer Patients in Transition Study survey

PURPOSE

The purpose of this study was to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care.

METHODS

In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors about their experiences with follow-up cancer care. We included respondents from this survey if they were diagnosed with non-metastatic breast, hematologic, colon, melanoma, and prostate cancer. Our primary outcome was cancer survivors' self-reported overall experience with follow-up cancer care. We used multivariable logistic regression to examine the influence of individual and structural factors on cancer survivors' experiences with follow-up cancer care.

RESULTS

Of the 8402 cancer survivors included in our study, 81.8% (n = 6,875) reported a positive experience with their follow-up cancer care. The individual factors associated with positive overall experiences were more commonly those associated with self-perceptions of respondents' personal health and well-being rather than baseline sociodemographic factors, such as sex, income, or education. For example, respondents were more likely to report a positive experience if they perceived their quality of life as good (OR 1.9, 95% CI 1.0-3.5, p < 0.01) or reported not having an unmet practical concern (OR 1.3, 95% CI 1.1-1.6, p < 0.01). The structural factors most strongly associated with positive overall experiences included respondents perceiving their oncology specialist was in charge of their follow-up cancer care (OR 5.2, 95% CI 3.6-7.5, p < 0.01) and reporting the coordination of their follow-up cancer care among healthcare providers was good or very good (OR 8.4, 95% CI 6.7-10.6, p < 0.01).

CONCLUSION

While real-world experiences with follow-up cancer care in Canada are reported to be positive by most cancer survivors included in this study, we found differences exist based on individual and structural factors. A better understanding of the reasons for these differences is required to guide the provision of high-quality follow-up care that is adapted to the needs and resources of individuals and contexts.

The critical need to implement and utilize patient-reported measures of function in cancer care delivery

The study by Smith et al. on the Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile shows that it can be used to measure how an individual functions and how his or her function changes during cancer treatments. This is important because most patients will experience a decline in function during cancer treatment and will struggle to fully participate in their life roles. Strong evidence demonstrates that rehabilitation improves function for individuals with cancer; rehabilitation is relatively underutilized. We suggest that using the PROMIS tool as a repeated measure throughout cancer treatment will help to identify those with functional decline who will benefit most from rehabilitation.

Physiatrists’ Attitudes and Knowledge About Cancer Rehabilitation

Objective

We aim to assess the awareness and evaluation pattern among physiatrists regarding cancer rehabilitation and associated barriers to access.

Design

The present study is a cross-sectional study in the Physical Medicine and Rehabilitation (PMR) Association Annual Meeting in Puerto Rico that used a 10-item questionnaire to summarize physiatrists’ clinical patterns with their persons diagnosed with cancer (PDWCs).

Results

Thirty-eight (66.7%) participants answered they received minimal to no education about cancer rehabilitation benefits. Cancer patients represented 10% or less of the weekly patient load for 47 (82.5%) physiatrists surveyed. The most common type of cancer encountered was breast cancer for the management of adverse effects. Twenty-nine (50.9%) physiatrists answered that a multifactorial barrier was the cause for limited services within this population group. All participants agreed that rehabilitation is at least sometimes beneficial for cancer patients, and 54 (94.7%) believed these services are needed.

Conclusion

Although rehabilitation specialists learn about the benefits of rehabilitation for PDWCs, there continues to be a limited number of PDWCs evaluated, mainly due to poor access, lack of information about cancer rehabilitation, and economic difficulties. Further efforts should be made to emphasize the importance of integrating rehabilitation techniques in the care of PDWCs.

Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial

BACKGROUND

For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning.

METHODS

This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings.

DISCUSSION

This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer.

TRIAL REGISTRATION

This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.

Safety, feasibility, and effectiveness of implementing supervised exercise into the clinical care of individuals with advanced cancer

OBJECTIVE

To evaluate the safety, feasibility, and preliminary effectiveness of implementing supervised exercise programming into the clinical care of individuals with advanced cancer.

DESIGN

Single group implementation feasibility study using a pre-posttest design.

SETTING

Exercise Oncology Unit of the Spanish Cancer Association (a cancer-specific community facility outside the hospital setting).

PARTICIPANTS

Adult individuals with advanced cancer profile involving advanced local cancer or distant metastases.

INTERVENTION

A 12-week, twice-weekly, supervised, clinic-based multi-component exercise program.

MAIN MEASURE

Paired t-tests were used to assess pre-post changes and analyses of covariance were used to compare effects based on selected participant characteristics.

