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Hussey C, Hanbridge M, Dowling M, Gupta A. Cancer survivorship: understanding the patients' journey and perspectives on post-treatment needs. BMC Sports Sci Med Rehabil 2024; 16:82. [PMID: 38605386 PMCID: PMC11010277 DOI: 10.1186/s13102-024-00864-y] [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: 10/29/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Cancer treatments have many adverse effects on patient's health leading to poor cardiorespiratory capacity, muscular- degeneration, fatigue, loss of strength and physical function, altered body-composition, compromised immune-function, peripheral neuropathy, and reduced quality of life (QOL). Exercise programs can significantly increase functional capacity when tailored to individual needs, thus improving health. Exercise interventions in cancer rehabilitation, when supported by appropriate nutrition can be effective in attaining a healthy weight and body-composition. The successful rehabilitation program should also include psycho-social education aimed to reduce anxiety and improve motivation. METHODS The current study aimed to collect information on the post-treatment needs of cancer patients including barriers and expectations facing them, their caregivers and their families through consultation in focus group interviews. Cancer survivors living in the Republic of Ireland were recruited from the University Hospital Galway, community-based cancer centres, cancer support groups and social media platforms to participate in the study and attend a focus group interview. The focus group discussions were designed to obtain information on the collective views of cancer survivors on relevant topics selected. The topics were developed in consultation with a patient and public involvement (PPI) group supporting the study. The topics list was circulated to all participants prior to the focus group. The interviews were audio recorded and transcribed verbatim. Focus group transcripts were analysed subjected to a thematic framework analysis using NVivo. RESULTS Thirty-six participants took part in 9 focus groups. Our analysis uncovered two main themes. The first theme 'cast adrift with no direction' was grouped into three sub-themes: everything revolves around treatment; panic and fear; and what exercise should I be doing? The second theme 'everybody is different' was clustered into two sub-themes: side effects get in the way; and personalised exercise program. CONCLUSION The study highlighted the lack of information and support needed by patients living with and beyond cancer. The study also highlighted the need for a personalised exercise programme designed to target the individual patient symptoms that would be ideal for the mitigation of long term symptoms and in improving QOL.
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Affiliation(s)
- Conor Hussey
- School of Medicine, University of Galway, Galway, Ireland
| | - Moira Hanbridge
- IPPOSI - Patient Education Programme in Health Innovation, Dublin, Ireland
| | - Maura Dowling
- School of Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Ananya Gupta
- School of Medicine, University of Galway, Galway, Ireland.
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Fauser D, Zollmann P, Streibelt M, Bethge M. [Work Participation after Multimodal Rehabilitation due to Cancer: Representative Analyses using Routine Data of the German Pension Insurance]. DIE REHABILITATION 2024; 63:107-118. [PMID: 38065547 DOI: 10.1055/a-2192-3476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
PURPOSE Cancer diseases are associated with multiple physical, psychosocial, and occupational burdens that jeopardize work participation and must be specifically addressed with rehabilitative interventions. This study addressed the following questions regarding cancer patients whose rehabilitation was covered by German Pension Insurance (GPI): (a) What socio-medical risks existed prior to rehabilitation, (b) how well persons were able to return to work after rehabilitation, and (c) what conditions determined work participation? METHODS We used the rehabilitation statistics database of the German Pension Insurance and included patients with completed medical rehabilitation due to cancer in 2017. Analyses were carried out for the entire group as well as for those differentiated according to their tumor sites (breast, prostate, colon and lung). Work participation was operationalized both via a monthly state up to 24 months after rehabilitation discharge and as a rate of all persons who were employed 12 or 24 months and the 3 preceding months (stable work participation). For the analysis of the influencing factors on stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS A total of 63,587 data sets were included in the analysis (breast cancer: n=20,545, 32%; prostate: n=6,434, 10%; colon: n=4,727, 7%; lung: n=2,866, 5%). Of the rehabilitation participants 55% (lung), 49% (colon), 46% (breast), and 13% (prostate) had sickness absences of six or more months in the year before rehabilitation. Two years after rehabilitation, return-to-work rates were 66% (breast), 54% (prostate), 50% (colon), and 24% (lung). The strongest factors influencing stable work participation were time of sick leave, wage before rehabilitation and age. CONCLUSION Two years after cancer rehabilitation, 5 to 6 out of 10 persons returned to stable work participation. Relevant influencing factors were the length of sick leave and wages prior to cancer rehabilitation. The results suggest inclusion of more work-related aspects in cancer rehabilitation and greater suppor, especially in the first year post-rehabilitation.
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Affiliation(s)
- David Fauser
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - Pia Zollmann
- Dezernat Reha-Wissenschaften , Deutsche Rentenversicherung Bund, Berlin
| | - Marco Streibelt
- Dezernat Reha-Wissenschaften , Deutsche Rentenversicherung Bund, Berlin
| | - Matthias Bethge
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
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de Boer AG, Tamminga SJ, Boschman JS, Hoving JL. Non-medical interventions to enhance return to work for people with cancer. Cochrane Database Syst Rev 2024; 3:CD007569. [PMID: 38441440 PMCID: PMC10913845 DOI: 10.1002/14651858.cd007569.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND People with cancer are 1.4 times more likely to be unemployed than people without a cancer diagnosis. Therefore, it is important to investigate whether programmes to enhance the return-to-work (RTW) process for people who have been diagnosed with cancer are effective. This is an update of a Cochrane review first published in 2011 and updated in 2015. OBJECTIVES To evaluate the effectiveness of non-medical interventions aimed at enhancing return to work (RTW) in people with cancer compared to alternative programmes including usual care or no intervention. SEARCH METHODS We searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO and three trial registers up to 18 August 2021. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs on the effectiveness of psycho-educational, vocational, physical or multidisciplinary interventions enhancing RTW in people with cancer. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life (QoL). DATA COLLECTION AND ANALYSIS Two review authors independently assessed RCTs for inclusion, extracted data and rated certainty of the evidence using GRADE. We pooled study results judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs) for RTW and mean differences (MD) or standardised mean differences (SMD) with 95% CIs for QoL. MAIN RESULTS We included 15 RCTs involving 1477 people with cancer with 19 evaluations because of multiple treatment groups. In this update, we added eight new RCTs and excluded seven RCTs from the previous versions of this review that were aimed at medical interventions. All included RCTs were conducted in high-income countries, and most were aimed at people with breast cancer (nine RCTs) or prostate cancer (two RCTs). Risk of bias We judged nine RCTs at low risk of bias and six at high risk of bias. The most common type of bias was a lack of blinding (9/15 RCTs). Psycho-educational interventions We found four RCTs comparing psycho-educational interventions including patient education and patient counselling versus care as usual. Psycho-educational interventions probably result in little to no difference in RTW compared to care as usual (RR 1.09, 95% CI 0.96 to 1.24; 4 RCTs, 512 participants; moderate-certainty evidence). This means that in the intervention and control groups, approximately 625 per 1000 participants may have returned to work. The psycho-educational interventions may result in little to no difference in QoL compared to care as usual (MD 1.47, 95% CI -2.38 to 5.32; 1 RCT, 124 participants; low-certainty evidence). Vocational interventions We found one RCT comparing vocational intervention versus care as usual. The evidence was very uncertain about the effect of a vocational intervention on RTW compared to care as usual (RR 0.94, 95% CI 0.78 to 1.13; 1 RCT, 34 participants; very low-certainty evidence). The study did not report QoL. Physical interventions Four RCTs compared a physical intervention programme versus care as usual. These physical intervention programmes included walking, yoga or physical exercise. Physical interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.08 to 1.39; 4 RCTs, 434 participants; moderate-certainty evidence). This means that in the intervention group probably 677 to 871 per 1000 participants RTW compared to 627 per 1000 in the control group (thus, 50 to 244 participants more RTW). Physical interventions may result in little to no difference in QoL compared to care as usual (SMD -0.01, 95% CI -0.33 to 0.32; 1 RCT, 173 participants; low-certainty evidence). The SMD translates back to a 1.8-point difference (95% CI -7.54 to 3.97) on the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire Core 30 (EORTC QLQ-C30). Multidisciplinary interventions Six RCTs compared multidisciplinary interventions (vocational counselling, patient education, patient counselling, physical exercises) to care as usual. Multidisciplinary interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.09 to 1.33; 6 RCTs, 497 participants; moderate-certainty evidence). This means that in the intervention group probably 694 to 844 per 1000 participants RTW compared to 625 per 1000 in the control group (thus, 69 to 217 participants more RTW). Multidisciplinary interventions may result in little to no difference in QoL compared to care as usual (SMD 0.07, 95% CI -0.14 to 0.28; 3 RCTs, 378 participants; low-certainty evidence). The SMD translates back to a 1.4-point difference (95% CI -2.58 to 5.36) on the EORTC QLQ-C30. AUTHORS' CONCLUSIONS Physical interventions (four RCTs) and multidisciplinary interventions (six RCTs) likely increase RTW of people with cancer. Psycho-educational interventions (four RCTs) probably result in little to no difference in RTW, while the evidence from vocational interventions (one RCT) is very uncertain. Psycho-educational, physical or multidisciplinary interventions may result in little to no difference in QoL. Future research on enhancing RTW in people with cancer involving multidisciplinary interventions encompassing a physical, psycho-educational and vocational component is needed, and be preferably tailored to the needs of the patient.
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Affiliation(s)
- Angela Gem de Boer
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Coronel Institute of Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Sietske J Tamminga
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Coronel Institute of Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Julitta S Boschman
- Cochrane Work, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Jan L Hoving
- Cochrane Work, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
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Wakabayashi H, Kakehi S, Kishima M, Itoda M, Nishioka S, Momosaki R. Impact of registered dietitian and dental hygienist involvement on functional outcomes in patients with dysphagia: triad of rehabilitation, nutrition, and oral management. Eur Geriatr Med 2023; 14:1301-1306. [PMID: 37442874 DOI: 10.1007/s41999-023-00833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To investigate whether the involvement of both registered dietitians and dental hygienists results in greater improvement in swallowing function and activities of daily living (ADL) in patients with dysphagia undergoing rehabilitation. METHODS Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database, 433 met the study eligibility criteria in a retrospective cohort study. Patients were divided into two groups based on whether or not they received intervention by both registered dietitians and dental hygienists. Outcomes were changes in the Food Intake Level Scale (FILS) and the Barthel Index (BI) at initial and follow-up assessments. Multiple regression analyses adjusted for age, sex, sarcopenia, dwelling, Charlson comorbidity index, malnutrition diagnosed by the Global Leadership Initiative on Malnutrition, and initial FILS or BI were conducted to examine the relationship between the involvement of both registered dietitians and dental hygienists. RESULTS The mean age was 80.5 and ± 10.7 years, and 222 were female. Both registered dietitians and dental hygienists were involved in 242 (57%) patients. Median and interquartile range changes in FILS and BI were 1 (0, 2) and 15 (0, 32.5), respectively. In multiple regression analyses, the change in the FILS was significantly higher in the involvement of both registered dietitians and dental hygienists (standardized coefficient = 0.075, P = 0.033), however, the change in the BI was not significantly different between the groups. CONCLUSION The involvement of both registered dietitians and dental hygienists improved swallowing function, but not ADL. Triad of rehabilitation, nutrition, and oral management may be useful for patients with dysphagia.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
| | - Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Masako Kishima
- Department of Dentistry, Wakakusa-Tatsuma Rehabilitation Hospital, Osaka, Japan
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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Brick R, Padgett L, Jones J, Wood KC, Pergolotti M, Marshall TF, Campbell G, Eilers R, Keshavarzi S, Flores AM, Silver JK, Virani A, Livinski AA, Ahmed MF, Kendig T, Khalid B, Barnett J, Borhani A, Bernard G, Lyons KD. The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review. J Cancer Surviv 2023; 17:1725-1750. [PMID: 35218521 PMCID: PMC8881759 DOI: 10.1007/s11764-022-01181-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.
