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Wang A, Gonzaga K. Assistive Devices for Addressing Mobility Impairments Linked to Cancer and Cancer Treatment: An Expert Perspective. Semin Oncol Nurs 2024:151683. [PMID: 38965022 DOI: 10.1016/j.soncn.2024.151683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Cancer survivors often experience mobility impairments that negatively impact their ability to engage in everyday activities. Healthcare providers working with patients in the continuum of cancer care play essential roles in identifying and addressing mobility impairments. The objective of this article is to present common assistive devices valuable in managing cancer and cancer treatment-related mobility impairments. METHODS Peer-reviewed scientific publications and expert opinions. RESULTS This article highlights assistive devices commonly used in various settings of cancer care and describes how they address different impairments faced by cancer survivors. The information presented can potentially serve as a resource when training clinical staff (eg, oncology nursing staff) on device provision across all settings. The information can also be useful for patients and caregivers to learn about potential functional impairments linked to cancer and treatments and assistive devices that can be useful to improve patients' functional capacity and reduce caregiver burden. CONCLUSION It is essential to involve different team members to identify and select the most appropriate assistive devices that match the patient's functional needs and physical capacity and to train them in device use so they can safely carry out their daily routine. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are one of the first providers to identify mobility impairments in cancer patients. This article will help increase their knowledge in common assistive devices valuable for addressing various mobility impairments associated with cancer and treatments. With additional training on device provision, oncology nurses will be more empowered to collaborate with rehabilitation to identify potential mobility impairments, initiate device provision, and encourage their patients to work with therapy services. Ultimately this could reduce injuries linked to mobility impairments and improve the patient's functional independence and overall quality of life.
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Affiliation(s)
- Allison Wang
- Staff Physical Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York.
| | - Kimberley Gonzaga
- Senior Occupational Therapist, Department of Neurology, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York
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2
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Willbanks A, Seals M, Karmali R, Roy I. Harnessing the Systemic Biology of Functional Decline and Cachexia to Inform more Holistic Therapies for Incurable Cancers. Cancers (Basel) 2024; 16:360. [PMID: 38254849 PMCID: PMC10814065 DOI: 10.3390/cancers16020360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Options for treatment of incurable cancer remain scarce and are largely focused on limited therapeutic mechanisms. A new approach specific to advanced cancers is needed to identify new and effective treatments. Morbidity in advanced cancer is driven by functional decline and a number of systemic conditions, including cachexia and fatigue. This review will focus on these clinical concepts, describe our current understanding of their underlying biology, and then propose how future therapeutic strategies, including pharmaceuticals, exercise, and rehabilitation, could target these mechanisms as an alternative route to addressing incurable cancer.
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Affiliation(s)
| | - Mina Seals
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
| | - Reem Karmali
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA
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3
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Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Fhoula B, Hadid M, Elomri A, Kerbache L, Hamad A, Al Thani MHJ, Al-Zoubi RM, Al-Ansari A, Aboumarzouk OM, El Omri A. Home Cancer Care Research: A Bibliometric and Visualization Analysis (1990-2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13116. [PMID: 36293702 PMCID: PMC9603182 DOI: 10.3390/ijerph192013116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Home cancer care research (HCCR) has accelerated, as considerable attention has been placed on reducing cancer-related health costs and enhancing cancer patients' quality of life. Understanding the current status of HCCR can help guide future research and support informed decision-making about new home cancer care (HCC) programs. However, most current studies mainly detail the research status of certain components, while failing to explore the knowledge domain of this research field as a whole, thereby limiting the overall understanding of home cancer care. We carried out bibliometric and visualization analyses of Scopus-indexed papers related to home cancer care published between 1990-2021, and used VOSviewer scientometric software to investigate the status and provide a structural overview of the knowledge domain of HCCR (social, intellectual, and conceptual structures). Our findings demonstrate that over the last three decades, the research on home cancer care has been increasing, with a constantly expanding stream of new papers built on a solid knowledge base and applied to a wide range of research themes.
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Affiliation(s)
- Boutheina Fhoula
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Majed Hadid
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Adel Elomri
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Laoucine Kerbache
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha 2713, Qatar
- Department of Chemistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Seo KS. Recent Trends in Rehabilitation for Cancer Patients. Ann Rehabil Med 2022; 46:111-113. [PMID: 35793899 PMCID: PMC9263325 DOI: 10.5535/arm.22072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kwan-Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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6
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Rehabilitation in Advanced Cancer Patients with Bone Metastases and Neural Compromise: Current Status and Future Directions. Curr Oncol Rep 2022; 24:1023-1033. [PMID: 35362828 DOI: 10.1007/s11912-022-01229-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review aimed to increase the understanding of oncologists and physiatrists about the necessity, efficacy, and safety of rehabilitation in advanced cancer patients with bone metastases and neural compromise. RECENT FINDINGS Recently, there are growing evidence supporting the safety and efficacy of rehabilitation in patients with bone metastases and neural compromise. Despite the potential benefits of rehabilitation, however, rehabilitative services are considerably underutilized in clinical practice. Many oncologists are not familiar with functional issues and have limited understanding of the available rehabilitative services. Moreover, medical professionals, even physiatrists, have uncertainties and concerns about skeletal complications and often regard rehabilitation as a contraindication in this patient group. This review aimed to raise awareness on the role of rehabilitation in the continuum of cancer treatment, to improve its use in clinical practice. A multidisciplinary team approach involving physiatrist may facilitate integration of relevant clinicians.
