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Williams GR, Dunham L, Chang Y, Deal AM, Pergolotti M, Lund JL, Guerard E, Kenzik K, Muss HB, Sanoff HK. Geriatric Assessment Predicts Hospitalization Frequency and Long-Term Care Use in Older Adult Cancer Survivors. J Oncol Pract 2019; 15:e399-e409. [PMID: 30870086 PMCID: PMC7846045 DOI: 10.1200/jop.18.00368] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The association between geriatric assessment (GA)-identified impairments and long-term health care use in older cancer survivors remains unknown. Our objective was to evaluate whether a GA performed at cancer diagnosis was predictive of hospitalizations and long-term care (LTC) use in older adult cancer survivors. METHODS Older adults with GA performed between 3 months before through 6 months after diagnosis were included (N = 125). Patients with Medicare Parts A and B coverage and no managed care were identified. Hospitalizations and LTC use (skilled nursing or assisted living) were assessed up to 5 years postdiagnosis. GA risk measures were evaluated in separate Poisson models estimating the relative risk (RR) for hospital and LTC visits, adjusting for age and Charlson comorbidity score. RESULTS The mean age of patients was 74 years, and the majority were female (80%) and white (90%). Breast cancer (64%) and early-stage disease (stages 0 to III, 77%) were common. Prefrail/frail status (RR, 2.5; P < .001), instrumental activities of daily living impairment (RR, 5.47; P < .001), and limitations in climbing stairs (RR, 2.94; P < .001) were associated with increased hospitalizations. Prefrail/frail status (RR, 1.86; P < .007), instrumental activities of daily living impairment (RR, 4.58; P < .001), presence of falls (RR, 6.73; P < .001), prolonged Timed Up and Go (RR, 5.45; P < .001), and limitations in climbing stairs (RR, 1.89; P < .005) were associated with LTC use. CONCLUSION GA-identified impairments were associated with increased hospitalizations and LTC use among older adults with cancer. GA-focused interventions should be targeted toward high-risk patients to reduce long-term adverse health care use in this vulnerable population.
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Affiliation(s)
- Grant R. Williams
- University of Alabama at Birmingham, Birmingham, AL,Grant R. Williams, MD, University of Alabama at Birmingham, 1600 7th Ave South, Lowder 500, Birmingham, AL 35233; e-mail:
| | - Lisette Dunham
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - YunKyung Chang
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | - Kelly Kenzik
- University of Alabama at Birmingham, Birmingham, AL
| | - Hyman B. Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Keesing S, Rosenwax L, McNamara B. The implications of women's activity limitations and role disruptions during breast cancer survivorship. ACTA ACUST UNITED AC 2019; 14:1745505718756381. [PMID: 29409399 PMCID: PMC5808959 DOI: 10.1177/1745505718756381] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles. This study aimed to explore the challenges of women and their partners as they attempted to resume activities and roles, identify unmet needs and make recommendations regarding a suitable framework to support women and partners to recommence valued activities and important roles during early survivorship. Qualitative methods utilising in-depth interviews of women (n = 18) and their partners (n = 8), and two focus groups (n = 10) were completed in Perth, Western Australia, between June 2014 and April 2015. These methods were used to facilitate women and partners' views regarding the resumption of previously meaningful activities and important life roles during early survivorship. Questions addressed their individual and shared experiences concerning self-care, leisure, social and productive activities and important roles. Thematic analysis was employed to determine themes. Women and partners reported significant impact on their ability to engage in valued activities, resulting in changes to participation in meaningful roles. Three themes were determined: (1) ambiguity regarding survivorship prevents resumption of activities and previous roles, (2) breast cancer continues to impact a couples' relationship during survivorship, and (3) support is needed to assist women and partners to resume activities and important roles. This research provides evidence suggesting that the ongoing symptoms of breast cancer treatment continue to impact many women and their partners, as they attempt to resume functional activities and important life roles during early survivorship. Disruption to these valued activities and roles may influence women and their partner's health and well-being during early survivorship and extend beyond this period. Rehabilitation following cessation of treatment could be offered as required to facilitate access to multi-disciplinary services and supports for both individuals and couples.