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Affiliation(s)
- Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Lynne Padgett
- VA Central Office, Health Services Research and Development, 1100 1st St NE, Suite 6, Washington, DC, 20002, USA
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kelley Covington Wood
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Timothy F Marshall
- Ivy Rehab Network, 1311 Mamaroneck Ave, Suite 140, White Plains, NY, 10605, USA
| | - Grace Campbell
- Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences and UPMC Hillman Cancer Center at UPMC Magee, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Rachel Eilers
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Center, 610 University Ave, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
- Brigham and Women's Hospital, 55 Fruit Street, Boston, MA, USA
- Spaulding Rehabilitation Hospital, 55 Fruit Street, Boston, MA, USA
| | - Aneesha Virani
- Department of Rehabilitation Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA, 30342, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, OD, NIH, MSC 1150, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mohammed Faizan Ahmed
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Tiffany Kendig
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Bismah Khalid
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1VT, Canada
| | - Jeremy Barnett
- George Washington University School of Medicine and Health Sciences, 2300 I St. NW, Washington, DC, 20052, USA
| | - Anita Borhani
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Graysen Bernard
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, Building 79/96, 79 13th Street, Boston, MA, 02129, USA
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Sheill G, Hennessy M, Devenney K, Reynolds S, Towns J, Gill M, Guinan E. A hospital to community exercise referral pathway: results of a pilot project. Ir J Med Sci 2023; 192:2051-2058. [PMID: 36624243 DOI: 10.1007/s11845-022-03257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND People living with chronic disease should ideally engage with community-based exercise services following hospital-based rehabilitation. However, transition from hospital to community exercise settings is extremely challenging and strategies to support this transition are underdeveloped. AIMS The aims of this study were to develop and explore the feasibility of a pilot exercise referral pathway between an acute hospital and community gyms for patients with chronic health conditions and to evaluate patient satisfaction with the exercise referral pathway. METHODS A stakeholder-informed exercise referral pathway was developed and offered to patients following completion of a hospital-based exercise programme for a chronic health condition. The pathway was evaluated using a mixed-methods approach. Quantitative data examining participant engagement was used to examine feasibility. Quantitative survey data and qualitative data from semi-structured interviews examined satisfaction with the pathway. RESULTS Forty-nine people living with chronic conditions (mean age 72 ± 7.8 years) participated (recruitment rate 59%). The average number of community gym visits over 4 months was 17.4 (range 0-51). Twenty-nine (78%) participants reported that they planned to continue their gym membership when the programme ended. Themed responses from participant interviews (n = 12) highlighted the benefits of a supported transition from hospital to gym membership and the need for more structured exercise support in community gyms. CONCLUSION A structured exercise referral pathway to support exercise transition between hospital and community settings in populations with chronic health conditions appears feasible. Participants reported high levels of satisfaction with the referral pathway.
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Affiliation(s)
- Gráinne Sheill
- Wellcome HRB Clinical Research Facility at St James's Hospital, Dublin, Ireland.
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
| | - Martina Hennessy
- Wellcome HRB Clinical Research Facility at St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Kate Devenney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Jeremy Towns
- Wellcome HRB Clinical Research Facility at St James's Hospital, Dublin, Ireland
| | - Michael Gill
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry & Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Gjerset GM, Skaali T, Seland M, Thorsen L. Health-Related Quality of Life, Fatigue, Level of Physical Activity, and Physical Capacity Before and After an Outpatient Rehabilitation Program for Women Within Working Age Treated for Breast Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:948-956. [PMID: 35974293 PMCID: PMC10234893 DOI: 10.1007/s13187-022-02211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 06/02/2023]
Abstract
The aims were to examine changes in patient-reported outcome measures (PROMs), level of physical activity (LPA), and physical capacity from before to after an outpatient rehabilitation program (ORP) for women with breast cancer (BC). Further aims were to explore the proportions of patients with clinically relevant improvements defined as ≥ 10% beneficial change in the scores of PROMs and variables associated with such improvements.A total of 270 women within working age (< 67 years) who recently (< 1.5 years) had completed primary therapy for BC with curative intent were included. The ORP consisted of seven weekly group sessions with patient education, group conversations, and PA. The patients completed questionnaires measuring health-related quality of life (HRQoL), fatigue and LPA before (T0), immediately after (T1), and 6 months after (T2) the program, and were physically tested at T0 and T1. The mean age of the patients was 50.4 years (SD 7.3) and the mean time since diagnosis was 10.6 months (SD 2.6). All patients had undergone surgery and 94% radiotherapy, and 96% had received chemotherapy and/or hormonal therapy.Physical-, role-, emotional-, cognitive-, and social function, global health, and fatigue significantly improved from T0 to T1. Physical-, role-, and cognitive function, and fatigue significantly improved from T1 to T2. LPA and physical capacity significantly improved from T0 to T1. More than 40% of the patients had a clinically relevant improvement in role-, social function, and fatigue symptoms, from T0 to T1. Low level of education was associated with an improvement in emotional function, and living alone was associated with an improvement in mental fatigue.HRQoL, fatigue, LPA, and physical capacity improved in women within working age recently treated for BC who participated in an ORP.
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Affiliation(s)
- Gunhild M Gjerset
- Unit for Psychosocial Oncology, Coping and Rehabilitation, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, P.O. Box 4953 Nydalen, 0424, Oslo, Norway.
- National Advisory Unit On Late Effects After Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
| | - Tone Skaali
- Unit for Psychosocial Oncology, Coping and Rehabilitation, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, P.O. Box 4953 Nydalen, 0424, Oslo, Norway
| | - Mette Seland
- Unit for Psychosocial Oncology, Coping and Rehabilitation, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, P.O. Box 4953 Nydalen, 0424, Oslo, Norway
| | - Lene Thorsen
- National Advisory Unit On Late Effects After Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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Accogli MA, Denti M, Costi S, Fugazzaro S. Therapeutic education and physical activity are feasible and safe in hematologic cancer patients referred to chemotherapy: results of a randomized controlled trial. Support Care Cancer 2023; 31:61. [PMID: 36534365 PMCID: PMC9763142 DOI: 10.1007/s00520-022-07530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Although over 60% of patients with hematologic cancer report distressing fatigue, they often do not receive recommendations on fatigue management strategies. The aim of this pilot study was to estimate the feasibility of therapeutic education and physical activity (TEPA) by measuring the patients' adherence to this multidimensional intervention. The secondary aim was to estimate the impact of TEPA on clinical outcomes. METHODS Patients with hematologic cancer participated in this single-center, open-label, randomized controlled trial. The control group (CG) received two educational group sessions on fatigue and physical activity. The experimental group (EG) received the two educational sessions plus six weekly individual sessions aimed at implementing a personalized physical exercise program. Follow-ups were at 1, 3, and 7 months. RESULTS Forty-six patients referred to chemotherapy were included, corresponding to 54% of recruitment rate. Adherence reached 90% in the EG and 68% in the CG. Most patients (65% in EG and 64% in CG) attended a minimum of 80% of the planned sessions. Overall retention rate was 87% (85% in EG and 91% in CG). No adverse events were registered. No between-group differences were detected in fatigue (FACIT-F), psychological distress (NCCN Distress Thermometer), QoL (EORTC QLQ-C30), or functional exercise capacity (TUG test and 6MWT). Adherence to an active lifestyle, measured by a semi-structured interview, increased from 56.5 to 84% in the EG at 7 months (p = 0.02), whereas it decreased slightly in the CG (from 47.8 to 42.9%). CONCLUSION Multidimensional rehabilitation interventions are feasible and safe in this population, and larger trials should focus on the efficacy of such approaches on clinically relevant outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03403075.
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Affiliation(s)
- Monia Allisen Accogli
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Viale Risorgimento N°80, 42123 Reggio Emilia, Italy
| | - Monica Denti
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Viale Risorgimento N°80, 42123 Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Viale Risorgimento N°80, 42123 Reggio Emilia, Italy ,grid.7548.e0000000121697570Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Via del Pozzo N°74, 41100 Modena, Italy
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Viale Risorgimento N°80, 42123 Reggio Emilia, Italy
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Menger F, Deane J, Patterson JM, Fisher P, O’Hara J, Sharp L. The nature and content of rumination for head and neck cancer survivors. Front Psychol 2022; 13:995187. [DOI: 10.3389/fpsyg.2022.995187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHead and neck cancer (HNC) diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth (PTG), which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.MethodsTwenty HNC survivors between 9 months and 5 years post-diagnosis were recruited (11 male, 9 female, age range 46–83). They had a range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.ResultsFour themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking (e.g., on treatment decisions made) and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears (e.g., concerns about their future) or returned to negative experiences (e.g., distressing exchanges with healthcare professionals or what they perceived as poor care).ConclusionThis study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination (commonly focused on ongoing fears or inability to resolve difficult experiences) helps to identify those who may benefit from more directed psychological support.
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Adams L, Feicke J, Eckert T, Pikkemaat R, Spörhase U, Bitzer EM, Göhner W. Development, implementation and formative evaluation of a motivational-volitional intervention to promote sustainable physical activity in breast cancer survivors. Eur J Cancer Care (Engl) 2022; 31:e13732. [PMID: 36220629 DOI: 10.1111/ecc.13732] [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: 05/31/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the current project was the development, implementation and evaluation of the programme, Motivational-Volitional Intervention-Movement After Breast Cancer (Mo-Vo-BnB), an intervention for the sustainable promotion of physical activity of breast cancer survivors. METHODS In a multi-stage interdisciplinary development process, the pedagogical-didactic, psychological and physical evidence-based programme was developed and implemented for women after breast cancer who were approved for medical rehabilitation and were minimally, physically active (<60 min/week). Train-the-trainer seminars were carried out for the implementation. Four sessions were implemented in two German clinics. The training quality, didactic methods and accompanying material were evaluated 6 weeks and 12 months after implementation by patients, trainers and project members (n = 127 evaluations). RESULTS The standardised and published MoVo-BnB programme can provide practical and quality training. Content and methods can be implemented according to the manual. Training quality, didactic methods, and accompanying materials were evaluated positively. CONCLUSION The results suggest that MoVo-BnB is a useful standardised intervention for promoting the physical activity of breast cancer survivors. The demonstrated process is also suitable for other projects. CLINICAL TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00011122; Trial registration date: 2016 October 13.
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Affiliation(s)
- Leonie Adams
- University of Education Freiburg, Freiburg, Germany
| | | | | | | | | | | | - Wiebke Göhner
- Catholic University of Applied Sciences, Freiburg, Germany
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11
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Health-Related Quality of Life in Adrenocortical Carcinoma: Development of the Disease-Specific Questionnaire ACC-QOL and Results from the PROFILES Registry. Cancers (Basel) 2022; 14:cancers14061366. [PMID: 35326518 PMCID: PMC8946128 DOI: 10.3390/cancers14061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Patients with the rare cancer adrenocortical carcinoma are exposed to many symptoms and treatment side-effects. Research on how this can affect their health-related quality of life (HRQoL) is limited, however. This article includes the first assessment of HRQoL in a population-based cohort of patients with adrenocortical carcinoma with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire and the newly developed disease-specific additional questionnaire ACC-QOL. The ACC-QOL has good psychometric properties in terms of validity, reliability, and responsiveness. Patients diagnosed more than 5 years ago reported a relatively good HRQoL compared with the Dutch reference population, but experienced residual fatigue and emotional problems. Patients after additional surgery reported a slightly lower HRQoL due to physical limitations. Patients who had recently received mitotane or chemotherapy reported a worse HRQoL and problems in many domains. This knowledge and the new disease-specific questionnaire can aid future research, side-effect monitoring, treatment guidance, and shared decision making. Abstract We aimed to develop a disease-specific adrenocortical carcinoma (ACC) health-related quality of life (HRQoL) questionnaire (ACC-QOL) and assess HRQoL in a population-based cohort of patients with ACC. Development was in line with European Organization for Research and Treatment of Cancer (EORTC) guidelines, though not an EORTC product. In phase I and II, we identified 90 potential HRQoL issues using literature and focus groups, which were reduced to 39 by healthcare professionals. Pilot testing resulted in 28 questions, to be used alongside the EORTC QLQ-C30. In Phase III, 100 patients with ACC were asked to complete the questionnaires twice in the PROFILES registry (3-month interval, respondents: first 67, second 51). Confirmatory factor analysis demonstrated the structural validity of 26 questions with their scale structure (mitotane side-effects, hypercortisolism/hydrocortisone effects, emotional effects). Internal consistency and reliability were good (Cronbach’s alpha 0.897, Interclass correlation coefficient 0.860). Responsiveness analysis showed good discriminative ability (AUC 0.788). Patients diagnosed more than 5 years ago reported a good HRQoL compared with the Dutch reference population, but experienced residual fatigue and emotional problems. Patients who underwent recent treatment reported a lower HRQoL and problems in several domains. In conclusion, we developed an ACC-specific HRQoL questionnaire with good psychometric properties.
