1
|
Navntoft S, Andreasen J, Petersen KS, Rossau HK, Jørgensen L. Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives. Disabil Rehabil 2024; 46:4617-4629. [PMID: 37961874 DOI: 10.1080/09638288.2023.2280073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. MATERIALS AND METHODS Two systematic searches were conducted in five databases mapping peer-reviewed research literature. RESULTS In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. CONCLUSION From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.
Collapse
Affiliation(s)
- Sophie Navntoft
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Jane Andreasen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Cancer Treatment & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
2
|
Rezende G, Gomes-Ferraz CA, Bacon IGFI, De Carlo MMRDP. The importance of a continuum of rehabilitation from diagnosis of advanced cancer to palliative care. Disabil Rehabil 2023; 45:3978-3988. [PMID: 36404719 DOI: 10.1080/09638288.2022.2140456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 10/22/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Identifying the evidence found in the international scientific literature, referring to the concept of rehabilitation in the setting of oncologic palliative care. METHODS Integrative literature review based on articles published in indexed journals on the electronic databases: LILACS, CINAHL and PubMed/MEDLINE, WEB OF SCIENCE, OTSEEKER and PEDRO, following the PRISMA criteria. The quantitative articles were evaluated using the McMaster form for quantitative studies and the qualitative studies were assessed by the Critical Appraisal Skills Program. The studies were inserted in the Rayyan™ application. RESULTS The final sample was composed of 21 qualitative and quantitative articles published in the period from 2004 to 2021, in nine different countries. Three thematic units were defined addressing the interface between palliative care and rehabilitation, the concept of palliative rehabilitation and the barriers to its implementation. The quality of the articles reviewed varied from 31% to 100% of the criteria met. CONCLUSION The international scientific production reinforces the importance of including rehabilitation in care in oncologic palliative care, highlighting the concept of palliative rehabilitation, but there is a need for expanding and divulging new research on the theme and the results.IMPLICATIONS FOR REHABILITATIONPalliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer.Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress.It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care.It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services.
Collapse
Affiliation(s)
- Gabriela Rezende
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Faculty of Health Social Care and Education, Kingston and St George's, University of London, London, UK
| | - Cristiane Aparecida Gomes-Ferraz
- Master of Health Sciences. Nursing Program on Public Health, Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | | | - Marysia Mara Rodrigues do Prado De Carlo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Postgraduate Program, Public Health Nursing, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
3
|
Rehman M, Ahmad U, Waseem M, Ali B, Tariq MI. Effects of Exercise Training in Patients with Lung Cancer during Chemotherapy Treatment. Malays J Med Sci 2023; 30:141-152. [PMID: 37102045 PMCID: PMC10125234 DOI: 10.21315/mjms2023.30.2.13] [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: 04/22/2022] [Accepted: 10/06/2022] [Indexed: 04/28/2023] Open
Abstract
Background Cancer is the second greatest cause of death and disability after cardiovascular disease. Objective To determine the effects of exercise training in patients with lung cancer during chemotherapy treatment. Methods A randomised clinical trial was conducted in Shaukat Khanum Memorial Cancer Hospital and Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar. A total of 40 participants were randomly divided into two groups: i) the Experimental group (EG, n = 20) and ii) Control group (CG, n = 20). Both groups received exercise training for 4 weeks, with five sessions per week. The EG received pulmonary rehabilitation and aerobic training. The CG received only pulmonary rehabilitation. Both groups were evaluated at baseline and after 6 weeks through Mindful Attention Awareness Scale (MAAS) Urdu version, Six Minute Walk Test (6MWT), digital spirometry, Borgs scale, Hospital Anxiety and Depression Scale (HADs) and Visual Analogue Scale (VAS). Results Both the EG and CG showed significant improvement in MAAS scores at post-study with a (P < 0.001). The scores of 6MWT were improved significantly in both groups after intervention with a (P = 0.001). The patient's anxiety scores were significantly improved in both groups after intervention with a (P < 0.001), while depression scores were also improved considerably between the two groups at post-level with a (P < 0.001). Regarding spirometry value, both groups showed significant improvement after intervention for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC (P < 0.001). Both groups show significant differences in patient pain intensity and dyspnea at post-level with P < 0.001. Conclusion This study concluded that pulmonary rehabilitation along with aerobic training can be more effective than pulmonary rehabilitation alone for patients with lung cancer during chemotherapy treatment.
