Multidisciplinary rehabilitation for follow-up of women treated for breast cancer

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review

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.

After 55 Years of Neurorehabilitation, What Is the Plan?

Neurological disorders often cause severe long-term disabilities with substantial activity limitations and participation restrictions such as community integration, family functioning, employment, social interaction and participation. Increasing understanding of brain functioning has opened new perspectives for more integrative interventions, boosting the intrinsic central nervous system neuroplastic capabilities in order to achieve efficient behavioral restitution. Neurorehabilitation must take into account the many aspects of the individual through a comprehensive analysis of actual and potential cognitive, behavioral, emotional and physical skills, while increasing awareness and understanding of the new self of the person being dealt with. The exclusive adoption by the rehabilitator of objective functional measures often overlooks the values and goals of the disabled person. Indeed, each individual has their own rhythm, unique life history and personality construct. In this challenging context, it is essential to deepen the assessment through subjective measures, which more adequately reflect the patient’s perspective in order to shape genuinely tailored instead of standardized neurorehabilitation approaches. In this overly complex panorama, where confounding and prognostic factors also strongly influence potential functional recovery, the healthcare community needs to rethink neurorehabilitation formats.

The psychosocial needs of underserved breast cancer survivors and perspectives of their clinicians and support providers

PURPOSE

Breast cancer survivors (BrCS) experience many psychosocial difficulties following treatment, leading to an increased risk of psychological distress compared to the general population. This is especially true for underserved BrCS whose unmet supportive care needs can result in worse physical and mental health outcomes. This qualitative study compared healthcare and support providers' perceptions of BrCS' needs to survivors' perceptions of their own needs.

METHODS

Semi-structured in-depth interviews were conducted with 25 underserved BrCS and 20 cancer survivorship stakeholders identified using purposeful sampling. Using the constant comparison method and content analysis, data were analyzed via an iterative process of coding and discussion. Data were summarized according to three intermediate and proximal themes mentioned by both stakeholders and survivors: (1) psychosocial needs of cancer survivors, (2) support, and (3) benefit finding/positive feelings about cancer. Demographic data were analyzed by calculating descriptive statistics.

RESULTS

There was consistency in providers' and survivors' perceptions of post-treatment mood changes, financial burden, familial stress, and physical changes. Providers and survivors differed in perceptions of BrCS' preferred sources of care and support, effects of cancer treatment on body image, the effects of fear of cancer recurrence on follow-up care, and benefit finding.

CONCLUSIONS

This study provides valuable insight into areas in which healthcare and support providers' perceptions may differ from underserved BrCS' lived experiences. Results from this study can be used to develop interventions and inform healthcare and support providers on how to provide high-quality care to underserved BrCS.

Association of human breast cancer CD44-/CD24- cells with delayed distant metastasis

Tumor metastasis remains the main cause of breast cancer-related deaths, especially delayed breast cancer distant metastasis. The current study assessed the frequency of CD44^-/CD24^- breast cancer cells in 576 tissue specimens for associations with clinicopathological features and metastasis and investigated the underlying molecular mechanisms. The results indicated that higher frequency (≥19.5%) of CD44^-/CD24^- cells was associated with delayed postoperative breast cancer metastasis. Furthermore, CD44^-/CD24^-triple negative breast cancer (TNBC) cells spontaneously converted into CD44⁺/CD24^-cancer stem cells (CSCs) with properties similar to CD44⁺/CD24^-CSCs from primary human breast cancer cells and parental TNBC cells in terms of stemness marker expression, self-renewal, differentiation, tumorigenicity, and lung metastasis in vitro and in NOD/SCID mice. RNA sequencing identified several differentially expressed genes (DEGs) in newly converted CSCs and RHBDL2, one of the DEGs, expression was upregulated. More importantly, RHBDL2 silencing inhibited the YAP1/USP31/NF-κB signaling and attenuated spontaneous CD44^-/CD24^- cell conversion into CSCs and their mammosphere formation. These findings suggest that the frequency of CD44^-/CD24^- tumor cells and RHBDL2 may be valuable for prognosis of delayed breast cancer metastasis, particularly for TNBC.

Gonioscopy-assisted transluminal trabeculotomy in primary angle-closure glaucoma

PURPOSE

This study aims to report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with primary angle-closure glaucoma (PACG).

METHODS

This study is a prospective, interventional, non-comparative case series. A total of 103 eyes from 88 patients with PACG underwent an ab interno trabeculotomy, using either a 5.0 polypropylene suture or an illuminated microcatheter, with up to 24 months of follow-up. The main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥ 20% from baseline or IOP between 6 and 21 mmHg, without further glaucoma surgery) and complication rate.

RESULTS

The mean preoperative IOP was 21.4 (SD 7.4) mmHg using 2.5 (SD 1.1) glaucoma medications. These decreased postoperatively to 12.1 (SD 2.4) mmHg and 0.8 (SD 1.2) medications, at 24 months (P < 0.05). Success rate was 78% at 24 months of follow-up, and complication rate was 4.8%.