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Jiang Y, Ghias K, Gupta S, Gupta A. MicroRNAs as Potential Biomarkers for Exercise-Based Cancer Rehabilitation in Cancer Survivors. Life (Basel) 2021; 11:1439. [PMID: 34947970 PMCID: PMC8707107 DOI: 10.3390/life11121439] [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] [Received: 11/11/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
Expression and functions of microRNAs (miRNAs) have been widely investigated in cancer treatment-induced complications and as a response to physical activity, respectively, but few studies focus on the application of miRNAs as biomarkers in exercise-based cancer rehabilitation. Research has shown that certain miRNA expression is altered substantially due to tissue damage caused by cancer treatment and chronic inflammation. MiRNAs are released from the damaged tissue and can be easily detected in blood plasma. Levels of the miRNA present in peripheral circulation can therefore be used to measure the extent of tissue damage. Moreover, damage to tissues such as cardiac and skeletal muscle significantly affects the individual's health-related fitness, which can be determined using physiologic functional assessments. These physiologic parameters are a measure of tissue health and function and can therefore be correlated with the levels of circulating miRNAs. In this paper, we reviewed miRNAs whose expression is altered during cancer treatment and may correlate to physiological, physical, and psychological changes that significantly impact the quality of life of cancer survivors and their role in response to physical activity. We aim to identify potential miRNAs that can not only be used for monitoring changes that occur in health-related fitness during cancer treatment but can also be used to evaluate response to exercise-based rehabilitation and monitor individual progress through the rehabilitation programme.
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Affiliation(s)
| | | | | | - Ananya Gupta
- Department of Physiology, National University of Ireland, H91 TK33 Galway, Ireland; (Y.J.); (K.G.); (S.G.)
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13
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Lognos B, Glondu-Lassis M, Senesse P, Gutowski M, Jacot W, Lemanski C, Amouyal M, Azria D, Guerdoux E, Bourgier C. [Non-pharmalogical interventions and breast cancer: What benefit in addition to radiotherapy?]. Cancer Radiother 2021; 26:637-645. [PMID: 34756691 DOI: 10.1016/j.canrad.2021.09.011] [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: 06/21/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
Adjuvant radiotherapy is one of the major anticancer treatments in early breast cancer patients. Acute and late radio-induced effects may occur during or after breast cancer radiotherapy, and their medical management is a major issue for radiation oncologists. Here, the present review of literature embraces complementary non-pharmacological interventions, which could be combined to adjuvant radiotherapy in order to improve patients care.
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Affiliation(s)
- Béatrice Lognos
- Département Universitaire de Médecine Générale, Université de Montpellier, 34000 Montpellier, France; UMR UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Inserm, Université de Montpellier, Montpellier, France; Maison de santé pluriprofessionnelle universitaire Pauline Lautaud, St Georges d'Orques, Prades le Lez, Vendargues, France.
| | - Murielle Glondu-Lassis
- Département Universitaire de Médecine Générale, Université de Montpellier, 34000 Montpellier, France; UMR UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Inserm, Université de Montpellier, Montpellier, France
| | - Pierre Senesse
- Département des Soins de Support, Institut Régional du Cancer de Montpellier (ICM), France
| | - Marian Gutowski
- Département de Chirurgie, Institut Régional du Cancer de Montpellier (ICM), France
| | - William Jacot
- Département d'oncologie Médicale, Institut Régional du Cancer de Montpellier (ICM), France
| | - Claire Lemanski
- Fédération Universitaire d'Oncologie Radiothérapie, ICM, Institut régional du Cancer Montpellier, rue croix verte, 34298 Montpellier cedex 05, France
| | - Michel Amouyal
- Département Universitaire de Médecine Générale, Université de Montpellier, 34000 Montpellier, France
| | - David Azria
- Fédération Universitaire d'Oncologie Radiothérapie, ICM, Institut régional du Cancer Montpellier, rue croix verte, 34298 Montpellier cedex 05, France; IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Univ Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - Estelle Guerdoux
- UMR UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Inserm, Université de Montpellier, Montpellier, France; Département des Soins de Support, Institut Régional du Cancer de Montpellier (ICM), France
| | - Céline Bourgier
- Fédération Universitaire d'Oncologie Radiothérapie, ICM, Institut régional du Cancer Montpellier, rue croix verte, 34298 Montpellier cedex 05, France; IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Univ Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
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14
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Tennison JM, Sullivan CM, Fricke BC, Bruera E. Analysis of Adherence to Acute Inpatient Rehabilitation in Patients with Cancer. J Cancer 2021; 12:5987-5990. [PMID: 34539872 PMCID: PMC8425205 DOI: 10.7150/jca.61010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022] Open
Abstract
Importance: The need for cancer rehabilitation is expected to continue to dramatically increase with the aging population and increasing number of cancer survivors. These survivors experience a wide range of physical limitations and symptoms that negatively affect their health and quality of life. Research is needed to determine the rate of adherence, reasons for non-adherence, and interventions to improve adherence to acute inpatient rehabilitation among patients with cancer. Objective: To evaluate the rate of adherence and reasons for non-adherence to acute inpatient rehabilitation in patients with cancer. Design, Setting, and Participants: This was a secondary analysis of a retrospective study that assessed medical complications in 165 patients with cancer who had a median length of stay of 11 days (interquartile range of 8-14) in acute inpatient rehabilitation. We reviewed the records of all consecutive patients who underwent acute inpatient rehabilitation from September 1, 2017 through February 28, 2018 at a large academic, quaternary National Cancer Institute-designated Cancer Center. Main Outcomes and Measures: We calculated the rehabilitation session adherence rate and descriptively summarized the reasons for non-adherence. Results: There were 78/165 (47%) patients that had 1 or more incomplete rehabilitation sessions due to medical complications. These patients had a median of 2 (interquartile range of 1-4) incomplete rehabilitation sessions. We noted other reasons for incomplete rehabilitation sessions in 146/165 (89%) patients, who had a median of 3 (interquartile range of 2-4) incomplete rehabilitation sessions. The median total number of days with incomplete rehabilitation sessions in the entire cohort was 2 (interquartile range 1-3). Conclusion and Relevance: Among patients with cancer undergoing acute inpatient rehabilitation, the adherence rate to 1-hour long intensive rehabilitation sessions were low due to medical complications and other reasons. This in turn affected compliance with the 3 hours of rehabilitation a day requirement for acute inpatient rehabilitation. Patients with cancer undergoing acute inpatient rehabilitation are medically complex and further research at multiple institutions with larger cohorts may be beneficial in further assessing adherence rates and reasons for non-adherence to improve participation in acute inpatient rehabilitation.
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Affiliation(s)
- Jegy M Tennison
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carly M Sullivan
- Department of Rehabilitation Services, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian C Fricke
- Department of Rehabilitation Medicine, UT Health San Antonio Long School of Medicine, San Antonio, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Covington KR, Marshall T, Campbell G, Williams GR, Fu JB, Kendig TD, Howe N, Alfano CM, Pergolotti M. Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. Support Care Cancer 2021; 29:6469-6480. [PMID: 33900458 DOI: 10.1007/s00520-021-06208-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. METHODS From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format. RESULTS We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains. CONCLUSIONS The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.
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Affiliation(s)
- Kelley R Covington
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA. .,Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA.
| | | | - Grace Campbell
- Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.,Department of Occupational Therapy, University of Pittsburgh School of Health & Rehabilitation Sciences, Pittsburgh, PA, USA.,UPMC Hillman Cancer Center at UPMC Magee Women's Hospital, Pittsburgh, PA, USA
| | - Grant R Williams
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tiffany D Kendig
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.,Kessler Institute of Rehabilitation, West Orange, NJ, USA
| | - Nancy Howe
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, USA.,Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
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16
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Weis J, Dresch C, Bartsch HH, Kurlemann U, Maiwald P, Rademaker AL, Valentini J, Joos S, Heidt V. Barrieren der Antragstellung in der Onkologischen Rehabilitation: Eine bundesweite Expertenstudie. DIE REHABILITATION 2021; 60:95-101. [DOI: 10.1055/a-1361-4050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Ziel der Studie Aus Perspektive verschiedener Expertengruppen, die in der Versorgung onkologisch Erkrankter tätig sind, werden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsmaßnahmen identifiziert. Darauf aufbauend werden Handlungsempfehlungen zur Optimierung abgeleitet. Die Studie wurde von der Deutschen Rentenversicherung Bund (DRV) gefördert.
Methodik Auf Basis einer Interviewstudie (N=61) wurde ein Fragebogeninstrument mit 55 Items zu möglichen Barrieren im Antragstellungsprozess konzipiert und online eingesetzt. Teilnehmer mit mehr als 33% fehlenden Werten wurden von den Analysen ausgeschlossen. Mittelwertanalysen wurden zur Identifikation der bedeutsamsten Relevanz angewendet. Um übergeordnete Dimensionen zu identifizieren, wurde eine exploratorische Faktorenanalyse durchgeführt.
Ergebnisse Insgesamt wurden 606 Experten aus dem onkologischen Bereich in die Auswertung eingeschlossen. Darunter waren 249 Ärzte, 194 Sozialarbeiter, 105 Pflegefachkräfte / Medizinische Fachangestellte, 55 Psychologen / Psychoonkologen und 3 sonstige Berufsgruppen. Die befragten Experten waren im Mittel 51 Jahre alt (SD=10,4) und seit 17 Jahren (SD=9,8) im onkologischen Bereich tätig. Die Barrieren konnten folgenden 7 faktoranalytisch bestimmten Inhaltsbereichen zugeordnet werden: Krankheitsverarbeitung, Antragsverfahren, Rehafähigkeit, Koordination, soziale Verpflichtungen, Patientenwünsche und Stellenwert der Reha. Die Experten gaben an, dass insbesondere der Wunsch des Patienten nach Normalität, die zu starre Frist für die Anschlussrehabilitation (AHB) und das für Patienten mit Migrationshintergrund schlecht verständliche Antragsverfahren einer Antragstellung entgegenstehen kann. Außerdem wurde darauf hingewiesen, dass die Vermittlung von multimorbiden Patienten in die Rehabilitationseinrichtungen schwierig sei.
Schlussfolgerung Aus der Expertenstudie können folgende Handlungsempfehlungen für einen erleichterten Rehabilitationszugang abgeleitet werden: Optimierung der Koordination zwischen verschiedenen Expertengruppen; Einrichtungen und mit den Kostenträgern, Flexibilisierung der AHB-Frist, Vereinfachung der Antragstellung, Bereitstellung von Anträgen / Informationsmaterialien in weiteren Sprachen, Ausrichtung der Reha-Kliniken auf spezifische Patientengruppen.