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Affiliation(s)
- Sharon Keesing
- 1 School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
| | - Lorna Rosenwax
- 2 Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Sagari A, Ikio Y, Imamura N, Deguchi K, Sakai T, Tabira T, Higashi T. Effect of occupation-based interventions in patients with haematopoietic malignancies undergoing chemotherapy: A pilot randomised controlled trial. Hong Kong J Occup Ther 2018; 31:97-105. [PMID: 30643497 PMCID: PMC6322108 DOI: 10.1177/1569186118818680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 11/20/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVE Chemotherapy for cancer negatively affects activities of daily living and quality of life. This study aimed to validate and compare the efficacy of two different interventions in patients with haematopoietic malignancies undergoing chemotherapy: (1) occupation-based interventions, designed using the Aid for Decision-making in Occupation Choice (ADOC) (an iPAD application) and (2) impairment-based interventions. ADOC helps promote decision-making during activities and participation in occupation-based goal setting. The impairment-based intervention group served as the comparison group and underwent impairment-based interventions focusing on dysfunction. METHODS In this single-blinded pilot randomised controlled trial, 19 participants received an occupation-based intervention (n = 9) or an impairment-based intervention (n = 10). The treatment period comprised two sessions. Recruitment, compliance and outcome completion rates were calculated for the study. Effect sizes were examined for outcomes regarding physical performance, instrumental activities of daily living and quality of life as evaluated by a blinded assessor. RESULTS In this study, 24.8% (28/113) of the eligible patients with haematopoietic malignancies were enrolled, and 67.9% (19/28) of these were retained up to the post-assessment stage. Recruitment (25%) and compliance (68%) rates were satisfactory. The Functional Assessment of Cancer Therapy-General emotional well-being and total scores were significantly higher for the occupation-based intervention group than for the impairment-based intervention group (both p < 0.05; d = 0.54, d = 0.51, respectively). Other outcomes showed no significant differences. CONCLUSION Occupation-based interventions designed using the ADOC application were useful for patients with haematopoietic malignancies.
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Affiliation(s)
| | - Yuta Ikio
- The Japanese Red Cross Society Nagasaki Genbaku Hospital, Japan
| | | | - Kayoko Deguchi
- The Japanese Red Cross Society Nagasaki Genbaku Hospital, Japan
| | - Toko Sakai
- The Japanese Red Cross Society Nagasaki Genbaku Hospital, Japan
| | | | - Toshio Higashi
- Nagasaki University Graduate School of Biomedical Sciences, Japan
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Capozzi LC, Dolgoy ND, McNeely ML. Physical Rehabilitation and Occupational Therapy. Oral Maxillofac Surg Clin North Am 2018; 30:471-486. [DOI: 10.1016/j.coms.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Moving beyond symptom management towards cancer rehabilitation for older adults: Answering the 5W's. J Geriatr Oncol 2018; 9:543-549. [DOI: 10.1016/j.jgo.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
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Deschler B, Ihorst G, Hüll M, Baier P. Regeneration of older patients after oncologic surgery. A temporal trajectory of geriatric assessment and quality of life parameters. J Geriatr Oncol 2018; 10:112-119. [PMID: 30314954 DOI: 10.1016/j.jgo.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/08/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
AIMS The effectiveness of surgery depends on it being carried out safely, which allows patients to return to independent lives. Because gastrointestinal cancers are a major cause of morbidity and mortality in older people, we examined the dynamics of recuperation after elective, curative surgery. As disease parameters alone may not suffice to address geriatric patients' issues after onco-surgical interventions, Comprehensive Geriatric and QOL Assessments (CGA/QOL) were performed at four time points to gain information on clinical, functional, and cognitive aspects. METHODS CGA/QOL including standard geriatric instruments, socio-demographic, clinical data, and the EORTCQLQ-C30 questionnaire were applied pre-operatively (T1), at discharge (T2), after three (T3), and after six months (T4). RESULTS 200 patients gave their informed consent, 70 patients declined. At T1 n = 195, at T2 n = 155, at T3 n = 130, and at T4 n = 124 patients were actually assessed. Patients experienced a significant decline in most functional capabilities and increased symptoms at T2. While most parameters re-approached baseline results by T4, sophisticated abilities (instrumental ADL, IADL) remained impaired. Fatigue was the most prominent symptom that persisted in many at T4. Risk for malnutrition as well as BMI significantly decreased during regeneration. Global QOL correlated with parameters of independence (ADL, IADL) and low symptom burden. Role and social functions' correlation with global QOL increased from T1 to T4. CONCLUSIONS Longitudinal assessments before and after oncologic surgery highlight changes even after six months in QOL and independence that may be ameliorated by focused supportive care. Trial registry number: DRKS: 00000425.