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7
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Huber MK, Wilson CM, Li NY. Acute Palliative Physical Therapy Services for a Patient With Metastatic Rectal Cancer and Subsequent Spinal Cord Compression. Cureus 2021; 13:e17691. [PMID: 34650865 PMCID: PMC8487640 DOI: 10.7759/cureus.17691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/05/2022] Open
Abstract
Colorectal cancer is the third most common cause of cancer-related deaths with approximately 40%-50% of people diagnosed experiencing subsequent metastases. Surgery is the only curative treatment for colorectal cancer, although chemotherapy and radiation are often used neoadjuvantly or adjuvantly to decrease recurrence rates and improve survival. Many individuals experience adverse effects and physical impairments secondary to extensive medical treatment. Therefore, the purpose of this case is to signify the important role of physical therapy in the continuum of care of a patient diagnosed with metastatic rectal cancer and subsequent spinal cord compression. The patient was a 70-year-old male admitted to the hospital for lower extremity (LE) numbness and weakness secondary to metastatic rectal cancer. Seventeen months prior to hospitalization, he was diagnosed with rectal cancer and underwent neoadjuvant chemotherapy and radiation followed by laparoscopic abdominoperineal resection with posterior prostatectomy en bloc with a colostomy. Adjuvant chemotherapy included FOLFIRI. While hospitalized, the patient experienced spinal cord compression secondary to metastasis and elected decompressive laminectomy with discectomy for palliation. Due to the poor prognosis of metastatic rectal cancer, the patient’s functional mobility and independence declined throughout hospitalization. The patient was able to achieve one of two personal goals; he was able to tolerate sitting in an upright position for his daughter’s wedding but unfortunately did not return home prior to expiration. Although the patient suffered eventual mortality, consistent physical therapy allowed him to achieve a major life goal, serving as an important motivator and improved quality of life (QoL) even in end-of-life conditions. Unfortunately, physical therapy services are often overlooked and under-utilized in patients with terminal conditions receiving palliative care, despite the growing body of literature supporting the benefits. By utilizing rehabilitation in reverse as well as skilled maintenance, physical therapy assists in maintaining mobility and achieving personal goals of individuals with terminal cancer, thus improving QoL even with a poor prognosis.
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Affiliation(s)
| | - Christopher M Wilson
- Rehabilitation Services, Beaumont Health, Troy, USA.,Physical Therapy, Oakland University, Rochester, USA
| | - Nathan Y Li
- Pharmaceutical Sciences, University of Michigan, Ann Arbor, USA
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Fettes L, Bone AE, Etkind SN, Ashford S, Higginson IJ, Maddocks M. Disability in Basic Activities of Daily Living Is Associated With Symptom Burden in Older People With Advanced Cancer or Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis. J Pain Symptom Manage 2021; 61:1205-1214. [PMID: 33096219 DOI: 10.1016/j.jpainsymman.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Managing activities of daily living is important to people with advanced cancer or chronic obstructive pulmonary disease (COPD). Understanding disability in activities of daily living may inform service planning. OBJECTIVE To identify the prevalence of disability in activities of daily living, associations and change over time, in older people with advanced cancer or COPD. METHODS Secondary analysis of International Access, Rights and Empowerment (IARE) studies in adults aged ≥65 years with advanced disease in the United Kingdom, Ireland, and United States, using cross-sectional (IARE I & II) and longitudinal (IARE II, 3 timepoints over 6 months) data. Measures included disability in activities of daily living (Barthel Index), symptom severity (Palliative Outcome Scale), and assistive device use (self-reported). Logistic regression was used to identify relationships between disability and age, sex, living alone, diagnosis, and symptom burden; visual graphical analysis explores individual disability trajectories. RESULTS One hundred fifty-nine participants were included (140 cancer, 19 COPD). Sixty-five percent had difficulty climbing stairs, 48% bathing, 39% dressing, and 36% mobilizing. Increased disability was independently associated with increased symptom burden (odds ratio, 1.08 [95% CI:1.02-1.15], P = 0.01) and walking unaided (z = 2.35, P = 0.02), but not with primary diagnosis (z = -0.47, P = 0.64). Disability generally increased over time but with wide interindividual variation. CONCLUSION Disability in activities of daily living in advanced cancer or COPD is common, associated with increased symptom burden, and may be attenuated by use of assistive devices. Individual disability trajectories vary widely, with diverse disability profiles. Services should include rehabilitative interventions, guided by disability in individual activities of daily living.
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Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK.
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK; Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK; Centre for Nursing Midwifery and Allied health Research and the National Hospital for Neurology and Neurosurgery, University College London Hospitals, Holborn, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
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9
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Gurgel ARB, Mingroni-Netto P, Farah JC, de Brito CMM, Levin AS, Brum PC. Determinants of Health and Physical Activity Levels Among Breast Cancer Survivors During the COVID-19 Pandemic: A Cross-Sectional Study. Front Physiol 2021; 12:624169. [PMID: 33613314 PMCID: PMC7893086 DOI: 10.3389/fphys.2021.624169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background Increased exercise and physical activity levels are recommended throughout cancer therapy and survivorship. Nonetheless, the COVID-19 pandemic and consequent social distancing are likely to cause a decline in physical activity. Objective to evaluate the level of unsupervised physical activity of breast cancer survivors during the COVID-19 pandemic, and the factors associated with difficulties in engaging and maintaining recommended physical activity levels. Methods This is a cross-sectional epidemiological study with a sample of 37 breast cancer survivors. They participated in a canoeing training program (project Remama) at the University of São Paulo before the COVID-19 pandemic. Socioeconomic aspects, engagement in physical activity, motivation, and potential exposure to COVID-19 were investigated through an online survey, administered in September of 2020. Results During the pandemic, participants increased their body weight (5 ± 3.4 kg); 90% reported decreasing physical activity levels associated with increased sedentary time. Twenty-one (58%) participants exhibited some COVID-19-related symptoms, most used public transportation (59%), or returned to work during the period of a high incidence of COVID-19. The only factor associated with perceived difficulty in engaging in physical activities was having had more than three cancer treatments (RR: 2.14; 95% CI: 1.07–4.27). Conclusion The COVID-19 pandemic led to a group of previously active breast cancer survivors to decrease their physical activity, gain weight, and have sedentary behavior. Specific tailored-care interventions are needed to prevent these occurrences, as overweight and physical inactivity may impose an additional risk for breast cancer recurrence and a severe course of COVID-19 in cancer patients.