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Affiliation(s)
- Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Medizinische Fakultät, Universität Freiburg
| | | | | | - Ulrich Kurlemann
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e. V. (DVSG), Berlin, Universitätsklinikum Münster
| | - Phillip Maiwald
- Klinik für onkologische Rehabilitation, Universitätsklinikum Freiburg
| | - Anna Lena Rademaker
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e. V. (DVSG), Berlin, Fachhochschule Bielefeld
| | - Jan Valentini
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Stefanie Joos
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Vitali Heidt
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO), Köln
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17
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Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin 2021; 71:149-175. [PMID: 33107982 PMCID: PMC7988887 DOI: 10.3322/caac.21639] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology/Oncology Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kathleen D Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Hanover, New Hampshire
| | - Karen Robb
- North East London Cancer Alliance, London, United Kingdom
- Transforming Cancer Services Team for London, Healthy London Partnership, London, United Kingdom
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
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18
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Dorey G, Cabaset S, Richard A, Dehler A, Kudre D, Schneider-Mörsch B, Sperisen N, Schmid M, Rohrmann S. National study for multidisciplinary outpatient oncological rehabilitation: online survey to support revised quality and performance criteria. Support Care Cancer 2020; 29:3839-3847. [PMID: 33294950 PMCID: PMC8163662 DOI: 10.1007/s00520-020-05913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE More and more people survive cancer, but the disease and its treatment often lead to impairment. Multidisciplinary ambulatory oncological rehabilitation (OR) programs have thus been developed. SW!SS REHA, the organization of major Swiss rehabilitation clinics, has defined ambulatory OR quality criteria for its members (about 50% of the Swiss rehabilitation capacity). However, SW!SS REHA criteria are not fully implemented and/or interpreted differently by different specialties or in different linguistic regions in Switzerland. The aim of our study was to carry out an online survey of existing outpatient programs to define quality criteria for an ideal OR program in Switzerland. METHODS A mixed methods approach was used for the survey-qualitative and quantitative. The qualitative part consisted of a guided discussion with OR experts and the quantitative part of an online survey. The quantitative part comprised the development and evaluation of an online questionnaire. It served to record the opinions of OR centers in Switzerland on the desired situation of outpatient rehabilitation. RESULTS Eighteen OR centers and 71 (49.7% response rate) OR actors participated in the online survey. The survey results indicate that some of the SW!SS REHA quality and performance criteria only partially match with the desired OR criteria for Switzerland. Key disparities occur particularly in the program design and structure and specifically around how many interventions are required to constitute an OR program, the extent of standardization versus individualization of the program, i.e., how many and which modules in a program should be obligatory, and finally the duration and intensity of the program. The online survey did not generate any statistical evidence that OR requirements vary significantly between different linguistic regions and among different specialties. CONCLUSIONS Cancer patients are heterogeneous with respect to cancer type, prognosis, and disability level, such that a standard program cannot be uniformly applied. Therefore, a flexible program is required with few mandatory modules and additional individual modules to achieve the threshold number of modules that would constitute a multidisciplinary OR program. Intensity and frequency of OR needs to consider the health state of the participants. The results indicate a need to modify some of the existing SW!SS REHA criteria to ensure that more patients can gain access and benefit form evidence-based OR interventions. Furthermore, the survey provides important findings so that the existing OR offer can be improved with the goal that OR centers will be able to be quality certified in the future.
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Affiliation(s)
- Graham Dorey
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland
| | - Sophie Cabaset
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland
| | - Aline Richard
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland
| | - Anna Dehler
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland
| | - Daisy Kudre
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland
| | | | - Nicolas Sperisen
- Krebsliga Schweiz, Effingerstrasse 40, CH-3001, Bern, Switzerland
| | - Margareta Schmid
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 82, CH-8001, Zurich, Switzerland.
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Dresch C, Bartsch HH, Kurlemann U, Maiwald P, Rademaker A, Valentini J, Joos S, Heidt V, Weis J. [Barriers in the Application Process for Oncological Rehabilitation: Results of a Qualitative Expert Survey]. REHABILITATION 2020; 60:235-242. [PMID: 33152777 DOI: 10.1055/a-1248-4979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE In this study, which was funded by the German Federal Pension Fund (DRV), barriers in the application process for oncological rehabilitation services were examined from the perspective of various expert groups. METHODS In an exploratory multicentre qualitative cross-sectional study 61 semi-structured interviews with experts working in oncological care were conducted: Physicians (n=26), social workers (n=22), psychologists/psycho-oncologists (n=6), nurses/medical assistants (n=5), administrative staff of the DRV (n=2). In guided interviews the participants were asked about their experiences with rehabilitation applications as well as their estimations and evaluations regarding possible reasons for non-utilisation. The evaluation of the interviews was computerized and based on the qualitative content analysis by Mayring. RESULTS The respondents had an average age of 52.51 years (SD=10.06; min=25, max=71) and were working in the consultation or treatment of oncological patients for an average of 19.26 years (SD=10.15; min=1, max=42). In total, 854 statements were coded and assigned to the following three main categories: expert-related, system-related and patient-related barriers. In the first main category, scepticism about the benefits of rehabilitation services and an insufficiently met need for information on the part of experts became the focus of attention. In the main category of system-related barriers, aspects were mentioned that addressed the application procedure, the low availability of, for example, outpatient rehabilitation services and the absence of a functioning referral system. The main category of patient-related barriers included psychosocial factors such as subcategories on the topic of coping with the disease which include the patient's desire to come home, experience everyday life again and the fear of being confronted with the disease. CONCLUSION The exploratory study revealed potential barriers in the application process for oncological rehabilitation services from an expert perspective. In particular, the findings form the basis for a multi-dimensional assessment instrument that can be used to analyze the barriers in a standardised way and to derive individual recommendations for action.
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Affiliation(s)
| | | | - Ulrich Kurlemann
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e.V. (DVSG), Berlin, Universitätsklinikum Münster
| | - Phillip Maiwald
- Klinik für onkologische Rehabilitation, Universitätsklinikum Freiburg
| | - AnnaLena Rademaker
- Deutsche Vereinigung für Soziale Arbeit im Gesundheitswesen e.V. (DVSG), Berlin, Fachhochschule Bielefeld
| | - Jan Valentini
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Stefanie Joos
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Vitali Heidt
- Wissenschaftliches Institut der Niedergelassenen Hämatologen und Onkologen (WINHO), Köln
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Universitätsklinikum Freiburg
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IJsbrandy C, Ottevanger PB, Gerritsen WR, van Harten WH, Hermens RPMG. Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study. J Cancer Surviv 2020; 15:163-177. [PMID: 32986232 PMCID: PMC7822788 DOI: 10.1007/s11764-020-00921-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. METHODS We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). RESULTS Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47-2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31-2.45), referral to PCRPs (OR 1.81, 95% CI 1.18-2.78), participation in PCRPs (OR 2.04, 95% CI 1.43-2.91), and PAU (OR 1.69, 95% CI 1.25-2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. CONCLUSIONS The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. IMPLICATIONS FOR CANCER SURVIVORS Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
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Affiliation(s)
- Charlotte IJsbrandy
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands. .,Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. .,Department of Radiation Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, MB-HTSR, University of Twente, Enschede, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Science (RIHS), Radboud University Medical Center Nijmegen, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
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21
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MacDonald AM, Chafranskaia A, Lopez CJ, Maganti M, Bernstein LJ, Chang E, Langelier DM, Obadia M, Edwards B, Oh P, Bender JL, Alibhai SMH, Jones JM. CaRE @ Home: Pilot Study of an Online Multidimensional Cancer Rehabilitation and Exercise Program for Cancer Survivors. J Clin Med 2020; 9:jcm9103092. [PMID: 32992759 PMCID: PMC7600555 DOI: 10.3390/jcm9103092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although facility-based cancer rehabilitation and exercise programs exist, patients are often unable to attend due to distance, cost, and other competing obligations. There is a need for scalable remote interventions that can reach and serve a larger population. METHODS We conducted a mixed methods pilot study to assess the feasibility, acceptability and impact of CaRE@Home: an 8-week online multidimensional cancer rehabilitation and exercise program. Feasibility and acceptability data were captured by attendance and adherence metrics and through qualitative interviews. Preliminary estimates of the effects of CaRE@Home on patient-reported and physically measured outcomes were calculated. RESULTS A total of n = 35 participated in the study. Recruitment (64%), retention (83%), and adherence (80%) rates, along with qualitative findings, support the feasibility of the CaRE@Home intervention. Acceptability was also high, and participants provided useful feedback for program improvements. Disability (WHODAS 2.0) scores significantly decreased from baseline (T1) to immediately post-intervention (T2) and three months post-intervention (T3) (p = 0.03 and p = 0.008). Physical activity (GSLTPAQ) levels significantly increased for both Total LSI (p = 0.007 and p = 0.0002) and moderate to strenuous LSI (p = 0.003 and p = 0.002) from baseline to T2 and T3. Work productivity (iPCQ) increased from T1 to T3 (p = 0.026). There was a significant increase in six minute walk distance from baseline to T2 and T3 (p < 0.001 and p = 0.010) and in grip strength from baseline to T2 and T3 (p = 0.003 and p < 0.001). CONCLUSIONS Results indicate that the CaRE@Home program is a feasible and acceptable cancer rehabilitation program that may help cancer survivors regain functional ability and decrease disability. In order to confirm these findings, a controlled trial is required.
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Affiliation(s)
- Anne Marie MacDonald
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- IMS Program, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Aleksandra Chafranskaia
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Physical Therapy, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Christian J. Lopez
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada;
| | - Lori J. Bernstein
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Eugene Chang
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
| | - David Michael Langelier
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
| | - Maya Obadia
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Beth Edwards
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Paul Oh
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
| | - Jacqueline L. Bender
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
| | - Shabbir MH Alibhai
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.O.); (S.M.A.)
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Jennifer M. Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; (A.M.M.); (A.C.); (C.J.L.); (L.J.B.); (E.C.); (D.M.L.); (M.O.); (B.E.); (J.L.B.)
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
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Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil 2020; 34:571-583. [PMID: 32037876 PMCID: PMC7350200 DOI: 10.1177/0269215520905112] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. METHOD This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. FINDINGS The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. CONCLUSION Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient's needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.
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Affiliation(s)
- Derick T Wade
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR) and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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23
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Steenaard RV, Kremers MNT, Michon LA, Zijlstra M, Haak HR. Patient and Partner Perspectives on Health-Related Quality of Life in Adrenocortical Carcinoma. J Endocr Soc 2020; 4:bvaa040. [PMID: 32342024 PMCID: PMC7174051 DOI: 10.1210/jendso/bvaa040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022] Open
Abstract
Little is known about the impact of adrenocortical carcinoma (ACC) on health-related quality of life (HRQoL), and no disease-specific questionnaire exists. This qualitative study aimed to identify relevant domains of HRQoL for patients with ACC. In 2 focus group interviews, we discussed concerns regarding living with ACC and its treatments. The first group consisted of 6 patients on mitotane therapy and their partners or relatives, the second group of 4 patients after surgery alone and their partners. Inductive qualitative content analysis was used to analyze the interviews. We identified 4 domains related to HRQoL in patients with ACC, namely physical complaints, mental consequences, social consequences, and functional limitations. For example, physical complaints included symptoms of the disease and side effects of mitotane therapy; mental consequences included feeling insecure and living from scan to scan; and functional limitations included daily activities and mobility. We further found that patients' experiences with the health care system and health care professionals and partner perspectives influence HRQoL. In conclusion, ACC has a large impact on HRQoL in 4 domains. These results can be used to improve communication about HRQoL issues. We will use our findings to generate a disease-specific questionnaire to measure HRQoL in patients with ACC.