RESULTS

Eighty-four individuals with advanced cancer completed the baseline assessment, with six participants withdrawing prior to the start of the program. Of the 78 participants, 17 dropped out, thus, a total of 61 completed the final assessment. Mean adherence was 82.5%. No serious adverse events occurred. Exercise significantly improved VO_2max by 5.2 mL·kg·min (p < 0.001), chest strength (p < 0.001), leg strength (p < 0.001), lean body mass (p  =  0.003), skeletal muscle mass (p < 0.002), % body fat (p  =  0.02), quality of life by 5.3 points (p  =  0.009), fatigue by 3.2 points (p  =  0.012), and physical activity by 1680 METs/week (p < 0.001).

CONCLUSIONS

Our clinically supervised and tailored exercise program involving moderate to vigorous intensity exercise was found to be feasible, safe, and effective for individuals with advanced cancer.

IMPLICATIONS FOR CANCER SURVIVORS

With proper screening and supervision, individuals with advanced cancer can benefit from tailored exercise oncology support as part of an overall therapeutic care plan.

Factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil

OBJECTIVE

To analyze factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil.

METHODS

This is a cross-sectional study of 463 older adults aged 60 years or older. The outcome variable was functional disability, evaluated by Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale. The independent variables were sociodemographic characteristics, lifestyle, social support, and health aspects. We performed bivariate and multivariate analyses and calculated prevalence ratios (PR) using Poisson regression with robust variance.

RESULTS

The prevalence of IADL functional disability was 55.3%. The variables associated with this disability in the multivariate analysis were: not working (PR=1.36; 95% confidence interval - 95%CI 1.03-1.78); low (PR=1.49; 95%CI 1.10-2.03) and moderate (PR=1.30; 95%CI 1.04-1.64) perceived affectionate support; depressive symptoms (PR=1.31; 95%CI 1.10-1.56); malnutrition (PR=1.28; 95%CI 1.03-1.59); having two or more comorbidities (PR=1.30; 95%CI 1.03-1.64), and having a companion to health services (PR=1.39; 95%CI 1.05-1.83).

CONCLUSION

In addition to physical health aspects, comorbidities, and malnutrition, functional disability was associated with emotional, social support, and work issues, reinforcing the importance of comprehensive care and actions to maintain and recover functional capacity, promoting a better quality of life, the independence of older adults with cancer, and a reduced risk of adverse biopsychosocial outcomes.

Evaluating the effects of telenursing on patients' activities of daily living and instrumental activities of daily living after myocardial infarction: A randomized controlled trial study

AIM

This study aimed to assess the effects of telenursing on patients' activities of daily living and instrumental activities of daily living (ADLs and IADLs) following a myocardial infarction (MI).

METHODS

This randomized, parallel-group, controlled trial was conducted on 95 patients post-MI from 2018 to 2019. Patients were randomly assigned to the intervention (telenursing) and control groups using permuted block randomization. Through telephone calls, telenursing was performed twice a week during the first six consecutive weeks, then once a week until week 12. ADL and IADL questionnaires were completed by both groups before intervention and 12 weeks later. The CONSORT 2010 checklist was used to report the study protocol.

RESULTS

The mean age of patients was 56.8 ± 11.07 and 54.2 ± 9.8 years in the telenursing and control group, respectively. The mean ADL and IADL scores in the telenursing group were substantially greater than in the control group [4.57 (3.18, 5.97); P < 0.001 and 4.40 (3.06, 5.75); P < 0.001, respectively]. The odds of a higher degree of independence (no disabilities vs. mild disabilities and disability as well as no disabilities and mild disabilities vs. disability) regarding ADLs and IADLs were significantly greater in the telenursing group as compared with the control group (P < 0.001 and P < 0.001, respectively).

CONCLUSIONS

Our findings suggest that the use of telenursing intervention may increase patients' ADLs and IADLs after an MI and may enhance their independence. Geriatr Gerontol Int 2022; ••: ••-••.

Development of an intervention influencing activity limitations in older breast cancer survivors: A modified Delphi study

INTRODUCTION

Older breast cancer survivors have difficulty accessing rehabilitation interventions addressing activity limitations. Stakeholder input may improve accessibility of interventions. We sought expert consensus on intervention content and delivery features (e.g., where, mode, duration) to inform development of more accessible interventions for this population.