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Affiliation(s)
| | - Pedro Mingroni-Netto
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Jose Carlos Farah
- Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP), São Paulo, Brazil
| | - Christina May Moran de Brito
- Instituto do Câncer do Estado de São Paulo, ICESP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious Diseases and LIM49, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Chakur Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Kline-Quiroz C, Nori P, Stubblefield MD. Cancer Rehabilitation: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 1. Med Clin North Am 2020; 104:239-250. [PMID: 32035566 DOI: 10.1016/j.mcna.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individuals with cancer commonly experience functional impairments. Symptoms may present immediately or years to decades following their treatment. These impairments may include fatigue, pain, neuropathy, lymphedema, or radiation fibrosis syndrome and have the potential to deleteriously impact their function and quality of life. Cancer rehabilitation is a comprehensive resource that facilitates maximizing and maintaining cancer survivors' physical, social, psychological, and vocational functioning. This article covers the common functional impairments experienced by cancer survivors and the treatment strategies used in cancer rehabilitation. Application of these services can enhance the ongoing care for cancer survivors.
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Affiliation(s)
- Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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12
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Harding Z, Hall C, Lloyd A. Rehabilitation in palliative care: a qualitative study of team professionals. BMJ Support Palliat Care 2019; 12:e28-e38. [PMID: 31888873 DOI: 10.1136/bmjspcare-2019-002008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There has been a recent drive to embed rehabilitation within palliative care. The concept of rehabilitative palliative care has been advocated to help patients preserve function and independence, through greater patient enablement and self-management. Such an approach requires engagement from all members of the palliative care team. There is a lack of understanding of such viewpoints. The objective of this research was to explore hospice-based palliative care professionals' understanding and perceptions of rehabilitation. METHODS Qualitative semi-structured interviews were conducted. Eighteen hospice-based healthcare professionals were recruited from a hospice in central Scotland. Interviews were audio-recorded, transcribed and thematically analysed. RESULTS Overall, participants clearly articulated the underlying values and benefits of rehabilitative palliative care. Emphasis was placed on ensuring that rehabilitation was appropriately tailored to each individual patient. There was more ambiguity regarding the pragmatic implementation of rehabilitative palliative care, with a number of barriers and facilitators identified. CONCLUSIONS The findings suggest that hospice-based palliative care professionals would be receptive to further implementation of rehabilitative palliative care. A lack of conceptual clarity among palliative care professionals may be a barrier to the effective implementation of rehabilitative palliative care. At an organisational level, this would require clarification of the approach, and additional training involving all members of the multidisciplinary team.
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Affiliation(s)
- Zoe Harding
- School of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlie Hall
- School of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Education and Research, St Columba's Hospice, Edinburgh, UK
| | - Anna Lloyd
- Education and Research, St Columba's Hospice, Edinburgh, UK
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Curtin S, Galvin R, Robinson K. The relationship between cancer survivors’ well-being and participation in work, activities of daily living and social engagement: Findings from the European Social Survey (2014). Scand J Occup Ther 2019; 28:531-541. [DOI: 10.1080/11038128.2019.1695932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Sara Curtin
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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14
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Javier NM, Montagnini M. The Role of Palliative Rehabilitation in Serious Illness #364. J Palliat Med 2018. [DOI: 10.1089/jpm.2018.0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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15
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Lee CH, Kim JK, Jun HJ, Lee DJ, Namkoong W, Oh JH. Rehabilitation of Advanced Cancer Patients in Palliative Care Unit. Ann Rehabil Med 2018; 42:166-174. [PMID: 29560337 PMCID: PMC5852220 DOI: 10.5535/arm.2018.42.1.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit. Methods Advanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire. Results Forty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p<0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p<0.05). Conclusion Advanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.
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Affiliation(s)
- Chang Hyun Lee
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Jong Kyu Kim
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Hyun Jung Jun
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Duk-Joo Lee
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Wook Namkoong
- Department of Family Medicine, Seoul Medical Center, Seoul, Korea
| | - Jae Ho Oh
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
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16
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Saotome T, Iwase S, Nojima M, Hewitt B, Chye R. Assessment of activities of daily living and quality of life among palliative care inpatients: A preliminary prospective cohort study. PROGRESS IN PALLIATIVE CARE 2018. [DOI: 10.1080/09699260.2018.1427677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Takako Saotome
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoru Iwase
- Division of Palliative Medicine, Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Masanori Nojima
- Center for Translational Research, Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Bronwen Hewitt
- Cancer Services, Musculoskeletal/Ambulatory Care Team, Physiotherapy, Liverpool Hospital, Level 2, Health Services Building, Corner of Campbell and Goulburn Street, Liverpool, Australia
| | - Richard Chye
- Sacred Heart Supportive & Palliative Care, Sacred Heart Health Service, Darlinghurst, Australia
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Olsson Möller U, Stigmar K, Beck I, Malmström M, Rasmussen BH. Bridging gaps in everyday life - a free-listing approach to explore the variety of activities performed by physiotherapists in specialized palliative care. BMC Palliat Care 2018; 17:20. [PMID: 29378566 PMCID: PMC5789614 DOI: 10.1186/s12904-018-0272-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A growing body of studies indicate benefits of physiotherapy for patients in palliative care, for symptom relief and wellbeing. Though physiotherapists are increasingly acknowledged as important members of palliative care teams, they are still an underutilized source and not fully recognized. The aim of this study was to explore the variety of activities described by physiotherapists in addressing the needs and problems of patients and their families in specialized palliative care settings. METHODS Using a free-listing approach, ten physiotherapists working in eight specialized palliative care settings in Sweden described as precisely and in as much detail as possible different activities in which patients and their families were included (directly or indirectly) during 10 days. The statements were entered into NVivo and analysed using qualitative content analysis. Statements containing more than one activity were categorized per activity. RESULTS In total, 264 statements, containing 504 varied activities, were coded into seven categories: Counteracting a declining physical function; Informing, guiding and educating; Observing, assessing and evaluating; Attending to signs and symptoms; Listening, talking with and understanding; Caring for basic needs; and Organizing, planning and coordinating. In practice, however, the activities were intrinsically interwoven. The activities showed how physiotherapists aimed, through care for the body, to address patients' physical, psychological, social and existential needs, counteracting the decline in a patient's physical function and wellbeing. The activities also revealed a great variation, in relation not only to what they did, but also to their holistic and inseparable nature with regard to why, how, when, where, with whom and for whom the activities were carried out, which points towards a well-adopted person-centred palliative care approach. CONCLUSIONS The study provides hands-on descriptions of how person-centred palliative care is integrated in physiotherapists' everyday activities. Physiotherapists in specialized palliative care help patients and families to bridge the gap between their real and ideal everyday life with the aim to maximize security, autonomy and wellbeing. The concrete examples included can be used in understanding the contribution of physiotherapists to the palliative care team and inform future research interventions and outcomes.