Collapse
Affiliation(s)
- Muheebur Rehman
- Department of Life Science, Abasyn University, Peshawar, Pakistan
| | - Uzair Ahmad
- College of Physical Therapy, Northwest Institute of Health Sciences, Peshawar, Pakistan
| | - Mehwish Waseem
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Babar Ali
- Department of Paramedics, Medical Teaching Institution, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Muhammad Iqbal Tariq
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| |
Collapse
|
4
|
Fettes L, Neo J, Ashford S, Higginson IJ, Maddocks M. Trajectories of disability in activities of daily living in advanced cancer or respiratory disease: a systematic review. Disabil Rehabil 2022; 44:1790-1801. [PMID: 32961067 DOI: 10.1080/09638288.2020.1820587] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Advanced cancer and/or respiratory disease threaten a person's independence in activities of daily living (ADL). Understanding how disability develops can help direct appropriate and timely interventions. AIM To identify different trajectories and associations of disability in ADL and appraise its measurement. METHODS Medline, Embase, PsychINFO, and CINAHL databases were searched for cohort studies with measures of disability in ADL in advanced cancer or respiratory disease at three or more timepoints. Data were narratively synthesized to produce a typology of disability trajectories and a model of factors and outcomes associated with increasing disability. RESULTS Of 5702 publications screened, 11 were included. Seventy-four disability trajectories were categorized into typologies of unchanging (n = 20), fluctuating (n = 21), and increasing disability (n = 33). Respiratory disease did not predict any particular disability trajectory. Advanced cancer frequently followed trajectories of increasing disability. Factors associated with increasing disability included: frailty, multi-morbidity, cognitive impairment, and infection. Increased disability led to recurrent hospital admissions, long-term care, and/or death. Methodological limitations included use of non-validated measures. CONCLUSIONS Increasing disability trajectories in advanced cancer and/or respiratory disease is related to potentially modifiable personal and environmental factors. We recommend future studies using validated disability instruments.Implications for rehabilitationDisability in activities of daily living (ADL) is a common unmet need in advanced cancer or respiratory disease and represents an important outcome for patients, caregivers and health and social care services.Trajectories of ADL disability can be categorized into increasing, fluctuating, and unchanging disability, which could help planning of rehabilitation services in advanced cancer or respiratory disease.Increasing disability in advanced cancer or respiratory disease relates to personal and environmental factors as well as bodily impairments, which can all be modifiable by intervention.This review highlights implications for the measurement of ADL disability in advanced cancer or respiratory disease and recommends use of validated measures of ADL to understand what factors can be modified through rehabilitation interventions.
Collapse
Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, UK
- University College London Hospitals, National Hospital for Neurology and Neurosurgery, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| |
Collapse
|
5
|
Maiwald P, Weis J, Kurlemann U, Dresch C, Rademaker AL, Valentini J, Joos S, Heidt V, Bartsch HH. Barriers to utilisation of cancer rehabilitation from the expert's view: A cross-sectional survey. Eur J Cancer Care (Engl) 2021; 31:e13522. [PMID: 34637572 DOI: 10.1111/ecc.13522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/19/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. METHODS We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values. Additionally, ANOVAs were calculated to test for group differences. RESULTS Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier-dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small- to medium-sized effects. CONCLUSION Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient-oriented publications. Suggestions for improving patients' health services accessibility are made.
Collapse
Affiliation(s)
- Phillip Maiwald
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Joachim Weis
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Endowment Professorship for Self-Help Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich Kurlemann
- German Professional Association for Social Work in Health Care e.V. (DVSG), Münster University Hospital, Münster, Germany
| | - Carolin Dresch
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Research Methods Department, University of Education Freiburg, Freiburg im Breisgau, Germany
| | - Anna Lena Rademaker
- Faculty of Social Sciences, Bielefeld University of Applied Sciences (FH Bielefeld), German Professional Association for Social Work in Health Care e.V. (DVSG), Bielefeld, Germany
| | - Jan Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Hematologists and Oncologists (WINHO), Cologne, Germany
| | - Hans Helge Bartsch