CONCLUSION

At 24 months of follow-up, our results for GATT in PACG demonstrate that this procedure effectively lowers IOP in this subtype of glaucoma, with a low complication rate.

Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB

OBJECTIVE

Determine the changes in shoulder strength, shoulder range of motion, and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) METHOD: Sixty-eight SLNB and 44 ALND patients were followed up from pre-surgery to 5 years after surgery. Primary outcomes were the differences between affected and non-affected sides for the following: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry, and lymphedema measured by volume. As a secondary outcome, health-related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. Generalized estimating equation models were constructed to assess the effect of SLNB and ALND over time.

RESULTS

After 5 years, the ALND group had significant loss of strength for internal rotators (1.39 kg, p = 0.001) and significant arm volume increase (132.45 mL, p = 0.031). The ALND group had a greater number of patients with clinically relevant internal rotator strength loss (38.7 vs. 13.6%, p = 0.012) and a greater number of lymphedema requiring treatment (33.3 vs. 3.4%, p < 0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in physical and arm domains persisted at 5 years in both SLNB and ALND groups.

CONCLUSION

These results could help understand and plan the prevention, needs, and long-term care of breast cancer patients.

Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors

OBJECTIVES

Over two million people in the UK are living with and beyond cancer. A third report diminished quality of life.

DESIGN

A review of published systematic reviews to identify effective non-pharmacological interventions to improve the quality of life of cancer survivors.

DATA SOURCES

Databases searched until May 2017 included PubMed, Cochrane Central, EMBASE, MEDLINE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

STUDY SELECTION

Published systematic reviews of randomised trials of non-pharmacological interventions for people living with and beyond cancer were included; included reviews targeted patients aged over 18. All participants had already received a cancer diagnosis. Interventions located in any healthcare setting, home or online were included. Reviews of alternative therapies or those non-English reports were excluded. Two researchers independently assessed titles, abstracts and the full text of papers, and independently extracted the data.

OUTCOMES

The primary outcome of interest was any measure of global (overall) quality of life.

ANALYTICAL METHODS

Quality assessment assessing methdological quality of systematic reviews (AMSTAR) and narrative synthesis, evaluating effectiveness of non-pharmacological interventions and their components.

RESULTS

Of 14 430 unique titles, 21 were included in the review of reviews. There was little overlap in the primary papers across these reviews. Thirteen reviews covered mixed tumour groups, seven focused on breast cancer and one focused on prostate cancer. Face-to-face interventions were often combined with online, telephone and paper-based reading materials. Interventions included physical, psychological or behavioural, multidimensional rehabilitation and online approaches. Yoga specifically, physical exercise more generally, cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) programmes showed benefit in terms of quality of life.

CONCLUSIONS

Exercise-based interventions were effective in the short (less than 3-8 months) and long term. CBT and MBSR also showed benefits, especially in the short term. The evidence for multidisciplinary, online and educational interventions was equivocal.

Optimizing post-acute care in breast cancer survivors: a rehabilitation perspective

Breast cancer (BC) is the most common malignancy and a leading cause of morbidity and mortality in women worldwide. Therapeutic advances and improved survival rates of women with BC have implications for long-term impact on disability, psychological function and quality of life (QoL), which may be amenable to rehabilitation. The focus of rehabilitation is on managing disability, reducing sequelae and symptoms, and enhancing participation and societal reintegration, to achieve the highest possible independence and the best QoL. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing the risk of losing important abilities or independence and should be individualized depending on disease phase, functional deficits, personal requirements and specific goals. A number of interventions have been trialled to support rehabilitation input for women with BC, which include physical therapy, psychological interventions (psychotherapy, cognitive behavioral training) and others. Multidisciplinary rehabilitation and uni-disciplinary interventions such as physical therapy have been shown to be beneficial in reducing disability, and improving participation and QoL. There is a need for comprehensive assessment of health domains in BC patients using a standardized framework and a common language for describing the impact of disease at different levels, using the International Classification of Functioning, Disability and Health core sets. This will provide more detailed information on the needs of these patients, so more efficient and targeted rehabilitation interventions can be provided.

Multidisciplinary rehabilitation after primary brain tumour treatment

BACKGROUND

Brain tumours can cause significant disability, which may be amenable to multidisciplinary rehabilitation. However, the evidence base for this is unclear. This review is an update of a previously published review in the Cochrane Database of Systematic Reviews [2013, Issue 1, Art. No. CD009509] on 'Multidisciplinary rehabilitation after primary brain tumour treatment'.

OBJECTIVES

To assess the effectiveness of multidisciplinary rehabilitation in people after primary brain tumour treatment, especially the types of approaches that are effective (settings, intensity).