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Affiliation(s)
- U Olsson Möller
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden. .,Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - K Stigmar
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - I Beck
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Faculty of Health Science, The Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
| | - M Malmström
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - B H Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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Dalzell MA, Smirnow N, Sateren W, Sintharaphone A, Ibrahim M, Mastroianni L, Vales Zambrano LD, O'Brien S. Rehabilitation and exercise oncology program: translating research into a model of care. ACTA ACUST UNITED AC 2017; 24:e191-e198. [PMID: 28680286 DOI: 10.3747/co.24.3498] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The Rehabilitation and Exercise Oncology model of care (ActivOnco) was established to optimize cancer survivorship through exercise prescription and active lifestyle promotion, providing a transition of care from hospital to community. Patients having any cancer diagnosis, stage of disease, and treatment were eligible for evaluation and exercise prescription upon deterioration of performance status. The team of professionals included hospital-based physiotherapists proactively screening for rehabilitation needs, loss of functional independence, and exercise eligibility, plus exercise specialists in a community-based Wellness Centre to provide follow-up or direct access for post-treatment or non-complex patients. METHODS From January 2011 to December 2015, the hospital team assessed 1635 patients representing all major cancer sites, and the Wellness Centre team evaluated and prescribed exercise for 1066 participants. Primary interventions provided were education about fatigue management, physical activity promotion, exercise prescription, fracture risk reduction, referral to specialized follow-up services (for example, occupational therapy, lymphedema clinic), and coordination for mobility aids and paratransit services. RESULTS AND CONCLUSIONS Implementation of the ActivOnco model of care showed that exercise alone is not a panacea for all functional deterioration associated with the cancer trajectory and its treatment. However, screening to identify rehabilitation needs combined with exercise prescription can effectively improve the quality of survivorship in cancer patients. Program developments are limited by the cost of human resources, lack of hospital-based physical resources, and lack of public funding, all of which significantly limit the scope and development of appropriate services.
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Affiliation(s)
- M A Dalzell
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | - N Smirnow
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | - W Sateren
- Hope and Cope, Jewish General Hospital, Montreal, QC.,Rossy Cancer Network, Montreal, QC.,Segal Cancer Centre, Jewish General Hospital, Montreal, QC
| | | | - M Ibrahim
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | - L Mastroianni
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | | | - S O'Brien
- Hope and Cope, Jewish General Hospital, Montreal, QC
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Feldstain A, MacDonald N, Bhargava R, Chasen M. Reported distress in patients living with advanced cancer: changes pre-post interdisciplinary palliative rehabilitation. Support Care Cancer 2017; 25:3191-3197. [DOI: 10.1007/s00520-017-3728-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
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Abstract
AbstractObjective:The aim of this study was to describe how patients in palliative care relate to occupation during hospitalization and to define the meaning it has for them.Method:Eight inpatients in palliative care with various cancer diagnoses were interviewed one time. These interviews were transcribed and analyzed using qualitative content analysis.Results:Patients experience occupations as meaningful when in hospital during the last period of their lives. They would like to be able to handle their own needs as much as possible. Staff behavior, the design of the environment, the lack of accessible occupations, and the degree to which patients can decide whether to receive or decline visits affect the possibility to make their wishes a reality. Our results also revealed that patients experience a sense of loss of their role, as well as a lack of control and participation.Significance of Results:Our results confirm the importance of occupation and of patients having the option to and being given opportunities to take care of themselves when in palliative care. Further studies are needed to enable us to understand how organized occupations might influence patients' experience of being in a hospital during the final period of life.
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Bayly JL, Lloyd-Williams M. Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review. Support Care Cancer 2016; 24:2359-2379. [DOI: 10.1007/s00520-015-3066-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
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Cheng L, Zhu M, Poss JW, Hirdes JP, Glenny C, Stolee P. Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms. BMC Med Inform Decis Mak 2015; 15:80. [PMID: 26453354 PMCID: PMC4600209 DOI: 10.1186/s12911-015-0203-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment. METHODS We applied two algorithms from machine learning and data mining - the LASSO and the random forest - to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada. RESULTS Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not. CONCLUSIONS Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.