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Affiliation(s)
- Rebecca V Steenaard
- Department of Internal Medicine, Máxima MC, Eindhoven/Veldhoven, the Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Marjolein N T Kremers
- Department of Internal Medicine, Máxima MC, Eindhoven/Veldhoven, the Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Laura A Michon
- Department of Internal Medicine, Máxima MC, Eindhoven/Veldhoven, the Netherlands
| | - Myrte Zijlstra
- Department of Internal Medicine, St. Jans Gasthuis, Weert, the Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Harm R Haak
- Department of Internal Medicine, Máxima MC, Eindhoven/Veldhoven, the Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Forbes CC, Swan F, Greenley SL, Lind M, Johnson MJ. Physical activity and nutrition interventions for older adults with cancer: a systematic review. J Cancer Surviv 2020; 14:689-711. [PMID: 32328828 PMCID: PMC7473955 DOI: 10.1007/s11764-020-00883-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
Purpose The aim of this review was to summarize the current literature for the effectiveness of activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults living with and beyond cancer (LWBC). Methods We conducted systematic structured searches of CINAHL, Embase, Medline, Cochrane CENTRAL databases, and bibliographic review. Two independent researchers selected against inclusion criteria: (1) lifestyle nutrition and/or activity intervention for people with any cancer diagnosis, (2) measured HRQoL, (3) all participants over 60 years of age and (4) randomized controlled trials. Results Searches identified 5179 titles; 114 articles had full text review, with 14 studies (participant n = 1660) included. Three had nutrition and activity components, one, nutrition only and ten, activity only. Duration ranged from 7 days to 1 year. Interventions varied from intensive daily prehabilitation to home-based gardening interventions. Studies investigated various HRQoL outcomes including fatigue, general and cancer-specific quality of life (QoL), distress, depression, global side-effect burden and physical functioning. Eight studies reported significant intervention improvements in one or more QoL measure. Seven studies reported using a psychosocial/theoretical framework. There is a gap in tailored nutrition advice. Conclusions Among the few studies that targeted older adults with cancer, most were activity-based programmes with half reporting improvements in QoL. Future research should focus on or include tailored nutrition components and consider appropriate behaviour change techniques to maximize potential QoL improvement. Implications for Cancer Survivors More research is needed to address the research gap regarding older adults as current recommendations are derived from younger populations. Electronic supplementary material The online version of this article (10.1007/s11764-020-00883-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK. .,University of Hull, Allam Medical Building 3rd Floor, Cottingham Road, Kingston-Upon-Hull, East Yorkshire, HU6 7RX, UK.
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Sarah L Greenley
- Academy of Primary Care, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Michael Lind
- Cancer Research Group, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
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Denti M, Accogli MA, Costi S, Fugazzaro S. Therapeutic Education and Physical Activity to Support Self-management of Cancer-related Fatigue in Hematologic Cancer Patients: Protocol of a Feasibility Randomized Controlled Trial. Integr Cancer Ther 2020; 19:1534735420969830. [PMID: 33243016 PMCID: PMC7705784 DOI: 10.1177/1534735420969830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hematologic malignancies account for nearly 8% of new cancer diagnosis in Italy. Cancer-related fatigue (CRF) is one of the most distressing symptoms reported by patients with cancer. As CRF has a multifactorial etiology, physical activity and therapeutic education may be beneficial for managing CRF, both during and after cancer treatment. However, there is a lack of evidence specific to hematologic malignancies. This paper describes the protocol of a feasibility study on Therapeutic Education and Physical Activity (TEPA) intervention to support self-management of CRF in patients with hematologic malignancies. METHODS TEPA was addressed to newly diagnosed adult individuals with hematologic malignancy able to take part in a rehabilitation programme at the AUSL-IRCCS of Reggio Emilia. The protocol was developed in 2 phases. Phase I was an observational cohort study involving a convenience sample of 10 participants with the aim to evaluate the feasibility of the assessment schedule and to register longitudinal clinical data regarding CRF (FACIT-F), psychologic distress (NCCN Distress Thermometer), QoL (EORTC QLQ-C30), physical performance (TUG and 6MWT) and habitual level of physical activity during first months after diagnosis. Phase II (underway) is a feasibility randomized controlled trial (TEPA) involving a convenience sample of 40 participants and comparing 2 parallel active interventions (Therapeutic Education versus Therapeutic Education and Physical Activity) on top of usual care. The primary aim is to estimate the feasibility of TEPA, measured by the adherence rate to the intervention. Secondary aims are: to estimate the effect size of TEPA in terms of changes in CRF, psychological distress, QoL, physical performance and habitual level of physical activity (measured as in Phase I); to collect patient satisfaction, perception of usefulness of the TEPA intervention and data on long-term adherence to an active lifestyle. Data are collected in both phases at the time of diagnosis and then at 1-, 3- (completion of intervention) and 7-month follow-up. DISCUSSION Data on feasibility and effect size of TEPA will be analyzed upon completion of Phase II, allowing us to design a large, adequately powered RCT to verify the effectiveness of this intervention on CRF management in patients with hematologic cancer. Trial registration: clinicaltrials.gov; Trial registration number: NCT03403075.
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Affiliation(s)
- Monica Denti
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monia Allisen Accogli
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Mujcic A, Blankers M, Bommelé J, Boon B, Berman AH, Verdonck‐de Leeuw IM, van Laar M, Engels R. The effectiveness of distance‐based interventions for smoking cessation and alcohol moderation among cancer survivors: A meta‐analysis. Psychooncology 2020; 29:49-60. [PMID: 31663182 PMCID: PMC8246955 DOI: 10.1002/pon.5261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate current evidence for the effectiveness of distance-based interventions to support smoking cessation (SC) or alcohol moderation (AM) among cancer survivors. Secondary, differences in effectiveness are explored regarding multibehaviour interventions versus single-behaviour interventions targeting SC or AM only. METHODS A systematic search of PubMed, PsycINFO, Web of Science, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials was conducted. Intervention studies with and without control groups and randomized controlled trials were included. Random effects meta-analyses were conducted for the main outcomes: SC and AM rates at the follow-up closest to 6 months. Using subgroup analyses and meta-regression, effectiveness of single-behaviour versus multibehaviour interventions was evaluated. RESULTS A total of 17 studies with 3796 participants; nine studies on SC only, eight studies on multibehaviour interventions including an SC or AM module, and no studies on AM only were included. All studies had at least some concerns regarding bias. Distance-based SC interventions led to higher cessation rates than control conditions (10 studies, odds ratio [OR] = 1.56; 95% CI, 1.13-2.15, P = .007). Single-behaviour SC interventions reduced smoking rates compared with baseline (risk difference [RD] = 0.29; 95% CI, 0.19-0.39, P < .0001), but multibehaviour interventions did not (RD = 0.13; 95% CI, -0.05 to 0.31, P = 0.15). There was insufficient evidence that distance-based multibehaviour interventions reduced alcohol use compared with controls (three studies, standardized mean difference [SMD] = 0.12; 95% CI, -0.08 to 0.31, P = .24). CONCLUSIONS Distance-based SC interventions are effective in supporting SC among cancer survivors. Single-behaviour SC interventions appear more effective than multibehaviour interventions. No evidence was found for the effectiveness of distance-based AM interventions for cancer survivors.
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Affiliation(s)
- Ajla Mujcic
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Erasmus School of Social and Behavioural SciencesErasmus University RotterdamRotterdamThe Netherlands
| | - Matthijs Blankers
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Department of Research, Arkin Mental Health CareAmsterdamThe Netherlands
- Amsterdam UMC, Location AMC, Department of PsychiatryUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jeroen Bommelé
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Brigitte Boon
- Academy Het Dorp Department Scientific Research, Siza Arnhem, The NetherlandsArnhemThe Netherlands
- Department Scientific ResearchSizaArnhemThe Netherlands
| | - Anne H. Berman
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
- Stockholm Center for Dependency DisordersStockholm Health Care Services, Stockholm RegionStockholmSweden
- Department of Public Health SciencesStockholm UniversityStockholmSweden
| | - Irma M. Verdonck‐de Leeuw
- Department of Otolaryngology—Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center AmsterdamAmsterdamThe Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public HealthAmsterdamThe Netherlands
| | - Margriet van Laar
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Rutger Engels
- Erasmus School of Social and Behavioural SciencesErasmus University RotterdamRotterdamThe Netherlands
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Rossen S, Trier K, Christensen B, Eriksen MA, Zwisler AD, Vibe-Petersen J. Municipality-based pragmatic rehabilitation stratified in accordance with individual needs-results from a longitudinal survey study. Support Care Cancer 2019; 28:1951-1961. [PMID: 31375907 DOI: 10.1007/s00520-019-04993-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/11/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evidence on municipality-based cancer rehabilitation is sparse. This longitudinal study explores the following: (1) Rehabilitation needs, (2) effectiveness of municipality-based rehabilitation, and (3) whether rehabilitative services are stratified according to individual needs in breast cancer patients. METHODS We collected data from a longitudinal survey among 82 breast cancer patients referred to municipality-based rehabilitation at the Copenhagen Centre for Cancer and Health. Rehabilitation needs, health-related quality of life (HRQoL), and functional status were collected using patient-reported outcomes (PROs) including distress thermometer, problem list, Functional Assessment of Cancer Therapy-Breast questionnaire (FACT-B), and upper body function with the abbreviated disability of the arm, shoulder, and hand (Quick-DASH) questionnaire. Data collection time points are as follows: entry, follow-up, and end of intervention. RESULTS At referral, scores were (mean (range)) distress 4.0 (0-10), problems 9.5 (0-24), and FACT-B 103.0 (49.8-135.5). HRQoL increased during rehabilitation (FACT-B ∆ mean 8.1 points (> MID, p < 0.0001)); 56% had a positive change, 34% no difference, and 11% a decline. Those with the lowest FACT-B entry score had significantly longer duration of rehabilitation (10.9 vs 8.7 months, p < 0.001), higher number of services (7.0 vs 5.3, p < 0.003), and participated more in group-based exercise (+3 sessions: 57% vs 8%, p < 0.001). CONCLUSION This is the first study to report on pragmatic municipality-based cancer rehabilitation. The results suggest that services are aimed at patients with rehabilitation needs, improve HRQoL, and are properly stratified to those who need it the most. We suggest future monitoring of municipality-based rehabilitation services to ensure quality of care.
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Affiliation(s)
- Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, DK-2200, Copenhagen N, Denmark.
| | - Karen Trier
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, DK-2200, Copenhagen N, Denmark
| | - Berit Christensen
- Department for Data and Analysis, Municipality of Copenhagen, Sjællandsgade 40, DK-2200, Copenhagen N, Denmark
| | - Martina A Eriksen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Vestergade 17, DK-5800, Nyborg, Denmark
| | - Jette Vibe-Petersen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, DK-2200, Copenhagen N, Denmark
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Bana M, Ribi K, Kropf-Staub S, Zürcher-Florin S, Näf E, Manser T, Bütikofer L, Rintelen F, Peters S, Eicher M. Implementation of the Symptom Navi © Programme for cancer patients in the Swiss outpatient setting: a study protocol for a cluster randomised pilot study (Symptom Navi© Pilot Study). BMJ Open 2019; 9:e027942. [PMID: 31289075 PMCID: PMC6615799 DOI: 10.1136/bmjopen-2018-027942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Self-management interventions show promising results on symptom outcomes and self-management behaviours. The Symptom Navi© Programme (SN©P) is a nurse-led intervention supporting patients' symptom self-management during anticancer treatment. It consists of written patient information (Symptom Navi© Flyers (SN©Flyers)), semistructured consultations and a training manual for nurses. METHODS AND ANALYSIS This pilot study will evaluate the implementation of the SN©P based on the Reach Effectiveness-Adoption Implementation Maintenance framework at Swiss outpatient cancer centres. We will use a cluster-randomised design and randomise the nine participating centres to the intervention or usual care group. We expect to include 140 adult cancer patients receiving first-line systemic anticancer treatment. Trained nurses at the intervention clusters will provide at least two semistructured consultations with the involvement of SN©Flyers. Outcomes include patients' accrual and retention rates, patient-reported interference of symptoms with daily functions, symptom burden, perceived self-efficacy, quality of nursing care, nurse-reported facilitators and barriers of adopting the programme, nurses' fidelity of providing the intervention as intended, and patients' safety (patients timely reporting of severe symptoms). We will use validated questionnaires for patient-reported outcomes, focus group interviews with nurses and individual interviews with oncologists. Linear mixed models will be used to analyse patient-reported outcomes. Focus group and individual interviews will be analysed by thematic analysis. ETHICS AND DISSEMINATION The Symptom Navi© Pilot Study has been reviewed and approved by Swiss Ethic Committee Bern (KEK-BE: 2017-00020). Results of the study will be disseminated in peer-reviewed journal and at scientific conferences. TRIAL REGISTRATION NUMBER NCT03649984; Pre-results.