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Affiliation(s)
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | - Michael Hüll
- Clinic for Geriatric Psychiatry, Emmendingen, Germany
| | - Peter Baier
- University of Freiburg Surgical Department, Freiburg, Germany; Caritas Krankenhaus Bad Mergentheim, Germany
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Hammill K, Stewart CG, Kosic N, Bellamy L, Irvine H, Hutley D, Arblaster K. Exploring the impact of brain cancer on people and their participation. Br J Occup Ther 2018. [DOI: 10.1177/0308022618800186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Brain cancer diagnoses are rising, and the prognosis is commonly life-limiting. Brain cancer symptoms and the side effects of treatment are imposing and harmful. Little is known about the effect of these symptoms and treatments on occupational participation or about the role that occupational therapy can play for people with brain cancer. Methods Sixteen participants with brain cancer were purposively recruited from a single site. Data was collected using semi-structured interviews. Interviews were analysed thematically. Results Three overarching themes were identified: (a) ‘there’s a lot of things that I can’t do anymore’: adverse effects of tumour and treatments; (b) ‘you adjust with adversity’: accepting altered occupational participation levels; (c) occupational therapy: ‘why is she here?’ Conclusions Findings highlight a connection between brain cancer symptoms, treatment side effects and occupational participation. A disconnect was found between occupational therapy services and occupational needs. Further research could explore whether realigning occupational therapy services to address the concerns identified in this study leads to enhanced occupational participation through the journey of brain cancer.
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Affiliation(s)
- Kathrine Hammill
- Lecturer in Occupational Therapy, School of Science & Health, Western Sydney University, Australia
| | - Catherine G Stewart
- Occupational Therapist, School of Science & Health, Western Sydney University, Australia
| | - Natasha Kosic
- Occupational Therapist, School of Science & Health, Western Sydney University, Australia
| | - Lauren Bellamy
- Occupational Therapist, School of Science & Health, Western Sydney University, Australia
| | - Hannah Irvine
- Occupational Therapist, School of Science & Health, Western Sydney University, Australia
| | - Dawn Hutley
- Senior Occupational Therapist, Nepean Blue Mountains Local Health District, Australia
| | - Karen Arblaster
- Lecturer in Occupational Therapy, Western Sydney University, School of Science & Health, Australia
- Manager of Mental Health, Allied Health, Wellbeing, Children and Families, Nepean Blue Mountains Local Health District, Australia
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Sposito AMP, Nascimento LC, Garcia-Schinzari NR, Mitre RMDA, Pfeifer LI, Lima RAGD. O melhor da hospitalização: contribuições do brincar para o enfrentamento da quimioterapia. AVANCES EN ENFERMERÍA 2018. [DOI: 10.15446/av.enferm.v36n3.61319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: la quimioterapia es una terapia bastante utilizada en el tratamiento del cáncer infantil y, aunque eficaz, provoca efectos colaterales y exige una reestructuración de lo cotidiano. El objetivo del estudio es comprender el juego como estrategia para enfrentar el tratamiento de laquimioterapia en niños.Método: estudio exploratorio con análisis cualitativo de datos. Participaron diez niños entre siete y doce añoscon cáncer, en tratamiento quimioterapéutico y hospitalizados. Fueron llevadas a cabo entrevistas semiestructuradas utilizando títeres como recurso facilitador de la comunicación. En el análisis de los datos, del tipo temática inductiva, se destacó la importancia del juego como facilitador del enfrentamiento a la quimioterapia.Resultados: los niños se refirieron a la relevancia del juego para combatir el ocio y destacaron la importancia de un espacio lúdico, adaptado a las necesidades del tratamiento dentro del ambiente hospitalario. La actuación del terapeuta ocupacional y de voluntarios caracterizados como clowns (payasos) fue citada como diferencial en este contexto.Consideraciones Finales: se destaca la importanciade inversión, por parte de la administración de los hospitales, en espacios y materiales lúdicos y en la contratación de personal cualificado para facilitar el juego en los niñoshospitalizados.