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Affiliation(s)
- Lu Cheng
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Mathematics Building No. 3, Waterloo, ON N2L 3G1 Canada
| | - Mu Zhu
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Mathematics Building No. 3, Waterloo, ON N2L 3G1 Canada
| | - Jeffrey W. Poss
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Christine Glenny
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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23
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Salakari MRJ, Surakka T, Nurminen R, Pylkkänen L. Effects of rehabilitation among patients with advances cancer: a systematic review. Acta Oncol 2015; 54:618-28. [PMID: 25752965 DOI: 10.3109/0284186x.2014.996661] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In parallel with the rising incidence of cancer and improved treatment, there is a continuous increase in the number of patients living with cancer as a chronic condition. Many cancer patients experience long-term disability and require continuous oncological treatment, care and support. The aim of this review is to evaluate the most recent data on the effects of rehabilitation among patients with advanced cancer. MATERIAL AND METHODS A systematic review was conducted according to Fink's model. Only randomized controlled trials (RCTs) published in 2009-2014 were included. Medline/PubMed and Cochrane databases were searched; five groups of keywords were used. The articles were evaluated for outcome and methodological quality. RESULTS Thirteen RCTs (1169 participants) were evaluated. Most studies were on the effects of physical exercise in patients with advanced cancer (N = 7). Physical exercise was associated with a significant improvement in general wellbeing and quality of life. Rehabilitation had positive effects on fatigue, general condition, mood, and coping with cancer. CONCLUSIONS Rehabilitation is needed also among patients with advanced disease and in palliative care. Exercise improves physical performance and has positive effects on several other quality of life domains. More data and RCTs are needed, but current evidence gives an indication that rehabilitation is suitable and can be recommended for patients living with advanced cancer.
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van den Dungen IA, Verhagen CA, van der Graaf WT, van den Berg JP, Vissers KC, Engels Y. Feasibility and Impact of a Physical Exercise Program in Patients with Advanced Cancer: A Pilot Study. J Palliat Med 2014; 17:1091-8. [DOI: 10.1089/jpm.2013.0638] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ilse A. van den Dungen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Constans A. Verhagen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jan-Paul van den Berg
- Department of Rehabilitation Medicine, Anthony van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kris C. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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R Krishna LK, Yong CYL, Koh SMC. The role of palliative rehabilitation in the preservation of personhood at the end of life. BMJ Case Rep 2014; 2014:bcr-2014-204780. [PMID: 25008339 DOI: 10.1136/bcr-2014-204780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Progressive advancements in the fields of medicine, oncology and palliative care have seen significant gains in the life expectancy but have also resulted in patients living longer with the burdens of cancer. It is within the sphere of end-of-life care that the role of palliative rehabilitation comes into its own in addressing the effects of increased physical and psychological morbidity that accompany many of these prognostic gains. Focusing on the cancer journey, we highlight the impact of rehabilitative measures on efforts to preserve the personhood of a patient with metastatic renal cell carcinoma and thus maintain her dignity and quality of life and provide her with appropriate and effective holistic care at the end of life. Through employing the Ring Theory of Personhood, the critical role of the complementary aspects of palliative rehabilitation in end-of-life care is brought to the fore.
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Affiliation(s)
- L K R Krishna
- Division of Palliative Medicine, National Cancer Centre, Singapore, Singapore
| | - C Y L Yong
- Department of Occupational Therapist, Bright Vision Hospital, Singapore, Singapore
| | - S M C Koh
- Department of Senior Medical Social Worker, Bright Vision Hospital, Singapore, Singapore
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Leslie P, Sandsund C, Roe J. Researching the rehabilitation needs of patients with life-limiting disease: Challenges and opportunities. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Transferring Inpatient Rehabilitation Facility Cancer Patients Back to Acute Care (TRIPBAC). PM R 2014; 6:808-13. [DOI: 10.1016/j.pmrj.2014.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/31/2013] [Accepted: 01/12/2014] [Indexed: 11/22/2022]
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Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 2013; 63:295-317. [PMID: 23856764 DOI: 10.3322/caac.21186] [Citation(s) in RCA: 247] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 02/06/2023] Open
Abstract
Adult cancer survivors suffer an extremely diverse and complex set of impairments, affecting virtually every organ system. Both physical and psychological impairments may contribute to a decreased health-related quality of life and should be identified throughout the care continuum. Recent evidence suggests that more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones. Research has also demonstrated that the majority of cancer survivors will have significant impairments and that these often go undetected and/or untreated, and consequently may result in disability. Furthermore, physical disability is a leading cause of distress in this population. The scientific literature has shown that rehabilitation improves pain, function, and quality of life in cancer survivors. In fact, rehabilitation efforts can ameliorate physical (including cognitive) impairments at every stage along the course of treatment. This includes prehabilitation before cancer treatment commences and multimodal interdisciplinary rehabilitation during and after acute cancer treatment. Rehabilitation appears to be cost-effective and may reduce both direct and indirect health care costs, thereby reducing the enormous financial burden of cancer. Therefore, it is critical that survivors are screened for both psychological and physical impairments and then referred appropriately to trained rehabilitation health care professionals. This review suggests an impairment-driven cancer rehabilitation model that includes screening and treating impairments all along the care continuum in order to minimize disability and maximize quality of life.
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Affiliation(s)
- Julie K Silver
- Associate Professor, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
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29
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Rydahl-Hansen S. Conditions That Are Significant for Advanced Cancer Patients’ Coping with Their Suffering—as Experienced by Relatives. J Psychosoc Oncol 2013; 31:334-55. [DOI: 10.1080/07347332.2013.778933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Eaton K. Supportive Care in Lung Cancer. Lung Cancer 2013. [DOI: 10.1002/9781118702857.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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White KM. Occupational therapy interventions for people living with advanced lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Occupational therapists are an integral part of the lung cancer multidisciplinary team, focusing on interventions to assist continued participation in activities that are valued as meaningful for the individual patient. The interventions occupational therapists utilize play a vital role in the management of refractory symptoms for people living with advanced lung cancer. Core interventions, such as energy conservation, anxiety management, home assessments, assistive equipment, technological devices and breathlessness management, are employed by occupational therapists to optimize function and enable participation in chosen, everyday activities, and will be reviewed in this paper.