MATERIALS AND METHODS

We conducted a modified Delphi process with patient, clinical, administrative, and research experts. In Round 1, experts evaluated content and delivery features according to domains of feasibility and prioritization. In Round 2, panelists were asked to re-rank or confer agreement of content and delivery features that met Round 1 consensus. Ranking was based on median score. Consensus was defined as a percentage of panelists that ranked an option within one unit of the median. For nominal data, consensus was defined as percent agreement.

RESULTS

Panelists (n = 20) prioritized physical activity strategies (Median Rank: 2; Consensus: 85%) and adaptive skills training (3; 65%). Panelists also prioritized delivery through outpatient services (1; 100%), post-treatment (1; 100%), combination mode of delivery (100%), duration of three months or less (100%) and occurring one to two days per week (100%).

DISCUSSION

Cancer rehabilitation interventions should be designed with input from stakeholders. The stakeholder intervention priorities identified in this study (e.g., content, setting, and mode) may improve relevance and accessibility of future cancer rehabilitation interventions. Interventions delivered in outpatient clinics and post-treatment using virtual and in-person visits may improve accessibility. Future research should examine the effectiveness and implementation of these intervention characteristics.

Functional Status and Survival in Older Nursing Home Residents With Advanced Non-Small-Cell Lung Cancer: A SEER-Medicare Analysis

PURPOSE

Many older patients with advanced lung cancer have functional limitations and require skilled nursing home care. Function, assessed using activities of daily living (ADL) scores, may help prognostication. We investigated the relationship between ADL impairment and overall survival among older patients with advanced non-small-cell lung cancer (NSCLC) receiving care in nursing homes.

METHODS

Using the SEER-Medicare database linked with Minimum Data Set assessments, we identified patients age 65 years and older with NSCLC who received care in nursing homes from 2011 to 2015. We used Cox regression and Kaplan-Meier survival curves to examine the relationship between ADL scores and overall survival among all patients; among patients who received systemic cancer chemotherapy or immunotherapy within 3 months of NSCLC diagnosis; and among patients who did not receive any treatment.

RESULTS

We included 3,174 patients (mean [standard deviation] age, 77 [7.4] years [range, 65-102 years]; 1,664 [52.4%] of female sex; 394 [12.4%] of non-Hispanic Black race/ethnicity), 415 (13.1%) of whom received systemic therapy, most commonly with carboplatin-based regimens (n = 357 [86%] patients). The median overall survival was 3.1 months for patients with ADL score < 14, 2.8 months for patients with ADL score between 14 and 17, 2.3 months for patients with ADL score between 18-19, and 1.8 months for patients with ADL score 20+ (log-rank P < .001). The ADL score was associated with increased risk of death (hazard ratio [HR], 1.20; 95% CI, 1.16 to 1.25 per standard deviation). One standard deviation increase in the ADL score was associated with lower overall survival rate among treated (HR, 1.14; 95% CI, 1.02 to 1.27) and untreated (HR, 1.20; 95% CI, 1.15 to 1.26) patients.

CONCLUSION

ADL assessment stratified mortality outcomes among older nursing home adults with NSCLC, and may be a useful clinical consideration in this population.

The Effectiveness and Safety of Medical Cannabis for Treating Cancer Related Symptoms in Oncology Patients

The use of medical cannabis (MC) to treat cancer-related symptoms is rising. However, there is a lack of long-term trials to assess the benefits and safety of MC treatment in this population. In this work, we followed up prospectively and longitudinally on the effectiveness and safety of MC treatment. Oncology patients reported on multiple symptoms before and after MC treatment initiation at one-, three-, and 6-month follow-ups. Oncologists reported on the patients' disease characteristics. Intention-to-treat models were used to assess changes in outcomes from baseline. MC treatment was initiated by 324 patients and 212, 158 and 126 reported at follow-ups. Most outcome measures improved significantly during MC treatment for most patients (p < 0.005). Specifically, at 6 months, total cancer symptoms burden declined from baseline by a median of 18%, from 122 (82-157) at baseline to 89 (45-138) at endpoint (-18.98; 95%CI= -26.95 to -11.00; p < 0.001). Reported adverse effects were common but mostly non-serious and remained stable during MC treatment. The results of this study suggest that MC treatment is generally safe for oncology patients and can potentially reduce the burden of associated symptoms with no serious MC-related adverse effects.