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Shahrokni A, Alexander K, Wildes TM, Puts MTE. Preventing Treatment-Related Functional Decline: Strategies to Maximize Resilience. Am Soc Clin Oncol Educ Book 2018; 38:415-431. [PMID: 30231361 DOI: 10.1200/edbk_200427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.
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Affiliation(s)
- Armin Shahrokni
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Koshy Alexander
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tanya M Wildes
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Martine T E Puts
- From the Memorial Sloan Kettering Cancer Center, New York, NY; Washington University School of Medicine, St. Louis MO; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Effect of Community-Based Occupational Therapy on Health-Related Quality of Life and Engagement in Meaningful Activities of Women with Breast Cancer. Occup Ther Int 2018; 2018:6798697. [PMID: 29849515 PMCID: PMC5932445 DOI: 10.1155/2018/6798697] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/19/2018] [Accepted: 02/27/2018] [Indexed: 01/07/2023] Open
Abstract
We aimed to evaluate the short-term effects of community-based occupational therapy on health-related quality of life and engagement in meaningful activities among women with breast cancer. An open label randomized controlled trial study design was applied. The participants were members of various societies of women with cancer. In total, 22 women have participated in the study. Participants of the experimental group (n = 11) participated in a 6-week community-based occupational therapy program and the usual activities of various societies, whereas the control group (n = 11) women participated in the usual activities of the societies only. 1 of the participants withdrew during the course; therefore 21 completed the study successfully. Participants of both groups were assessed for health-related quality of life and the participants of the experimental group were assessed for engagement in meaningful activities. The evaluation was carried out during the nonacute period of the disease-at the beginning of the study and after 6 weeks. Women of the experimental group demonstrated statistically significantly better scores in the global quality of life, role functions, physical, emotional, cognitive, and social functions, fatigue, insomnia, financial impact, systemic therapy side effects, and breast symptoms scales compared to the control group participants (p < 0.05) after the 6 weeks, as measured by the EORTC QLQ-C30 questionnaire and its breast cancer module QLQ-BR23. Furthermore, women of the experimental group demonstrated significant greater engagement in meaningful activities when applying community-based occupational therapy (p < 0.05), as measured by using the Engagement in Meaningful Activities Survey (EMAS). The evaluation of the associations between the women's engagement in meaningful activities and changes in health-related quality of life showed that greater engagement in meaningful activities was associated with better emotional functions and a lower level of insomnia (p < 0.05). Based on the results of our study, we recommend applying occupational therapy in the field of community healthcare in order to maintain or improve breast cancer patients' health-related quality of life and suggest involving women into meaningful activities during community-based occupational therapy after clarifying which activities are important to them.