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Affiliation(s)
- Kahren M White
- Clinical Specialist Oncology & Palliative Care, PO Box 6089 Marrickville South, NSW 2204, Australia
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Lau LKP, Mok E, Lai T, Chung B. Quality-of-life concerns of Chinese patients with advanced cancer. SOCIAL WORK IN HEALTH CARE 2013; 52:59-77. [PMID: 23301935 DOI: 10.1080/00981389.2012.728560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study aimed to examine the quality of life (QOL) of patients with advanced cancer in Hong Kong. Ninety participants were recruited from the oncology ward of the study hospital. They responded to a 28-item, 8-subscale multidimensional questionnaire and a single-item scale that measured QOL in a face-to-face interview. Participation in health care decisions, food-related concerns, and existential distress were some QOL concerns that require health care professionals' attention. Walking ability predicted the level of QOL in certain QOL domains that surfaces patients' need for rehabilitation. That the QOL domain value of life was the most important domain that predicted overall QOL calls for meaning-of-life interventions for palliative care.
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Affiliation(s)
- Liam Ka-Po Lau
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
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Nelson LA, Hasson F, Kernohan WG. Exploring district nurses' reluctance to refer palliative care patients for physiotherapy. Int J Palliat Nurs 2012; 18:163-4, 166-70. [DOI: 10.12968/ijpn.2012.18.4.163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lesley Ann Nelson
- Community Specialist Palliative Care Team, Ards Community Hospital, Newtownards, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, Shore Road, BT37 0QB, Northern Ireland
| | - W George Kernohan
- Institute of Nursing Research and School of Nursing, University of Ulster, Northern Ireland
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Oncologists' and Physiatrists' Attitudes Regarding Rehabilitation for Patients With Advanced Cancer. PM R 2012; 4:96-108. [DOI: 10.1016/j.pmrj.2011.08.539] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 08/02/2011] [Accepted: 08/21/2011] [Indexed: 11/19/2022]
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Low J, Davis S, Drake R, King M, Tookman A, Turner K, Serfaty M, Leurent B, Jones L. The role of acceptance in rehabilitation in life-threatening illness. J Pain Symptom Manage 2012; 43:20-8. [PMID: 21855291 DOI: 10.1016/j.jpainsymman.2011.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/11/2011] [Accepted: 03/15/2011] [Indexed: 11/21/2022]
Abstract
CONTEXT Palliative care rehabilitation aims to maximize physical and psychological functioning, but negative thoughts can hinder patients from attempting this approach. Acceptance and commitment therapy (ACT), a modified form of cognitive behavioral therapy, encourages individuals to experience and manage negative emotions by focusing on changing individual behavior and so improve functioning. ACT has been used in many health-related behavioral interventions but not in palliative care rehabilitation. OBJECTIVES To investigate the relationship between acceptance (often called experiential acceptance in ACT) and psychological and physical status. METHODS Cross-sectional study in which a consecutive sample of patients attending a specialist palliative care day therapy unit for rehabilitation completed the Acceptance and Action Questionnaire-II to measure acceptance and the Kessler-10 questionnaire to measure psychological morbidity. Physical function was assessed by a timed two-minute walking test and one-minute sit-to-stand test. Correlation statistics and multivariable regression analyses were used to explore the strength of relationships between acceptance and psychological morbidity and physical function. RESULTS One hundred one patients were recruited, mainly white women with a mean age of 64 years. Correlation analysis showed a negative association between acceptance and psychological morbidity (r=-0.59) and a positive association between acceptance and sit to stand (r=0.27) and distance walked (r=0.21). All three of these relationships were statistically significant after adjustment. CONCLUSION These associations suggest that it may be possible to reduce psychological morbidity and improve physical mobility by increasing patients' acceptance using an ACT-based intervention. Future work is now needed to develop an ACT-based intervention in palliative care rehabilitation and test its acceptability and feasibility.
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Affiliation(s)
- Joseph Low
- Marie Curie Palliative Care Research Unit, Research Department of Mental Health Sciences, University College London, London, United Kingdom.
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Javier NSC, Montagnini ML. Rehabilitation of the hospice and palliative care patient. J Palliat Med 2011; 14:638-48. [PMID: 21592031 DOI: 10.1089/jpm.2010.0125] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Disability is a common problem among hospice and palliative care patients. It leads to depression, poor quality of life, increased caregiver needs, health care resource utilization, and need for institutionalization. There is a growing body of evidence that rehabilitation interventions improve functional status, quality of life, and symptoms such as pain and anxiety in this population. Having adequate knowledge about rehabilitation is essential for the provision of comprehensive end-of-life care. The goals of this article are to review the role and benefits of rehabilitation in hospice and palliative care; to discuss the elements of patient assessment for rehabilitation including the use of functional assessment tools; and to review the roles of physical, occupational, and speech therapy in hospice and palliative care patients.
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Affiliation(s)
- Noel S C Javier
- Division of Geriatrics, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2011; 19:144-9. [DOI: 10.1097/moo.0b013e3283457616] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Palliative care is an interdisciplinary and holistic approach aimed at alleviating suffering from physical, psychosocial, and spiritual issues in progressive, advanced disease. Progressive fatigue and anorexia-cachexia syndrome can contribute to loss of physical function in the palliative cancer patient, to the detriment of overall quality of life. Physical activity is one potential intervention, which may address these needs in the palliative cancer patient. There is preliminary evidence that at least some palliative cancer patients are willing and able to tolerate physical activity interventions, with some patients demonstrating improvement in select supportive care outcomes postintervention. Methodologically rigorous studies and consensus on common definitions are required to advance this area of research.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Drive NW, Edmonton, T6G 1Z2, Alberta, Canada.