Rural-Urban Differences in Common Mental Disorders, Functional Limitation and Social Support among Adults with Cancer: A Population-Based Study in Spain

The psychological, physical and social well-being components may differ for cancer patients living in urban vs. rural zones. This study aimed to examine the common mental disorders (CMDs), functional limitation (FL) and perceived social support (PSS) of rural and urban Spanish cancer patients from 2006 to 2017, to compare sociodemographic variables, health-related determinants and use of healthcare resources and to identify which sociodemographic and health-related factors were related to CMDs, FL and PSS. We performed a cross-sectional study among cancer patients using data from the Spanish National Health Surveys (2006, 2011 and 2017). A total of 698 of the subjects resided in rural areas and 1824 in urban areas. Binary logistic and multiple linear regressions were performed to determine the factors related to CMDs, FL and PSS. Rural residents visited their general practitioners more frequently than the city dwellers (61.03% vs. 56.63%, p = 0.04). A decreased prevalence of CMDs was observed among urban individuals over time (2006: 39.13%, 2011: 38.87%, 2017: 34.30%; p for trend = 0.04). Among rural residents, FL was associated with age, educational level and self-perceived health status, while among city dwellers, PSS was linked to marital status, nationality, having chronic conditions and self-perceived health status.

Functional limitations before and after cancer diagnosis and contributing factors: findings from the China health and retirement longitudinal study

BACKGROUND

Although there is a general trend of functional decline with age, there lacks an understanding of how cancer diagnosis and other factors may contribute to this trend. This study aimed to examine functional limitation trajectories among adults with and without cancer, and before versus after the cancer diagnosis, and to explore potential contributing factors associated with functional trajectories among cancer survivors.

METHODS

The sample were middle-aged and older Chinese adults who participated in all 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Ordinary and multiphase growth curve analyses were conducted to examine (1) differences in functional trajectories between participants with (n = 139) and without cancer (n = 7,313), (2) pre-and post-cancer diagnosis changes in functional limitations among those who reported a cancer diagnosis over the 4-year timeframe, and (3) contributing factors associated with functional trajectories among cancer survivors, guided by the Disablement Process Models, including psychological (depressive symptoms), physical (pain and falls), cognitive (self-reported memory problems), and environmental (social contact and available support) factors.

RESULTS

There was a trend of increased functional limitations among all participants over time (unstandardized β = 0.17, p < .0001). However, participants with cancer did not differ from non-cancer participants in neither the level (unstandardized β = 0.77, p = .08) nor the rate of functional decline (unstandardized β = -0.43, p = .07). Functional limitation trajectories were different pre- versus post-cancer diagnosis, although not in expected directions (unstandardized β = -0.48, p < .05). Cancer survivors with greater pain had higher levels of functional limitations which were sustained over time compared to those with less pain (unstandardized β = 0.93, p < .001).

CONCLUSIONS

The study confirmed that Chinese middle-aged and older adults had overall decreased functional decline over time. A novel finding that cancer survivors experienced less rapidly functional decline after the cancer diagnosis suggested that cancer diagnosis might serve as an inflection point at which early intervention is promising to slow the functional decline. In addition, findings that within-person contributing factors, such as pain, can be influential in functional limitation trajectories suggested that more attention is needed to pay to patients with cancer-pain. These findings demonstrated the heterogeneity of functional limitation trajectories and needs for person-centered interventions among Chinese cancer survivors.

Trajectories of disability in activities of daily living in advanced cancer or respiratory disease: a systematic review

INTRODUCTION

Advanced cancer and/or respiratory disease threaten a person's independence in activities of daily living (ADL). Understanding how disability develops can help direct appropriate and timely interventions.

AIM

To identify different trajectories and associations of disability in ADL and appraise its measurement.

METHODS

Medline, Embase, PsychINFO, and CINAHL databases were searched for cohort studies with measures of disability in ADL in advanced cancer or respiratory disease at three or more timepoints. Data were narratively synthesized to produce a typology of disability trajectories and a model of factors and outcomes associated with increasing disability.

RESULTS

Of 5702 publications screened, 11 were included. Seventy-four disability trajectories were categorized into typologies of unchanging (n = 20), fluctuating (n = 21), and increasing disability (n = 33). Respiratory disease did not predict any particular disability trajectory. Advanced cancer frequently followed trajectories of increasing disability. Factors associated with increasing disability included: frailty, multi-morbidity, cognitive impairment, and infection. Increased disability led to recurrent hospital admissions, long-term care, and/or death. Methodological limitations included use of non-validated measures.