SEARCH METHODS

For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library up to Issue 12 of 12, 2014), MEDLINE (1950 to January week 2, 2015), EMBASE (1980 to January week 2, 2015), PEDro (1985 to January week 2 2015), and LILACS (1982 to January week 2, 2015). We checked the bibliographies of papers we identified and contacted the authors and known experts in the field to seek published and unpublished trials.

SELECTION CRITERIA

Controlled clinical trials (randomised and non-randomised clinical trials) that compared multidisciplinary rehabilitation in primary brain tumour with either routinely available local services or lower levels of intervention, or studies that compared multidisciplinary rehabilitation in different settings or at different levels of intensity.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed study quality, extracted data, and performed a 'best evidence ' synthesis based on methodological quality.

MAIN RESULTS

We did not identify any studies for inclusion in the previous version of this review. For this update, the literature search identified one low-quality controlled clinical trial involving 106 participants. The findings from this study suggest 'low-level' evidence to support high-intensity ambulatory (outpatient) multidisciplinary rehabilitation in reducing short- and long-term motor disability (continence, mobility and locomotion, cognition), when compared with standard outpatient care. We found improvement in some domains of disability (continence, communication) and psychosocial gains were maintained at six months follow-up. We found no evidence for improvement in overall participation (quality of life and societal relationship). No adverse events were reported as a result of multidisciplinary rehabilitation. We found no evidence for improvement in quality of life or cost-effectiveness of rehabilitation. It was also not possible to suggest best 'dose' of therapy.

AUTHORS' CONCLUSIONS

Since the last version of this review, one new study has been identified for inclusion. The best evidence to date comes from this CCT, which provides low quality evidence that higher intensity ambulatory (outpatient) multidisciplinary rehabilitation reduces short- and long-term disability in people with brain tumour compared with standard outpatient care. Our conclusions are tentative at best, given gaps in current research in this area. Although the strength of evidence has increased with the identification of a new controlled clinical trial in this updated review, further research is needed into appropriate and robust study designs; outcome measurement; caregiver needs; evaluation of optimal settings; type, intensity, duration of therapy; and cost-effectiveness of multidisciplinary rehabilitation in the brain tumour population.

Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews

Context

Breast cancer is the most prevalent cancer amongst women but it has the highest survival rates amongst all cancer. Rehabilitation therapy of post-treatment effects from cancer and its treatment is needed to improve functioning and quality of life. This review investigated the range of methods for improving physical, psychosocial, occupational, and social wellbeing in women with breast cancer after receiving breast cancer surgery.

Method

A search for articles published in English between the years 2009 and 2014 was carried out using The Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, PubMed, and ScienceDirect. Search terms included: ‘breast cancer’, ‘breast carcinoma’, ‘surgery’, ‘mastectomy’, ‘lumpectomy’, ‘breast conservation’, ‘axillary lymph node dissection’, ‘rehabilitation’, ‘therapy’, ‘physiotherapy’, ‘occupational therapy’, ‘psychological’, ‘psychosocial’, ‘psychotherapy’, ‘exercise’, ‘physical activity’, ‘cognitive’, ‘occupational’, ‘alternative’, ‘complementary’, and ‘systematic review’.

Study selection

Systematic reviews on the effectiveness of rehabilitation methods in improving post-operative physical, and psychological outcomes for breast cancer were selected. Sixteen articles met all the eligibility criteria and were included in the review.

Data extraction

Included review year, study aim, total number of participants included, and results.

Data synthesis

Evidence for exercise rehabilitation is predominantly in the improvement of shoulder mobility and limb strength. Inconclusive results exist for a range of rehabilitation methods (physical, psycho-education, nutritional, alternative-complementary methods) for addressing the domains of psychosocial, cognitive, and occupational outcomes.

Conclusion

There is good evidence for narrowly-focused exercise rehabilitation in improving physical outcome particularly for shoulder mobility and lymphedema. There were inconclusive results for methods to improve psychosocial, cognitive, and occupational outcomes. There were no reviews on broader performance areas and lifestyle factors to enable effective living after treatment. The review suggests that comprehensiveness and effectiveness of post-operative breast cancer rehabilitation should consider patients’ self-management approaches towards lifestyle redesign, and incorporate health promotion aspects, in light of the fact that breast cancer is now taking the form of a chronic illness with longer survivorship years.

Expression of the PXR gene in various types of cancer and drug resistance

Pregnane X receptor (PXR) is a member of the nuclear receptor superfamily of ligand-regulated transcription factors. PXR is a key xenobiotic receptor that regulates the expression of genes implicated in drug metabolism, detoxification and clearance, including drug metabolizing enzymes and transporters, suggesting that it is significant in the drug resistance of cancer cells. PXR is expressed in a wide range of tissues in the human body. Studies have demonstrated that PXR is expressed in a variety of tumor types, correlating not only with drug resistance but also with the cell proliferation, apoptosis and prognosis of cancer. The purpose of the present review is to provide a comprehensive review of PXR and its potential roles in multidrug resistance and the biological characteristics of PXR-positive tumors.