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Hackman D. “What's the point?” exploring rehabilitation for people with 1° CNS tumours using ethnography: Patients' perspectives. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:201-17. [DOI: 10.1002/pri.506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Revised: 11/08/2010] [Accepted: 11/14/2010] [Indexed: 11/05/2022]
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Roe JWG, Leslie P. Beginning of the end? Ending the therapeutic relationship in palliative care. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 12:304-332. [PMID: 20590511 DOI: 10.3109/17549507.2010.485330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hersh (2010) raises important issues regarding the ending of the therapeutic relationship. In this paper, we will explore this concept in relation to speech-language pathology (SLP) and palliative care. Palliative care aims to affirm life and minimize the complications of life limiting disease. Speech-language pathologists (SLPs) work with people with progressive and life limiting disease as rehabilitation experts but often work independently of specialist palliative care teams. Rehabilitation may seem incongruent with palliation but SLPs have a vital role in the empowerment of patients with communication difficulties and symptom reduction through specialist dysphagia management and communication therapy. This is vital in the last months and weeks of life. Starting and closing episodes of care remains a challenging area for therapists. SLP membership of palliative care multidisciplinary teams is limited and there may be a lack of understanding between professionals regarding the SLP role. In this paper we will use case studies and the palliative care literature to define a role for rehabilitation and the transition from supportive to palliative rehabilitation and closing episodes of care.
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Affiliation(s)
- Justin W G Roe
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom.
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Mok E, Lam WM, Chan LN, Lau KP, Ng JSC, Chan KS. The meaning of hope from the perspective of Chinese advanced cancer patients in Hong Kong. Int J Palliat Nurs 2010; 16:298-305. [DOI: 10.12968/ijpn.2010.16.6.48836] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esther Mok
- School of Nursing, The Hong Kong Polytechnic University
| | - Wai Man Lam
- Pulmonary and Palliative Care Unit, Haven of Hope Hospital
| | - Lai Ngor Chan
- Pulmonary and Palliative Care Unit, Haven of Hope Hospital
| | - Ka Po Lau
- School of Nursing, The Hong Kong Polytechnic University
| | - Jeffrey SC Ng
- Pulmonary and Palliative Care Unit, Haven of Hope Hospital
| | - Kin Sang Chan
- Pulmonary and Palliative Care Unit, Haven of Hope Hospital, Hong Kong
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"The healthy me appears": palliative cancer patients' experiences of participation in a physical group exercise program. Palliat Support Care 2010; 7:459-67. [PMID: 19939308 DOI: 10.1017/s1478951509990460] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tentative results from a pilot study showed that patients with advanced cancer were willing and able to take part in a group exercise intervention. Limited knowledge exists, though, about the meaning and significance of such programs. The purpose of the present study was to understand the meaning of such an intervention for the individual participant and thereby to provide knowledge for shaping future clinical practice. METHODS Thirty-four palliative cancer patients with a life expectancy of less than 1 year completed a 6-week group exercise program. Five randomly selected individuals were interviewed 7 months after completion. Results from a self-report evaluation questionnaire identified relevant themes that formed the basis of an interview guide. These were addressed in a semistructured interview. Verbatim transcripts were analyzed with a phenomenological-hermeneutical approach. RESULTS Two main themes emerged from the interviews: (1) perceptions of the group and (2) a secure and caring setting for the group. Themes identified regarding perception of the group were a sense of belonging and commitment. Themes identified regarding a secure and caring setting for the group were a life-empowering group as a setting for enhancing coping, the qualifications of those who led the group, and a public gym as an unsuitable setting. SIGNIFICANCE OF RESULTS Our study indicates that an individually adjusted group exercise program, with competent leaders, can provide a setting to enhance psychological well-being in cancer patients with life expectancy below 1 year. Small sample size, however, limits the possibility to generalize the findings.
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A retrospective study of the role of an occupational therapist in the cancer nutrition rehabilitation program. Support Care Cancer 2009; 18:1589-96. [PMID: 19956981 DOI: 10.1007/s00520-009-0782-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 11/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study was to determine how frequently each domain of activity was addressed and how frequently specific interventions were used by an occupational therapist (OT) with cancer patients who attended an 8-week Cancer Nutrition and Rehabilitation (CNR) program. METHODS Sixty-two patients with cancer were assessed. All received interventions by the OT within the CNR program. The following activity domains: (1) self-care, (2) productivity, and (3) leisure that were addressed during appointments with the OT were recorded following each visit. Seven categories of interventions were predetermined and their use was recorded using a checklist. RESULTS Descriptive statistics were conducted and revealed that 36% of the therapist's time was spent assessing patients' functional capacity while 64% was spent providing interventions. The OT's interventions addressed leisure and exercise (54%), productive activities such as housework and paid employment (32%), and basic activities of daily living (14%). The frequency of specific interventions provided were as follows: 40% in teaching of energy conservation and activity management techniques, 33% in goal setting/support and counseling, 9% in cognitive retraining/stimulation, 6% in communication with community agencies, and 4% in teaching of joint and bone protection techniques, help with management of neuropathies, and education on scar management respectively. CONCLUSION It is suggested that OTs practicing in oncology use a variety of interventions to better address productive and leisure activities. The data suggests that limitations in these areas were more prevalent than in self-care activities. Further study is needed to examine OT interventions in oncology.
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Jagannathan A, Juvva S. Life after cancer in India: coping with side effects and cancer pain. J Psychosoc Oncol 2009; 27:344-60. [PMID: 19544181 DOI: 10.1080/07347330902979150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The article aims to understand the coping strategies of postsurgery head and neck cancer patients in Mumbai, India. A descriptive research design with a sample of 80 patients suffering from head and neck cancer was selected to analyze their coping strategies in relation to sociodemographic profile and illness characteristics. The findings of the study highlighted that the spiritual methods of coping (such as prayer and meditation, adopting a positive attitude) were the most frequently used mainstream coping strategy, apart from other traditional methods (such as taking medications, indulging in exercise and activities to divert one's attention, etc.) of coping. The findings of the study help to broaden the understanding of various psychosocial aspects faced by the patient in India and provide progressive recommendations to improve the quality of life of the patient suffering from cancer.
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Affiliation(s)
- A Jagannathan
- National Institute of Mental Health and Neurosciences, Koramangala, Bangalore, India.