CONCLUSIONS

Increasing disability trajectories in advanced cancer and/or respiratory disease is related to potentially modifiable personal and environmental factors. We recommend future studies using validated disability instruments.Implications for rehabilitationDisability in activities of daily living (ADL) is a common unmet need in advanced cancer or respiratory disease and represents an important outcome for patients, caregivers and health and social care services.Trajectories of ADL disability can be categorized into increasing, fluctuating, and unchanging disability, which could help planning of rehabilitation services in advanced cancer or respiratory disease.Increasing disability in advanced cancer or respiratory disease relates to personal and environmental factors as well as bodily impairments, which can all be modifiable by intervention.This review highlights implications for the measurement of ADL disability in advanced cancer or respiratory disease and recommends use of validated measures of ADL to understand what factors can be modified through rehabilitation interventions.

Falls, walking or balance problems, and limitations in activities of daily living (ADLs) among older endometrial cancer survivors

PURPOSE

Functional status deficits are important quality of life concerns for older cancer survivors. We examined the prevalence of falls, walking/balance problems, and limitations in activities of daily living (ADLs) among older women with a history of endometrial cancer.

METHODS

Cancer registry records from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare Health Outcomes Survey (MHOS) data were used to identify endometrial cancer survivors aged ≥ 65 years who completed a survey ≥ 1 year after their cancer diagnosis (N = 3766), as well as an age- and race-matched group of women without a cancer history (N = 3766). We estimated prevalence ratios (PRs) to compare the prevalence of falls, walking or balance problems, and limitations in ADLs (bathing, dressing, eating, getting in/out of chairs, walking, using the toilet) between groups.

RESULTS

Difficulty with walking or balance was more common among survivors than the noncancer group (43% vs 36%; PR = 1.19; 95% CI: 1.10-1.27). Fall prevalence was similar between groups (endometrial cancer: 25%; noncancer: 26%; PR = 0.98; 95% CI: 0.89-1.08). Nearly half of endometrial cancer survivors (47%) reported at least one ADL limitation, with several activities (getting in/out of a chair, walking, bathing, using the toilet) more often limited among survivors than among women without cancer.

CONCLUSION

Functional impairments, especially problems with walking and/or balance, are common among older endometrial cancer survivors. Our results highlight the importance of addressing functional problems during the ongoing survivorship care of women with a history of endometrial cancer, with referral to rehabilitation or other relevant services when indicated.

Impact of Early Supportive Care Assessment on treatment decision in head and neck cancer before concomitant chemoradiotherapy

OBJECTIVE

To assess the impact of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC) and early supportive care interventions on oncological treatment choice in patients with chemoradiation (CRT) indication for head and neck cancer (HNC).

METHODS

In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain.

RESULTS

OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR = 2.18 95%IC[1.02-4.63] p = 0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p = 0.0836).

CONCLUSION

We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favours therapeutic adaptation, personalized follow-up and optimization of supportive care.

Work, daily activities and leisure after cancer

Objective

Determine if cancer survivors have lower participation in paid work, more limitations in daily activities or more limitations in leisure compared with those without cancer, stratified by age (working age ≤65 years; retirement age >65 years). Secondary objectives are identifying sociodemographic or clinical factors associated with work, daily activities or leisure and analysis of the relationship between work, daily activities and leisure.

Methods

Secondary analyses, using logistic regression, were performed on three cohorts (lymphoma, prostate and thyroid cancer) from the Dutch Patient Reported Outcomes Following Initial treatment and Long‐term Evaluation of Survivorship (PROFILES) registry and a nationally representative non‐cancer sample.

Results

Working‐age cancer survivors (n = 926) were significantly (p < 0.001) less likely to participate in paid work and more likely to report limitations in daily activities and leisure compared to the non‐cancer cohort (n = 1279). Among retirement aged cancer survivors (n = 1046), paid work was significantly more likely (p < 0.001), as were limitations in leisure (p < 0.05), compared with the non‐cancer controls (n = 334).

Conclusions

Cancer impacts daily activities and leisure, as well as paid work. These roles are important for cancer survivors' quality of life, suggesting support to return to these activities may be an important component of survivorship care.

Association of dietary risks, behavioural and lifestyle factors, and the magnitude of disability burden among Australian cancer patients: An observational epidemiology study

BACKGROUND

Cancer patients are confronted with a variety of other health-related issues, including physical disability, poor quality of life, and psychological challenges. This study aims to quantify the association of dietary, behavioural and lifestyle risk factors and comorbidities on the magnitude and distribution of disability burden among cancer patients in Australia.