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Grants
- Swiss Cancer League, Bern, Switzerland
- Lindenhofgruppe, Bern, Switzerland
- CHUV, Departement of Oncology, Lausanne, Switzerland
- Heds-FR, School of Health Sciences, Fribourg, Switzerland
- Dr. Hans Altschüler Stiftung, St. Gallen, Switzerland
- Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University of Lausanne, Switzerland
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Affiliation(s)
- Marika Bana
- HedS-FR School of Health Sciences, University of Applied Science and Arts Western Switzerland, Fribourg, Switzerland
- IUFRS Institut de formation et de recherche en soins, Université de Lausanne Faculté de biologie et médecine, Lausanne, Switzerland
| | - Karin Ribi
- IUFRS Institut de formation et de recherche en soins, Université de Lausanne Faculté de biologie et médecine, Lausanne, Switzerland
- Quality ofLife Office, International Breast Cancer Study Group, Bern, Switzerland
| | | | | | - Ernst Näf
- Department of Practice Development in Nursing, Solothurner Spitaler AG, Solothurn, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | | | | | | | - Manuela Eicher
- IUFRS Institut de formation et de recherche en soins, Université de Lausanne Faculté de biologie et médecine, Lausanne, Switzerland
- Departement of Oncology, CHUV, Lausanne, Switzerland
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Treanor CJ, Santin O, Prue G, Coleman H, Cardwell CR, O'Halloran P, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev 2019; 6:CD009912. [PMID: 31204791 PMCID: PMC6573123 DOI: 10.1002/14651858.cd009912.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.
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Affiliation(s)
- Charlene J Treanor
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Olinda Santin
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Gillian Prue
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Helen Coleman
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Peter O'Halloran
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Michael Donnelly
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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Martinez-Martin E, Cazorla M. Rehabilitation Technology: Assistance from Hospital to Home. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2019; 2019:1431509. [PMID: 31281333 PMCID: PMC6589308 DOI: 10.1155/2019/1431509] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/28/2019] [Indexed: 11/18/2022]
Abstract
Rehabilitation is essential for disabled people to achieve the highest level of functional independence, reducing or preventing impairments. Nonetheless, this process can be long and expensive. This fact together with the ageing phenomenon has become a critical issue for both clinicians and patients. In this sense, technological solutions may be beneficial since they reduce the costs and increase the number of patients per caregiver, which makes them more accessible. In addition, they provide access to rehabilitation services for those facing physical, financial, and/or attitudinal barriers. This paper presents the state of the art of the assistive rehabilitation technologies for different recovery methods starting from in-person sessions to complementary at-home activities.
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Affiliation(s)
| | - Miguel Cazorla
- RoViT, University of Alicante, P.O. Box 99, 03080 Alicante, Spain
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Csontos JK, Fitzsimmons D, Jones M, Wilkinson WM, Horton J, Love-Gould L, Tee A, Watts T. Realist evaluation of cancer rehabilitation services in South Wales (REEACaRS): a mixed methods study protocol. BMJ Open 2019; 9:e025953. [PMID: 31015271 PMCID: PMC6500344 DOI: 10.1136/bmjopen-2018-025953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Long-term and late effects of cancer treatments can cause functional limitations and reduce quality of life. Cancer rehabilitation services, which can comprise physical exercise, psychological support and educational interventions depending on the individual's needs, have been found to have a positive effect on health-related quality of life worldwide. However, accessibility or the lack of awareness on available help can act as barriers and influence the uptake of services, resulting in people having unmet rehabilitation needs. In Wales, UK, 41% of people, who have had health and social care needs resulting from cancer and its treatments, reported that they did not receive care when needed. The reason for this lack of support has not yet been fully investigated. The aim of this study is to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms in South Wales, UK, specifically addressing barriers, facilitators and costs. METHODS AND ANALYSIS Realist evaluation, which explains for whom a service works in what circumstances and how through context-mechanism-outcome pattern conjunctions, will be used in three phases to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms. Phase 1 will be secondary analysis of a cancer rehabilitation database from a local Health Board to give context to who are accessing rehabilitation. Phase 2 will be thematic analysis of face-to-face, semistructured rehabilitation participant (n=20) and healthcare professional (n=20) interviews to explore the mechanisms of how cancer rehabilitation works. Phase 3 will be two case studies and cost-consequences analysis of cancer rehabilitation services. ETHICS AND DISSEMINATION This study received favourable ethical opinion from London South-East Research Ethics Committee (17/LO/2123) in December 2017. This project is part of the author's PhD thesis and it is expected that the findings will be disseminated in academic journals and at local and international conferences.
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Affiliation(s)
| | | | | | | | - Joanne Horton
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | | | - Anna Tee
- Macmillan Cancer Support, Bridgend, UK
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Lyons KD, Newman RM, Sullivan M, Pergolotti M, Braveman B, Cheville AL. Employment Concerns and Associated Impairments of Women Living With Advanced Breast Cancer. Arch Rehabil Res Clin Transl 2019; 1:100004. [PMID: 33543044 PMCID: PMC7853337 DOI: 10.1016/j.arrct.2019.100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To describe the clinical and personal factors associated with work status, distress regarding work status, and the desire to resume employment and receive help to address work challenges reported by women living with advanced breast cancer. Design Descriptive statistics and univariate and multivariate logistic regression were used to explore factors related to employment challenges in this secondary analysis of an existing dataset. Setting Participants were recruited from an outpatient oncology clinic specializing in breast cancer at a free-standing comprehensive cancer center. Participants English-speaking women older than 18 years living with metastatic breast cancer with intact mental status and Karnofsky Performance Scale scores between 40 and 90 (N=163). Intervention Not applicable. Main Outcome Measures Dependent variables included (1) continued employment if working at the time of cancer diagnosis; (2) interest in resuming employment if working at the time of cancer diagnosis and now no longer working; (3) distress regarding vocational limitations; and (4) interest in receiving help to resume work. Results Seventy percent of the sample was working before their cancer diagnosis (n=114), yet only 21% (n=35) was working when surveyed. Lower functional status and higher symptom burden were strongly and consistently associated with lack of work retention, distress related to vocational role limitations, and desire for help in addressing limitations (all P values<.01). Conclusions With more people living longer with metastatic cancer, there is a need to assess and support survivors’ desire and capacity to maintain employment. Participants’ reduced employment was strongly associated with potentially actionable clinical targets (ie, higher symptom burden and lower functional status) that fall within cancer rehabilitation’s mission.
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Affiliation(s)
- Kathleen Doyle Lyons
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Psychiatry, Dartmouth College, Hanover, New Hampshire
| | - Robin M Newman
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | | | | | | | - Andrea L Cheville
- Physical Medicine and Rehabilitation Department, Mayo Clinic, Rochester, Minnesota
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Heim ME, Länzlinger B, Wünnenberg E, Sigrist S, Frank B, Berthold I, Schröter T. [Verbesserung der Lebensqualität durch integrative onkologische Rehabilitation]. Complement Med Res 2019; 26:166-173. [PMID: 30947174 DOI: 10.1159/000495421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
Abstract
Hintergrund: Die onkologische Rehabilitation ist integraler Bestandteil der Versorgung krebskranker Menschen. Nach einer dreiwöchigen stationären Rehabilitation mit multimodalem und integrativem Ansatz wurden die Effekte auf Belastungen und Lebensqualität der Patienten überprüft. Patienten und Methoden: 74 Krebspatienten erhielten ein komplexes Therapieprogramm, das Therapien zur Verbesserung der funktionalen Gesundheit, zur Reduktion psychosozialer Belastungen und komplementäre Massnahmen beinhaltete. Der Erfolg der Therapie wurde mit validierten Fragebögen am Abschluss der Rehabilitation (T2) und 3 Monate danach (T3) bestimmt. Ergebnisse: Es zeigte sich eine signifikante Besserung von Distress, Angst, Depression, Fatigue und Lebensqualitätsfunktionsskalen zum Zeitpunkt T2 und T3. Von T2 nach T3 war der Therapieeffekt rückläufig, ohne die Werte von T1 zu erreichen. Schlussfolgerungen: Eine multimodale, integrative onkologische Rehabilitation führt zu einer über 3 Monate anhaltenden Besserung des subjektiven Befindens der Patienten. Dieses Therapiekonzept sollte in einer Folgestudie mit einer Standardrehabilitation verglichen werden. BACKGROUND Oncological rehabilitation is an integral part in the care of cancer patients. Following an inpatient rehabilitation of 3 weeks’ duration with multidimensional and integrative components, the effects on distress and quality of life were measured. PATIENTS AND METHODS 74 cancer patients received a complex treatment program, including treatments for improvement of functional health, reduction of psychosocial distress and complementary therapies. The treatment outcome was evaluated with validated questionnaires at the end of the rehabilitation (T2) and 3 months thereafter (T3). RESULTS We observed significant improvement of distress, anxiety, depression, fatigue and quality of life at T2 and T3. In the interval from T2 to T3, the treatment effect was declining, without reaching the values of T1. CONCLUSIONS A multidimensional integrative oncological rehabilitation improves the subjective condition of the patients over a 3-month period. This treatment concept should be tested in a comparative study against standard rehabilitation.
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Affiliation(s)
- Manfred E Heim
- Sokrates-Gesundheitszentrum Bodensee, Güttingen, Schweiz,
| | | | | | | | - Bianca Frank
- Sokrates-Gesundheitszentrum Bodensee, Güttingen, Schweiz
| | - Irina Berthold
- Sokrates-Gesundheitszentrum Bodensee, Güttingen, Schweiz
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Kwan JYY, Croke J, Panzarella T, Ubhi K, Fyles A, Koch A, Dinniwell R, Levin W, McCready D, Chung C, Liu F, Bender JL. Personalizing post-treatment cancer care: a cross-sectional survey of the needs and preferences of well survivors of breast cancer. ACTA ACUST UNITED AC 2019; 26:e138-e146. [PMID: 31043819 DOI: 10.3747/co.26.4131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Improved treatments resulting in a rising number of survivors of breast cancer (bca) calls for optimization of current specialist-based follow-up care. In the present study, we evaluated well survivors of bca with respect to their supportive care needs and attitudes toward follow-up with various care providers, in varying settings, or mediated by technology (for example, videoconference or e-mail). Methods A cross-sectional paper survey of well survivors of early-stage pT1-2N0 bca undergoing posttreatment follow-up was completed. Descriptive and univariable logistic regression analyses were performed to examine associations between survivor characteristics, supportive care needs, and perceived satisfaction with follow-up options. Qualitative responses were analyzed using conventional content analysis. Results The 190 well survivors of bca who participated (79% response rate) had an average age of 63 ± 10 years. Median time since first follow-up was 21 months. Most had high perceived satisfaction with in-person specialist care (96%, 177 of 185). The second most accepted model was shared care involving specialist and primary care provider follow-up (54%, 102 of 190). Other models received less than 50% perceived satisfaction. Factors associated with higher perceived satisfaction with non-specialist care or virtual follow-up by a specialist included less formal education (p < 0.01) and more met supportive care needs (p < 0.05). Concerns with virtual follow-up included the perceived impersonal nature of virtual care, potential for inadequate care, and confidentiality. Conclusions Well survivors of bca want specialists involved in their follow-up care. Compared with virtual follow-up, in-person follow-up is perceived as more reassuring. Certain survivor characteristics (for example, met supportive care needs) might signal survivor readiness for virtual or non-specialist follow-up. Future work should examine multi-stakeholder perspectives about barriers to and facilitators of shared multimodal follow-up care.
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Affiliation(s)
- J Y Y Kwan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - J Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - T Panzarella
- Departments of Oncology and Biostatistics, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON
| | - K Ubhi
- ellicsr Health, Wellness and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - A Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - A Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - R Dinniwell
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - W Levin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - D McCready
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON
| | - C Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - F Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - J L Bender
- ellicsr Health, Wellness and Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Musanti R, Chao YY, Collins K. Fitness and Quality of Life Outcomes of Cancer Survivor Participants in a Community Exercise Program. J Adv Pract Oncol 2019; 10:24-37. [PMID: 31308986 PMCID: PMC6605700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Exercise is recommended for cancer survivors, as it mitigates treatment side effects and improves overall wellness. Therefore, survivors attend community-based exercise programs and report positive results, but published evaluations of outcomes of these programs are scarce in the literature. The objective of this study is to validate the anecdotal reports of the physical fitness and quality of life benefits of the LIVESTRONG at the YMCA program. A retrospective analysis of deidentified data consisting of 17 program cohorts of the LIVESTRONG at the YMCA program (n = 88) was conducted. Statistically significant improvements were seen when compared to baseline in the physical fitness measures of the 6-minute walk, the chest and leg presses, the sit-and-reach test, and the one-leg stand test, as well as in the domains of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) Profile, a health-related quality of life questionnaire. These domains are physical function, anxiety, depression, fatigue, social role satisfaction, and pain. The anecdotal impression that participation in the LIVESTRONG at the YMCA program improves physical fitness and subjective quality of life perceptions was supported by statistical analysis of the subjective and objective pre- and postprogram measurements for this data set. Exercise in this cancer-specific community exercise program is likely to improve physical fitness and quality of life outcomes.