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Abstract
Physical exercise has attracted increased interest in rehabilitation of oncological patients. The purpose of this paper is to review the literature and summarize the evidence of physical exercise in preventing cancer, its ability in attenuating the effect of cancer and its treatments and to provide guidelines for exercise prescription Review of recent literature by electronic search of MEDline (Pub Med), Cancer lit, Cochrane libraries, CINAHL were done using Keywords and the variables were identified and systematically evaluated. There is strong evidence for reduced risk of colorectal and breast cancer with possible association for prostate, endometrial and lung cancer with increasing physical activity. Exercise helps cancer survivors cope with and recover from treatment; exercise may improve the health of long term cancer survivors and extend survival. Physical exercise will benefit throughout the spectrum of cancer. However, an understanding of the amount, type and intensity of exercise needed has not been fully elucidated. There is sufficient evidence to promote exercise in cancer survivors following careful assessment and tailoring on exercise prescription.
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Affiliation(s)
- P. Rajarajeswaran
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry – 6, India
| | - R. Vishnupriya
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry – 6, India
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Tay SS, Ng YS, Lim PAC. Functional Outcomes of Cancer Patients in an Inpatient Rehabilitation Setting. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n3p197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: Cancer is the leading cause of death and the second most common cause of hospitalisation in Singapore. Significant functional gains are achievable with cancer rehabilitation yet there are no formal cancer rehabilitation programmes in Singapore. This study aims to describe the demographics, clinical characteristics, complications and functional outcomes of cancer patients undergoing comprehensive inpatient rehabilitation at our unit and compare these with non-cancer patients. It also seeks to compare these data within sub-groups of the cancer cohort.
Materials and Methods: This is a prospective cohort study. The Department of Rehabilitation Medicine database was reviewed for the period between 1 July 2002 and 31 December 2006. One thousand seven hundred and fifty patients had complete records, of which 58 are cancer patients. The primary outcome measures were the discharge total Functional Independence Measure (FIM), FIM gain and FIM efficiency. Other outcome measures included the length of rehabilitation stay, discharge destination, complication rates, rate of transfer back to the referring unit, the length of survival of the cancer patients upon discharge and the durability of the functional improvement made.
Results: The mean age of the cancer patients was 57.4 ± 16.1 years and 62% were male. The mean admission total FIM was 70.9 ± 18.0 and the total discharge FIM was 86.2 ± 18.3. The average FIM gain was 15.3 ± 11.6 and the mean efficiency was 0.867 ± 0.806. This improvement is highly significant, and there is no statistical difference in FIM gain or efficiency between the cancer and non-cancer cohort, or between the cancer sub- groups. The length of stay was similar in cancer and non-cancer cohorts but cancer patients with spinal metastasis and those who underwent concomitant radiotherapy stayed longer. There were good rates of discharge home, transfer back, survivorship and durability in functional gains.
Conclusion: Cancer patients benefit as much as non-cancer patients in undergoing a rehabilitation programme. More patients should be admitted to such programmes and these programmes should be better structured and refined.
Key words: Complications, Durability, Efficiency, Radiotherapy
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The role of physical therapy and occupational therapy in the rehabilitation of pediatric and adolescent patients with osteosarcoma. Cancer Treat Res 2009; 152:367-84. [PMID: 20213402 DOI: 10.1007/978-1-4419-0284-9_20] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The approach to rehabilitation of patients with osteosarcoma has evolved with the many advances in the medical treatment and surgical management of this pediatric and adolescent cancer. In the past, amputation (often radical amputation) was the standard method for treating patients with extremity sarcomas, and rehabilitation was geared toward providing either functional training for patients who had not had limb replacement or prosthetic training for those who had received prostheses. Currently, limb-sparing procedures combined with adjuvant chemotherapy (and occasionally radiotherapy) are used to treat most patients with this disease. In addition, physical-therapy and occupational-therapy interventions are now tailored to address the multiple physical and psychosocial difficulties these patients will face for the remainder of their lives. Integral parts of the interdisciplinary team, practitioners of these disciplines, provide services that enable patients to achieve their highest functional status to permit them to return to their role in society and hence enjoy dignity and improved quality of life.
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Jeyasingam L, Agar M, Soares M, Plummer J, Currow D. A prospective study of unmet activity of daily living needs in palliative care inpatients. Aust Occup Ther J 2008; 55:266-72. [DOI: 10.1111/j.1440-1630.2007.00705.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schleinich MA, Warren S, Nekolaichuk C, Kaasa T, Watanabe S. Palliative care rehabilitation survey: a pilot study of patients' priorities for rehabilitation goals. Palliat Med 2008; 22:822-30. [PMID: 18772213 DOI: 10.1177/0269216308096526] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rehabilitation in palliative care is often overlooked. Settings that do consider occupational or physical therapy for palliative care patients often consult to therapists with competing caseloads. Few therapists specialise in palliative care, but nearly all ask, 'What needs doing'? and 'How well am I doing that'? No existing instruments address their questions. The objective is to develop and test a questionnaire for identifying patient goals and priorities for rehabilitation in palliative care. A questionnaire representing 11 domains of the Canadian Model of Occupational Performance was designed and pilot tested at four palliative care sites. Each question reflected a typical rehabilitation intervention in palliative care. Patients were asked to rate how important each of these interventions was on a numerical rating scale (0, not important-10, extremely important). Open-ended questions captured verbatim comments regarding thoughts of rehabilitation. The questionnaire was tested for test-retest reliability with two interviews approximately 1 week apart. Forty patients participated in the first interview and 32 in the second. Eight of eleven domain sub-scores achieved an intra-class correlation coefficient of 0.6 or higher. The highest means were for the physical (8.2), institutional (7.8) and self-care (7.8) domains on the first interview and for the spiritual domain (7.9) on the second interview. Suggestions are provided to shorten the questionnaire and strengthen validity. This work furthers the understanding of the role of rehabilitation in palliative care. It also illustrates the feasibility of involving palliative care patients in research that contributes to setting standards and measuring quality of service.
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Affiliation(s)
- M A Schleinich
- Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.
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