METHODS

This study comprised a sample of 2283 cancer patients drawn from the latest nationwide Australian National Health Survey conducted in 2017-18. Negative binomial regression models were used to estimate the incidence rate ratio (IRR) of the number of disabilities and its associations.

RESULTS

Forty-five percent of cancer patients experienced at least one disability. The magnitude of disability was significantly associated with sugar-sweetened drink consumption ≥ 3 days per week (IRR= 1.12, 95% CI: 1.02-1.26), a lack of physical activity (IRR = 1.69, 1.38-2.07), frequent or regular alcohol consumption (IRR = 1.95, 1.84-2.08), poor health status (IRR = 1.99, 1.78-2.24) and the presence of five or more chronic comorbid conditions (IRR = 3.59, 2.90-4.46). Cancer patients who consumed vegetables at least two or more times per day had a 10% lower risk of disability burden (IRR = 0.90, 0.82-0.99).

CONCLUSIONS

This study shows the association of diet, behavioural, and lifestyle risk factors on the degree of disability burden among cancer patients, highlighting the need for bold and effective policies. The findings will inform the implementation of evidence-based lifestyle interventions and offer a foundation for evaluating their influence on cancer survivors' health.

Quality of life and return to work and sports after spinal ependymoma resection

Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.

Functional Decline in the Cancer Patient: A Review

A decline in functional status, an individual's ability to perform the normal activities required to maintain adequate health and meet basic needs, is part of normal ageing. Functional decline, however, appears to be accelerated in older patients with cancer. Such decline can occur as a result of a cancer itself, cancer treatment-related factors, or a combination of the two. The accelerated decline in function seen in older patients with cancer can be slowed, or even partly mitigated through routine assessments of functional status and timely interventions where appropriate. This is particularly important given the link between functional decline and impaired quality of life, increased mortality, comorbidity burden, and carer dependency. However, a routine assessment of and the use of interventions for functional decline do not typically feature in the long-term care of cancer survivors. This review outlines the link between cancer and subsequent functional decline, as well as potential underlying mechanisms, the tools that can be used to assess functional status, and strategies for its prevention and management in older patients with cancer.

Association of Lower Extremity Lymphedema With Physical Functioning and Activities of Daily Living Among Older Survivors of Colorectal, Endometrial, and Ovarian Cancer

Importance

Lower extremity lymphedema (LEL) is associated with decreased physical functioning (PF) and activities of daily living (ADLs) limitations. However, the prevalence of LEL in older survivors of cancer is unknown.

Objectives

To examine LEL among older female survivors of colorectal, endometrial, or ovarian cancer and investigate the association of LEL with PF and ADLs.

Design, Setting, and Participants

This secondary analysis of the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study was conducted using data from postmenopausal women enrolled at 40 US centers. Participants were women who had a prior diagnosis of endometrial, colorectal, or ovarian cancer and who had completed the WHI LILAC baseline and year 1 follow-up questionnaires as of September 2017.

Exposures

The 13-item Lower Extremity Lymphedema Screening Questionnaire in Women was used to determine LEL (ie, score ≥5).

Main Outcomes and Measures

Validated surveys were used to assess PF and ADLs.

Results

Among 900 older women diagnosed with endometrial, colorectal, or ovarian cancer, the mean (SD) age was 78.5 (5.9) years and the mean (range) time since cancer diagnosis was 8.75 (1.42-20.23) years. Overall, 292 women (32.4%) reported LEL, with the highest LEL prevalence among survivors of ovarian cancer (38 of 104 women [36.5%]), followed by survivors of endometrial cancer (122 of 375 women [32.5%]) and colorectal cancer (132 of 421 women [31.4%]). Compared with women without LEL, women with LEL had a PF score that was lower by a mean (SE) 16.8 (1.7) points (P < .001) and higher odds of needing help with ADLs (odds ratio [OR], 2.45; 95% CI, 1.64-3.67). In the association of LEL with PF, the mean (SE) decrease in PF score was greatest among survivors of colorectal cancer (-21.8 [2.6]) compared with survivors of endometrial cancer (-13.3 [2.7]) and ovarian cancer (-12.8 [5.2]). Additionally, among survivors of colorectal cancer, LEL was associated with increased odds of needing help with ADLs (OR, 3.59; 95% CI, 1.94-6.66), while there was no such association among survivors of endometrial cancer or ovarian cancer. However, there were no interaction associations between LEL and cancer type for either outcome. Additionally, the overall mean (SE) difference in PF between women with and without LEL was greater among those aged 80 years and older (-19.4 [2.6] points) vs those aged 65 to 79 years (-14.9 [2.2] points). However, among survivors of colorectal cancer, the mean (SE) difference in PF score was greater among women aged 65 to 79 years (-22.9 [3.7] points) vs those aged 80 years or older (-20.8 [3.7] points) (P for 3-way interaction = .03).