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Keesing S, Rosenwax L, McNamara B. Identifying the contribution of occupational therapy in meeting the needs of women survivors of breast cancer. Br J Occup Ther 2018. [DOI: 10.1177/0308022618762080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Little is known about how occupational therapy could assist women survivors of breast cancer and their partners who experience activity and role limitations during survivorship. This study sought to obtain views and consensus among occupational therapists regarding their potential role and the barriers and enablers to this potential service. Method We used a three-round classical Delphi process to determine the views of occupational therapists ( n = 40), and sought consensus (70%) for 49 statements concerning barriers and enablers affecting occupational therapy service provision during survivorship. Thematic analysis was used to determine themes and descriptive statistics to determine consensus level and median for statements. Findings Forty-six statements showed consensus. Themes identified were: (a) women and partners experience unmet needs; (b) gaps exist regarding supportive care; (c) access to comprehensive survivorship support is required; (d) barriers to occupational therapy exist; and (e) occupational therapists offer many supports to improve activity and role engagement for women and partners. Conclusion Occupational therapy is well-positioned to affect improvements in occupational engagement and role participation for women survivors of breast cancer and their partners. However, many barriers are identified. Occupational therapists must advocate the value of occupational therapy during survivorship to facilitate women’s engagement in meaningful activities and roles.
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Affiliation(s)
- Sharon Keesing
- Lecturer, School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
| | - Lorna Rosenwax
- Professor and Deputy Pro Vice-Chancellor, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Beverley McNamara
- Adjunct Professor, Faculty of Health Sciences, Curtin University, Perth, Australia
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Rijpkema C, Van Hartingsveldt M, Stuiver MM. Occupational therapy in cancer rehabilitation: going beyond physical function in enabling activity and participation. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1438844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Corine Rijpkema
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margo Van Hartingsveldt
- Faculty of Health, ACHIEVE Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Martijn M. Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Faculty of Health, ACHIEVE Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Hornbrook MC, Cobb MD, Tallman NJ, Colwell J, McCorkle R, Ercolano E, Grant M, Sun V, Wendel CS, Hibbard JH, Krouse RS. Costs of an ostomy self-management training program for cancer survivors. Psychooncology 2017; 27:879-885. [PMID: 29139176 DOI: 10.1002/pon.4584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/18/2017] [Accepted: 10/27/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To measure incremental expenses to an oncologic surgical practice for delivering a community-based, ostomy nurse-led, small-group, behavior skills-training intervention to help bladder and colorectal cancer survivors understand and adjust to their ostomies and improve their health-related quality of life, as well as assist family caregivers to understand survivors' needs and provide appropriate supportive care. METHODS The intervention was a 5-session group behavior skills training in ostomy self-management following the principles of the Chronic Care Model. Faculty included Wound, Ostomy, and Continence Nurses (WOCNs) using an ostomy care curriculum. A gender-matched peer-in-time buddy was assigned to each ostomy survivor. The 4-session survivor curriculum included the following: self-management practice and solving immediate ostomy concerns; social well-being; healthy lifestyle; and a booster session. The single family caregiver session was coled by a WOCN and an ostomy peer staff member and covered relevant caregiver and ostomate support issues. Each cohort required 8 weeks to complete the intervention. Nonlabor inputs included ostomy supplies, teaching materials, automobile mileage for WOCNs, mailing, and meeting space rental. Intervention personnel were employed by the University of Arizona. Labor expenses included salaries and fringe benefits. RESULTS The total incremental expense per intervention cohort of 4 survivors was $7246 or $1812 per patient. CONCLUSIONS A WOCN-led group self-help ostomy survivorship intervention provided affordable, effective, care to cancer survivors with ostomies.