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Gifford W, Thomas O, Thomas R, Grandpierre V, Ukagwu C. Spirituality in cancer survivorship with First Nations people in Canada. Support Care Cancer 2018; 27:2969-2976. [PMID: 30564938 DOI: 10.1007/s00520-018-4609-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/11/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Advancements in cancer survivorship care have shown that holistic approaches, tailored to people's unique survivorship needs, can decrease cancer burden and enhance well-being and quality of life. The purpose of this study was to explore the meanings of spirituality in cancer survivorship for First Nations people, the largest Indigenous population in Canada, and describe how spiritual practices are incorporated into healing. METHODS This study is part of a larger arts-based project about cancer survivorship with First Nations people. Thirty-one cancer survivors discussed spirituality as part of their cancer survivorship experiences. Data were generated through sharing sessions (n = 8) and individual interviews (n = 31). Qualitative descriptive analysis was conducted. RESULTS Three themes emerged about the meaning of spirituality in cancer survivorship. Spirituality was expressed as a complex phenomenon that (1) interconnected self with traditional roots and culture, (2) merged the body and mind, and (3) gave meaning, strength, and faith in the cancer journey. First Nations people incorporated spirituality into cancer survivorship by giving thanks, attending places of spiritual connectedness, singing, praying, speaking to the Creator, and engaging the sun and moon. CONCLUSION First Nations cancer survivors have viewed cancer as an opportunity for emotional and spiritual growth that enabled healing. Understanding the role of spirituality in cancer survivorship is important to develop and deliver culturally safe health services that reduce the burden of cancer and ultimately improve outcomes for First Nations people in Canada.
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Affiliation(s)
- Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
| | - Ovini Thomas
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Roanne Thomas
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Grandpierre
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Chijindu Ukagwu
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Barker K, Holland AE, Lee AL, Ritchie K, Boote C, Lowe S, Pazsa F, Thomas L, Turczyniak M, Skinner EH. A rehabilitation programme for people with multimorbidity versus usual care: A pilot randomized controlled trial. JOURNAL OF COMORBIDITY 2018; 8:2235042X18783918. [PMID: 30057892 PMCID: PMC6060614 DOI: 10.1177/2235042x18783918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multimorbidity, the coexistence of two or more chronic conditions, is common in clinical practice. Rehabilitation for people with multimorbidity may provide access to a rehabilitation programme that can address common symptoms and risk factors for multiple chronic diseases. OBJECTIVE The aims of this study were to (1) evaluate the feasibility of a rehabilitation programme compared to usual medical care (UMC) in people with multimorbidity and (2) gather preliminary data regarding clinical effects and impact on functional exercise capacity, activities of daily living, health-related quality of life and resource utilization. DESIGN A pilot feasibility parallel randomized controlled trial was undertaken. Adults with multimorbidity were randomized to the rehabilitation programme (intervention) or UMC (control). The duration of the rehabilitation programme was 8 weeks and comprised exercise (1 h, twice weekly) and education (1 h, once weekly). The UMC group did not participate in a structured exercise programme. RESULTS One hundred people were screened to recruit 16 participants, with a 71% completion rate for the intervention group. The rehabilitation group achieved a mean (standard deviation) improvement in 6-minute walk distance of 44 (41) m and the UMC group of 23 (29) m. CONCLUSIONS This study suggests that it would be feasible to conduct a larger randomized control trial investigating a rehabilitation programme for people with multimorbidity. Low uptake of the study suggests that refinement of the inclusion criteria, recruitment sources and programme model will be needed to achieve the number of participants required.
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Affiliation(s)
- Kathryn Barker
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora,
Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria,
Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health,
Heidelberg, Victoria, Australia
| | - Annemarie L Lee
- Discipline of Physiotherapy, La Trobe University, Bundoora,
Victoria, Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health,
Heidelberg, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health
Science, School of Primary and Allied Health Care, Monash University, Frankston,
Victoria, Australia
| | - Kathryn Ritchie
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Claire Boote
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria,
Australia
| | - Stephanie Lowe
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Fiona Pazsa
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Lee Thomas
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Monica Turczyniak
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
- Australian Institute of Musculoskeletal Science, Western Centre for
Health Research and Education, Western Health, Victoria, Australia
- Allied Health Research Unit, Faculty of Medicine, Nursing and Health
Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health
Sciences, Melbourne School of Health Sciences, The University of Melbourne,
Victoria, Australia
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A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005-2017). PM R 2018; 9:S347-S384. [PMID: 28942909 DOI: 10.1016/j.pmrj.2017.07.074] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/27/2017] [Accepted: 07/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population. OBJECTIVES To aggregate information regarding the benefit of exercise through a systematic review of existing systematic reviews in the cancer exercise literature. DATA SOURCES PubMed, CINAHL Plus, Scopus, Web of Science, and EMBASE. STUDY ELIGIBILITY CRITERIA Systematic reviews and meta-analyses of the impact of movement-based exercise on the adult cancer population. METHODS Two author teams reviewed 302 abstracts for inclusion with 93 selected for full-text review. A total of 53 studies were analyzed. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used as a quality measure of the reviews. Information was extracted using the PICO format (ie, participants, intervention, comparison, outcomes). Descriptive findings are reported. RESULTS Mean AMSTAR score = 7.66/11 (±2.04) suggests moderate quality of the systematic reviews. Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer-related impairments. Moderate-to-vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer-related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common. LIMITATIONS Movement-based exercise intervention outcomes are reported. No analysis of pooled effects was calculated across reviews due to significant heterogeneity within the systematic reviews. Findings do not consider exercise in advanced cancers or pediatric populations. CONCLUSIONS Exercise promotes significant improvements in clinical, functional, and in some populations, survival outcomes and can be recommended regardless of the type of cancer. Although generally safe, patients should be screened and appropriate precautions taken. Efforts to strengthen uniformity in clinical trial reporting, develop clinical practice guidelines, and integrate exercise and rehabilitation services into the cancer delivery system are needed.
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Son H, Son YJ, Kim H, Lee Y. Effect of psychosocial interventions on the quality of life of patients with colorectal cancer: a systematic review and meta-analysis. Health Qual Life Outcomes 2018; 16:119. [PMID: 29884182 PMCID: PMC5994008 DOI: 10.1186/s12955-018-0943-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 05/22/2018] [Indexed: 12/31/2022] Open
Abstract
Background We conducted a systematic review and meta-analysis of randomized controlled trials examining the effect of psychosocial interventions on the quality of life of patients with colorectal cancer. Methods We searched the main health-related databases for relevant papers. Then, we examined the titles and abstracts of the retrieved papers, applying exclusion criteria to filter out irrelevant papers; a more in-depth filtering process was then conducted by reading the full texts. Eight studies remained at the end of this process. Next, we performed data extraction and assessed the methodological quality of the selected studies. This was followed by computation of effect sizes and the heterogeneity of the results, and then an assessment of the potential bias. Results The systematic review found that most of the interventions in these eight studies did not have a significant effect on quality of life. Meanwhile, the meta-analysis, the overall effect of psychosocial interventions at the post-intervention period was found to be statistically significant but small. Conclusions This meta-analysis provides evidence for the beneficial effect of face-to-face psychosocial interventions on the quality of life of colorectal cancer patients. It is, however, suggested that further studies be conducted on this topic to assess the roles of physical functioning and severity of symptoms before utilizing such face-to-face interventions. Electronic supplementary material The online version of this article (10.1186/s12955-018-0943-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heesook Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, Republic of Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, Republic of Korea
| | - Hyerang Kim
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, Republic of Korea
| | - Yoonju Lee
- College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.
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Kiasuwa Mbengi RL, Nicolaie AM, Goetghebeur E, Otter R, Mortelmans K, Missinnne S, Arbyn M, Bouland C, de Brouwer C. Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up. BMJ Open 2018; 8:e014094. [PMID: 29455161 PMCID: PMC5855469 DOI: 10.1136/bmjopen-2016-014094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/17/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes. PARTICIPANTS We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks. RESULTS The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work. CONCLUSION Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.
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Affiliation(s)
- Régine Levo Kiasuwa Mbengi
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
| | | | | | - Renee Otter
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
| | | | - Sarah Missinnne
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Catherine Bouland
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
| | - Christophe de Brouwer
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
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Kinkead B, Schettler PJ, Larson ER, Carroll D, Sharenko M, Nettles J, Edwards SA, Miller AH, Torres MA, Dunlop BW, Rakofsky JJ, Rapaport MH. Massage therapy decreases cancer-related fatigue: Results from a randomized early phase trial. Cancer 2018; 124:546-554. [PMID: 29044466 PMCID: PMC5780237 DOI: 10.1002/cncr.31064] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/15/2017] [Accepted: 09/07/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a prevalent and debilitating symptom experienced by cancer survivors, yet treatment options for CRF are limited. In this study, we evaluated the efficacy of weekly Swedish massage therapy (SMT) versus an active control condition (light touch [LT]) and waitlist control (WLC) on persistent CRF in breast cancer survivors. METHODS This early phase, randomized, single-masked, 6-week investigation of SMT, LT, and WLC enrolled 66 female stage 0-III breast cancer survivors (age range, 32-72 years) who had received surgery plus radiation and/or chemotherapy/chemoprevention with CRF (Brief Fatigue Inventory > 25). The primary outcome was the Multidimensional Fatigue Inventory (MFI), with the National Institutes of Health PROMIS Fatigue scale secondary. RESULTS Mean baseline MFI scores for 57 evaluable subjects were 62.95 for SMT, 55.00 for LT, and 60.41 for WLC. SMT resulted in a mean (standard deviation) 6-week reduction in MFI total scores of -16.50 (6.37) (n = 20) versus -8.06 (6.50) for LT (n = 20) and an increase of 5.88 (6.48) points for WLC (n = 17) (treatment-by-time P < .0001). The mean baseline PROMIS Fatigue scores were SMT, 22.25; LT, 22.05; and WLC, 23.24. The mean (standard deviation) reduction in PROMIS Fatigue scores was -5.49 (2.53) points for SMT versus -3.24 (2.57) points for LT and -0.06 (1.88) points for WLC (treatment-by-time P = .0008). Higher credibility, expectancy, and preference for SMT than for LT did not account for these results. CONCLUSION SMT produced clinically significant relief of CRF. This finding suggests that 6 weeks of a safe, widely accepted manual intervention causes a significant reduction in fatigue, a debilitating sequela for cancer survivors. Cancer 2018;124:546-54. © 2017 American Cancer Society.
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Affiliation(s)
- Becky Kinkead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Pamela J. Schettler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | | | | | | | - James Nettles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
- Atlanta School of Massage, Atlanta, GA USA
| | - Sherry A. Edwards
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
- Winship Cancer Institute, Atlanta, GA USA
| | - Mylin A. Torres
- Winship Cancer Institute, Atlanta, GA USA
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA USA
| | - Boadie W. Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Jeffrey J. Rakofsky
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Mark Hyman Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
- Winship Cancer Institute, Atlanta, GA USA
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Rick O, Dauelsberg T, Kalusche-Bontemps EM. Oncological Rehabilitation. Oncol Res Treat 2017; 40:772-777. [DOI: 10.1159/000481709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 01/06/2023]
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Cheng KKF, Lim YTE, Koh ZM, Tam WWS. Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database Syst Rev 2017; 8:CD011152. [PMID: 28836379 PMCID: PMC6483678 DOI: 10.1002/14651858.cd011152.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. OBJECTIVES To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. SEARCH METHODS In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review. MAIN RESULTS We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%. AUTHORS' CONCLUSIONS The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.