Conclusions and Relevance

This study found that nearly one-third of older female survivors of colorectal, endometrial, or ovarian cancer experienced LEL and that LEL was associated with decreased PF and increased odds of needing help with ADLs. These findings suggest that clinicians may need to regularly assess LEL among older survivors of cancer and provide effective interventions to reduce LEL symptoms and improve PF for this population.

Prevalence of cognitive impairment following chemotherapy treatment for breast cancer: a systematic review and meta-analysis

Breast cancer survival rates have markedly improved. Consequently, survivorship issues have received increased attention. One common sequel of treatment is chemotherapy-induced cognitive impairment (CICI). CICI causes a range of impairments that can have a significant negative impact on quality of life. Knowledge of the prevalence of this condition is required to inform survivorship plans, and ensure adequate resource allocation and support is available for sufferers, hence a systematic review of prevalence data was performed. Medline, Scopus, CINAHL and PSYCHInfo were searched for eligible studies which included prevalence data on CICI, as ascertained though the use of self-report, or neuropsychological tests. Methodological quality of included studies was assessed. Findings were synthesised narratively, with meta-analyses being used to calculate pooled prevalence when impairment was assessed by neuropsychological tests. The review included 52 studies. Time-points considered ranged from the chemotherapy treatment period to greater than 10 years after treatment cessation. Summary prevalence figures (across time-points) using self-report, short cognitive screening tools and neuropsychological test batteries were 44%, 16% and 21-34% respectively (very low GRADE evidence). Synthesised findings demonstrate that 1 in 3 breast cancer survivors may have clinically significant cognitive impairment. Prevalence is higher when self-report based on patient experience is considered. This review highlights a number of study design issues that may have contributed to the low certainty rating of the evidence. Future studies should take a more consistent approach to the criteria used to assess impairment. Larger studies are urgently needed.

Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge

Objectives:

The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.

Methods:

A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.

Results:

Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.

Conclusions:

To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

Fatores associados à incapacidade funcional em idosos com câncer atendidos em ambulatórios de referência no estado de Mato Grosso, Brasil

RESUMO: Objetivo: Analisar os fatores associados à incapacidade funcional em idosos com câncer atendidos em ambulatórios de referência do estado de Mato Grosso, Brasil. Métodos: Estudo transversal, com 463 idosos de 60 anos ou mais. A variável desfecho foi a incapacidade funcional, avaliada por meio da Escala de Atividades Instrumentais de Vida Diária (AIVD) desenvolvida por Lawton e Brody. As variáveis independentes foram características sociodemográficas, estilo de vida, apoio social e condições de saúde. Foram realizadas análises bivariada e múltipla, calculando-se as razões de prevalência (RP), com o uso de regressão de Poisson com variância robusta. Resultados: A prevalência de incapacidade funcional para as AIVD foi de 55,3%. As variáveis que se associaram a essa incapacidade na análise múltipla foram: não trabalhar (RP=1,36, intervalo de confiança — IC95% 1,03–1,78); percepção de apoio afetivo baixo (RP=1,49; IC95% 1,10–2,03) e médio (RP=1,30; IC95% 1,04–1,64); sintomas depressivos (RP=1,31; IC95% 1,10–1,56); desnutrição (RP=1,28; IC95% 1,03–1,59); ter duas ou mais comorbidades (RP=1,30; IC95% 1,03–1,64) e ter acompanhante aos serviços de saúde (RP=1,39; IC95% 1,05–1,83). Conclusão: Além das condições de saúde física, comorbidade e desnutrição, as questões emocionais, de apoio social e trabalho associaram-se à incapacidade funcional, reforçando a importância de uma atenção integral e de ações de manutenção e recuperação da capacidade funcional, promovendo maior qualidade de vida, a independência do idoso com câncer e a redução do risco de desfechos adversos em âmbito biopsicossocial.