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Affiliation(s)
| | - Martha D Cobb
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Nancy J Tallman
- Wound Ostomy Continence Nurse, Private Practice, Tucson, AZ, USA
| | - Janice Colwell
- School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, USA
| | | | - Marcia Grant
- City of Hope National Medical Center/Beckman Research Institute, Duarte, CA, USA
| | - Virginia Sun
- City of Hope National Medical Center/Beckman Research Institute, Duarte, CA, USA
| | - Christopher S Wendel
- College of Medicine, University of Arizona, Tucson, AZ, USA.,Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA
| | - Judith H Hibbard
- Health Policy Research Group, University of Oregon, Eugene, OR, USA
| | - Robert S Krouse
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,CMC Veterans Affairs Medical Center, Philadelphia, PA, USA
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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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Farley E, McCarthy L, Pergolotti M. Rehabilitation Strategies in Older Adult Oncology Patients: a Focus on Occupational and Physical Therapy. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0228-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nipp RD, Fuchs G, El-Jawahri A, Mario J, Troschel FM, Greer JA, Gallagher ER, Jackson VA, Kambadakone A, Hong TS, Temel JS, Fintelmann FJ. Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer. Oncologist 2017; 23:97-104. [PMID: 28935775 PMCID: PMC5759817 DOI: 10.1634/theoncologist.2017-0255] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/22/2017] [Indexed: 12/25/2022] Open
Abstract
Cancer cachexia and sarcopenia can occur frequently in patients with advanced cancer, and may negatively affect treatment outcomes. This article highlights the importance of assessing sarcopenia and describes the relationship between sarcopenia and patients' quality of life in patients with newly diagnosed, incurable cancer. Background. Patients with advanced cancer often experience muscle wasting (sarcopenia), yet little is known about the characteristics associated with sarcopenia and the relationship between sarcopenia and patients’ quality of life (QOL) and mood. Materials and Methods. As part of a randomized trial, we assessed baseline QOL (Functional Assessment of Cancer Therapy‐General [FACT‐G]) and mood (Hospital Anxiety and Depression Scale [HADS]) in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer, and prior to randomization. Using computed tomography scans collected as part of routine clinical care, we assessed sarcopenia at the level of the third lumbar vertebra with validated sex‐specific cutoffs. We used logistic regression to explore characteristics associated with presence of sarcopenia. To examine associations between sarcopenia, QOL and mood, we used linear regression, adjusted for patients’ age, sex, marital status, education, and cancer type. Results. Of 237 participants (mean age = 64.41 ± 10.93 years), the majority were male (54.0%) and married (70.5%) and had lung cancer (56.5%). Over half had sarcopenia (55.3%). Older age (odds ratio [OR] = 1.05, p = .002) and education beyond high school (OR = 1.95, p = .047) were associated with greater likelihood of having sarcopenia, while female sex (OR = 0.25, p < .001) and higher body mass index (OR = 0.79, p < .001) correlated with lower likelihood of sarcopenia. Sarcopenia was associated with worse QOL (FACT‐G: B = −4.26, p = .048) and greater depression symptoms (HADS‐depression: B = −1.56, p = .005). Conclusion. Sarcopenia was highly prevalent among patients with newly diagnosed, incurable cancer. The associations of sarcopenia with worse QOL and depression symptoms highlight the need to address the issue of sarcopenia early in the course of illness. Implications for Practice. This study found that sarcopenia, assessed using computed tomography scans acquired as part of routine clinical care, is highly prevalent in patients with newly diagnosed, incurable cancer. Notably, patients with sarcopenia reported worse quality of life and greater depression symptoms than those without sarcopenia. These findings highlight the importance of addressing muscle loss early in the course of illness among patients with incurable cancer. In the future, investigators should expand upon these findings to develop strategies for assessing and treating sarcopenia while striving to enhance the quality of life and mood outcomes of patients with advanced cancer.