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Affiliation(s)
- Karis Kin Fong Cheng
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Yee Ting Ethel Lim
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Zhi Min Koh
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Wilson Wai San Tam
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
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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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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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Guldhav KV, Jepsen R, Ytrehus S, Grov EK. Access to information and counselling - older cancer patients' self-report: a cross-sectional survey. BMC Nurs 2017; 16:18. [PMID: 28428732 PMCID: PMC5397690 DOI: 10.1186/s12912-017-0211-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 04/11/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An increasingly older population, improved diagnostics and treatment increase the number of older cancer survivors, thus more than 60% of those affected by cancer are over the age of 65. Symptom relief and the prevention of functional impairment are important tasks for home care nursing, considering that patients can live a long time with their cancer disease and related side effects. The aim of this study was to investigate the extent to which cancer patients over the age of 65 reported access to information and counselling from home care nursing services, including those offered by the cancer coordinator. METHODS A cross-sectional survey was used. The survey consisted of 174 cancer patients from two regions in Norway living at home (101 women; 66-92 years). The questionnaire contained questions of various sequences including information and advices given and data on access to and use of home health care services. The questions focused on the extent to which home health care services provided the following: 1) information about the disease and treatment, 2) information about consequences and complications of the cancer disease, 3) nutritional advice and 4) advice on physical activity. Demographic, clinical and organizational variables were used. SPSS program version 22 was employed to perform descriptive and inferential statistics including correlation and logistic regression analysis. For ethical reasons, patients who were dying, delirious or with presence of cognitive impairment (any kind of dementia) were excluded. RESULTS The results showed that a majority (67-77%) of the respondents reported low levels of information and counselling offered. Low levels represents in this study medium, small and very small degree (Likert scale). Women, those above 85 years of age and patients with a gynecological or hematological cancer diagnosis experienced less access to information and counselling. Respondents facing availability of a cancer coordinator reported significantly higher access to information about the disease and treatment (p = 0.03), nutritional advice (p = 0.04) and advice on physical activity (p = 0.04) compared to those who only had contact with a home health care nurse or home health care assistant. CONCLUSIONS The results indicated that the availability of a cancer coordinator facilitated personalized information and counselling for older cancer patients.
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Affiliation(s)
| | - Randi Jepsen
- Nykøbing Falster Hospital, Region Sjælland, Fjordvej 15, DK-4800 Nykøbing F., Denmark
- Faculty of Health Studies, Sogn og Fjordane University College, PO Box 523, 6803 Førde, Norway
| | - Siri Ytrehus
- Faculty of Health Studies, Sogn og Fjordane University College, PO Box 523, 6803 Førde, Norway
| | - Ellen Karine Grov
- Faculty of Health Studies, Sogn og Fjordane University College, PO Box 523, 6803 Førde, Norway
- Oslo and Akershus University College of Applied Sciences Faculty of Health, Institute of Nursing and Health Promotion, PO Box 4, St. Olavs plass, 0130 Oslo, Norway
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Wilkinson WM, Rance J, Fitzsimmons D. Understanding the importance of therapeutic relationships in the development of self-management behaviours during cancer rehabilitation: a qualitative research protocol. BMJ Open 2017; 7:e012625. [PMID: 28096252 PMCID: PMC5253542 DOI: 10.1136/bmjopen-2016-012625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Cancer is a growing health, social and economic problem. 1 in 3 people in the UK will develop cancer in their lifetime. With survival rates rising to over 50%, the long-term needs of cancer survivors are of growing importance. Cancer rehabilitation is tailored to address the physical or psychosocial decline in ability to engage in daily activities. Its use is supported by high-quality international, multicentre research. Incorporating strategies for self-management behaviour development into rehabilitation can prepare individuals for cancer survivorship. However, healthcare professionals will need to adjust their therapeutic interactions accordingly. Research is yet to clarify the impact of the therapeutic relationship on rehabilitation outcomes in cancer. This study aims to explore the impact of therapeutic relationships on self-management behaviours after cancer. METHODS AND ANALYSIS This qualitative study aims to understand cancer rehabilitation participants' beliefs regarding the importance of therapeutic relationships in developing self-management behaviours. A sample representative of a local cancer rehabilitation cohort will be asked to complete a semistructured interview to identify their perspectives on the importance of therapeutic relationships in cancer rehabilitation. Data obtained from the interviews will be analysed, coded and entered into a Delphi questionnaire for circulation to a local cancer rehabilitation population to determine if the views expressed by the interviewees are supported by group consensus. ETHICS AND DISSEMINATION This study was approved by Wales Research Ethics Committee 6 (15/WA/0331) in April 2016. Findings will be disseminated through the first author's doctoral thesis; peer-reviewed journals; local, national and international conference presentations; and public events involving research participants and the general public.
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Affiliation(s)
- Wendy M Wilkinson
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
- Wales Cancer Network
- Swansea University, Swansea, UK
| | - Jaynie Rance
- College of Human and Health Sciences, Swansea University, Swansea, UK
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Hoffman AJ, Brintnall RA. A Home-based Exercise Intervention for Non-Small Cell Lung Cancer Patients Post-Thoracotomy. Semin Oncol Nurs 2017; 33:106-117. [PMID: 28062324 DOI: 10.1016/j.soncn.2016.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are no evidenced-based rehabilitative guidelines for postsurgical non-small cell lung cancer (NSCLC) patients. This qualitative study provides evidence on the acceptability of an effective postsurgical exercise intervention targeting the self-management of cancer-related fatigue to fill this gap. DATA SOURCES Qualitative perspective of 37 individuals randomized to a 6-week exercise program following hospital discharge post-thoracotomy for NSCLC. CONCLUSION Postsurgical NSCLC participants found this rehabilitative exercise intervention highly acceptable because it removed traditional barriers to exercise. IMPLICATION FOR NURSING PRACTICE A highly acceptable and effective solution for meeting the unmet rehabilitative support needs of NSCLC patients has broader implications for extension to other vulnerable, aging, deconditioned populations.
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Dennett AM, Peiris CL, Shields N, Morgan D, Taylor NF. Exercise therapy in oncology rehabilitation in Australia: A mixed-methods study. Asia Pac J Clin Oncol 2016; 13:e515-e527. [PMID: 28004526 DOI: 10.1111/ajco.12642] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/20/2016] [Accepted: 10/03/2016] [Indexed: 02/05/2023]
Abstract
AIM Oncology rehabilitation improves outcomes for cancer survivors but little is known about program availability in Australia. The aims of this study were: to describe oncology rehabilitation programs in Australia: determine whether the exercise component of programs is consistent with guidelines: and to explore barriers and facilitators to program implementation. METHODS A sequential, explanatory mixed-methods study was completed in two phases: (1) a survey of Australian oncology rehabilitation programs; and (2) purposively sampled follow-up semistructured interviews with senior clinicians working in oncology rehabilitation who were involved with exercise prescription. RESULTS Hospitals and/or cancer centers from 42 public hospital health networks (representing 163 hospitals) and 39 private hospitals were contacted to identify 31 oncology rehabilitation programs. All 31 surveys were returned (100% response rate). Programs were typically multidisciplinary, ran twice weekly, provided education and exercise and included self-management strategies. Exercise prescription and progression was patient centered and included a combination of resistance and aerobic training supplemented by balance, pelvic floor, and core stability exercises. Challenges to implementation included a lack of awareness of programs in the community and organizational barriers such as funding. Strong links with oncologists facilitated program referrals. CONCLUSION Despite evidence to support oncology rehabilitation, there are few programs in Australia and there are challenges that limit it becoming part of standard practice. Programs that exist are multidisciplinary with a focus on exercise with the majority of programs following a cardiac rehabilitation model of care.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, La Trobe University and Allied Health Clinical Research Office, Eastern Health, VIC, Australia
| | - Casey L Peiris
- School of Allied Health, La Trobe University and Northern Health, VIC, Australia
| | - Nora Shields
- School of Allied Health, La Trobe University and Northern Health, VIC, Australia
| | - Delwyn Morgan
- Ambulatory and Community Services Program, Eastern Health, VIC, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University and Allied Health Clinical Research Office, Eastern Health, VIC, Australia
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Hubbard G, Munro J, O’Carroll R, Mutrie N, Kidd L, Haw S, Adams R, Watson AJM, Leslie SJ, Rauchhaus P, Campbell A, Mason H, Manoukian S, Sweetman G, Treweek S. The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial with embedded feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundColorectal cancer (CRC) survivors are not meeting the recommended physical activity levels associated with improving their chances of survival and quality of life. Rehabilitation could address this problem.ObjectivesThe aims of the Cardiac Rehabilitation In Bowel cancer study were to assess whether or not cardiac rehabilitation is a feasible and acceptable model to aid the recovery of people with CRC and to test the feasibility and acceptability of the protocol design.DesignIntervention testing and feasibility work (phase 1) and a pilot randomised controlled trial with embedded qualitative study (phase 2), supplemented with an economic evaluation. Randomisation was to cardiac rehabilitation or usual care. Outcomes were differences in objective measures of physical activity and sedentary behaviour, self-reported measures of quality of life, anxiety, depression and fatigue. Qualitative work involved patients and clinicians from both cancer and cardiac specialties.SettingThree colorectal cancer wards and three cardiac rehabilitation facilities.ParticipantsInclusion criteria were those who were aged > 18 years, had primary CRC and were post surgery.ResultsPhase 1 (single site) – of 34 patient admissions, 24 (70%) were eligible and 4 (17%) participated in cardiac rehabilitation. Sixteen clinicians participated in an interview/focus group. Modifications to trial procedures were made for further testing in phase 2. Additionally, 20 clinicians in all three sites were trained in cancer and exercise, rating it as excellent. Phase 2 (three sites) – screening, eligibility, consent and retention rates were 156 (79%), 133 (67%), 41 (31%) and 38 (93%), respectively. Questionnaire completion rates were 40 (97.5%), 31 (75%) and 25 (61%) at baseline, follow-up 1 and follow-up 2, respectively. Forty (69%) accelerometer data sets were analysed; 20 (31%) were removed owing to invalid data.Qualitative studyCRC and cardiac patients and clinicians were interviewed. Key themes were benefits and barriers for people with CRC attending cardiac rehabilitation; generic versus disease-specific rehabilitation; key concerns of the intervention; and barriers to participation (CRC participants only).Economic evaluationThe average out-of-pocket expenses of attending cardiac rehabilitation were £50. The costs of cardiac rehabilitation for people with cancer are highly dependent on whether it involves accommodating additional patients in an already existing service or setting up a completely new service.Limitations and conclusionsThe main limitation is that this is a small feasibility and pilot study. The main novel finding is that cardiac rehabilitation for cancer and cardiac patients together is feasible and acceptable, thereby challenging disease-specific rehabilitation models.Future workThis study highlighted important challenges to doing a full-scale trial of cardiac rehabilitation but does not, we believe, provide sufficient evidence to reject the possibility of such a future trial. We recommend that any future trial must specifically address the challenges identified in this study, such as suboptimal consent, completion, missing data and intervention adherence rates and recruitment bias, and that an internal pilot trial be conducted. This should have clear ‘stop–proceed’ rules that are formally reviewed before proceeding to the full-scale trial.Trial registrationCurrent Controlled Trials ISRCTN63510637.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 4, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gill Hubbard
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
| | - Julie Munro
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
| | - Ronan O’Carroll
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Lisa Kidd
- Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | - Sally Haw
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
| | - Richard Adams
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Angus JM Watson
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
- NHS Highland, Raigmore Hospital, Inverness, UK
| | - Stephen J Leslie
- School of Health Sciences, University of Stirling (Highland Campus), Centre for Health Science, Inverness, UK
- NHS Highland, Raigmore Hospital, Inverness, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Anna Campbell
- Edinburgh Napier University, Faculty of Life Science, Sport and Social Sciences, Edinburgh, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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