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Affiliation(s)
- Ryan D Nipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Georg Fuchs
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Mario
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Fabian M Troschel
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Department of Medicine, Division of Palliative Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
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Ulfers SS, Berg C. Occupational Therapists With Oncology Exposure: Perceived Needs on Adults and Older Adults With Cancer-Related Cognitive Impairments. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017. [PMID: 28621217 DOI: 10.1177/1539449217698105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related cognitive impairments (CRCI) can limit participation in meaningful activities before, during, and after cancer treatment. This study explored occupational therapists' perceived knowledge gaps and needs regarding CRCI in adults and older adults. An online survey was sent to a convenience sample of 60 practitioners at facilities throughout the continuum of care and 176 directors and faculty in accredited occupational therapy programs. Using a snowball sampling approach, recipients were asked to forward the survey to other occupational therapists. One hundred seven occupational therapists participated. The majority (92%) responded that it would be beneficial to attend a face-to-face continuing education program; preferences for the content and design of a continuing competency seminar are described. These findings support the development and delivery of continuing competence programs tailored toward occupational therapists' CRCI knowledge needs.
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Buckland N, Mackenzie L. Exploring the role of occupational therapy in caring for cancer survivors in Australia: A cross sectional study. Aust Occup Ther J 2017; 64:358-368. [DOI: 10.1111/1440-1630.12386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Lynette Mackenzie
- Discipline of Occupational Therapy; University of Sydney; Lidcombe New South Wales Australia
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Smith SR, Zheng JY. The Intersection of Oncology Prognosis and Cancer Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017; 5:46-54. [PMID: 28458958 PMCID: PMC5387014 DOI: 10.1007/s40141-017-0150-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review examines the delivery of rehabilitation care to cancer patients with relation to disease prognosis. This includes the evaluation when patients are referred for rehabilitation services and the effectiveness of rehabilitation interventions across the cancer continuum. RECENT FINDINGS Although prognosticating life expectancy is difficult, referrals for rehabilitation interventions appear to be affected by physician attitudes towards patients with advanced disease, in part because of misconceptions about the nature of rehabilitation for oncology patients. Rehabilitation may also be underutilized in long-term survivors with no evidence of disease. Despite this, our review found that rehabilitation in advanced disease, end-of-life, geriatric cancer patients, and in long-term survivors can be beneficial. There is a relative dearth in studies on rehabilitation interventions specifically at the end-of-life. SUMMARY Cancer rehabilitation can be helpful to patients along the spectrum of cancer prognoses. Examining more accurate ways to prognosticate life expectancy, improving communication and education between oncologists and rehabilitation team members, and modifying survivorship plans to include patient education on functional changes over time may improve the delivery of rehabilitation care.
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Affiliation(s)
- Sean Robinson Smith
- Department of Physical Medicine & Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI 48108 USA
| | - Jasmine Yiqian Zheng
- Department of Physical Medicine & Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI 48108 USA
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Koll T, Pergolotti M, Holmes HM, Pieters HC, van Londen GJ, Marcum ZA, MacKenzie AR, Steer CB. Supportive Care in Older Adults with Cancer: Across the Continuum. Curr Oncol Rep 2016; 18:51. [PMID: 27342609 PMCID: PMC5504916 DOI: 10.1007/s11912-016-0535-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent.
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Affiliation(s)
- Thuy Koll
- Internal Medicine Division of Geriatric Medicine, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, 68198-6155, NE, USA
| | - Mackenzi Pergolotti
- Cancer Outcomes Research Group, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, UTHealth, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin, MSB 5.116, Houston, 77030, TX, USA
| | | | - G J van Londen
- University of Pittsburgh, S. 140 Cooper Pavilion, 5115 Centre Ave., Pittsburgh, 15232, PA, USA
| | - Zachary A Marcum
- University of Washington, 1959 NE Pacific Ave, H375G, Box 357630, Seattle, 98195, WA, USA
| | - Amy R MacKenzie
- Department of Medical Oncology, Division of Regional Cancer Care, Thomas Jefferson University, 925 Chestnut St., 4th floor, Philadelphia, 9107, PA, USA
| | - Christopher B Steer
- Border Medical Oncology, Suite 1, 69 Nordsvan Drive, Wodonga, 3690, VIC, Australia.
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