- Tumor Biology Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Song K, Amatya B, Khan F. Cancer rehabilitation in Australia and New Zealand: A pilot cross-sectional survey. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Exercise Training in Patients With Non-Small Cell Lung Cancer During In-Hospital Chemotherapy Treatment: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev 2020; 39:127-133. [PMID: 30801436 PMCID: PMC6407827 DOI: 10.1097/hcr.0000000000000410] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aimed to assess the impact of exercise training in patients with lung cancer on several outcomes compared to a control group. Results suggest that exercise programs in patients with lung cancer are a practical and beneficial intervention for enhancing mobility and physical fitness. Purpose: The aim of this study was to perform a randomized trial to assess the impact of exercise training in patients with non–small cell lung cancer during chemotherapy on several outcomes in comparison to a control group (CG). Methods: The exercise training group (ETG) consisted of 20 patients and the CG consisted of 10 patients. In the ETG, a 4-wk in-hospital exercise training program was performed in 2-wk cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. The exercise training program was individualized and included warm-up, respiratory muscle exercise, training on a cycle ergometer or treadmill, and Nordic walking. CG participants were assessed before and after 6 wk of chemotherapy alone. Results: Comparing pre- and post-intervention values, the ETG demonstrated an increase in 6-min walk distance (486 ± 92 vs 531 ± 103 m, P = .01). In a battery of physical performance tests: Up and Go Test (6.3 ± 1.0 vs 6.0 ± 1.1 sec, P = .01); chair stand (13.3 ± 2.8 vs 14.3 ± 3.4 repetitions, P = .001); and arm curl (18.4 ± 3.1 vs 20.4 ± 3.5 repetitions, P = .001) all improved significantly. Spirometry values also improved: FEV1 % predicted (76 ± 16 vs 84 ± 15, P = .01), FVC % predicted (87 ± 14 vs 95 ± 13, P = .01), and FEV1/FVC (73 ± 13% vs 76 ± 12%, P = .04). The exercise training was well tolerated, without any adverse events due to exercise. There were no significant improvements in the CG. Conclusions: This study suggests that planned, individualized, and supervised exercise programs in patients with advanced lung cancer during chemotherapy are a practical and beneficial intervention for enhancing mobility and physical fitness.
Collapse
|
10
|
Ji W, Kwon H, Lee S, Kim S, Hong JS, Park YR, Kim HR, Lee JC, Jung EJ, Kim D, Choi CM. Mobile Health Management Platform-Based Pulmonary Rehabilitation for Patients With Non-Small Cell Lung Cancer: Prospective Clinical Trial. JMIR Mhealth Uhealth 2019; 7:e12645. [PMID: 31228180 PMCID: PMC6611149 DOI: 10.2196/12645] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/30/2019] [Accepted: 05/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. Objective This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non–small cell lung cancer. Methods We conducted a prospective clinical trial in 64 patients with non–small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. Results Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P=.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P=.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P=.002). Conclusions A personalized mobile health–based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non–small cell lung cancer can supplement traditional health care center–based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life.
Collapse
Affiliation(s)
- Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Kwon
- LifeSemantics, Seoul, Republic of Korea
| | | | - Seulgi Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Sook Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
11
|
Guo SE, Shen HC, Okoli C, Liao YC, Tsai KD, Lin MS, Hsu HT. Generalist versus specialist nurses' knowledge, attitudes, and behavioral intentions toward promoting pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: A cross-sectional correlational study. Medicine (Baltimore) 2018; 97:e12975. [PMID: 30412124 PMCID: PMC6221739 DOI: 10.1097/md.0000000000012975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. Data were collected by anonymous, self-administered questionnaires. We aimed to understand if there would be differences in the Chest Medicine and Generalist nurses on these outcomes, given the specialty versus generalist nature of their practice. Results were analyzed using multiple linear regressions.Although the 2 groups of nurses (ie, Chest Medicine, General Medicine) showed no differences in PR knowledge, attitudes, or behavioral intentions, they lacked sufficient PR knowledge and skills. The accuracy rate of PR knowledge was approximately 12% and self-evaluated PR skills were less than 50%. Self-efficacy in promoting PR was above average (ie, 57%-60%), and the strength of attitudes and behavioral intentions was over 70%. A multiple linear regression revealed that behavioral intentions of nurses working in the chest medicine ward were influenced by behavioral attitudes, and also PR skills and self-efficacy (explanatory power 33.3%).Attitudes, skills, and self-efficacy heavily affected pulmonary nurses' ability to promote PR; however, PR knowledge and skills remain low. Therefore, future implementation of practical PR training courses is needed to strengthen nurses' behavioral intentions toward PR promotion.Improved pulmonary rehabilitation-related skill, attitudes, clinical experience of PR programs, and/or practical PR training are needed among both generalist and specialist nurses. Education courses and clinical practice training should be increased in the future to promote pulmonary rehabilitation of COPD patients.
Collapse
Affiliation(s)
- Su-Er Guo
- Department of Nursing and Graduate Institute of Nursing, College of Nursing
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST)
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi County
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Hsueh-Chen Shen
- Department of Nursing and Graduate Institute of Nursing, College of Nursing
| | - Chizimuzo Okoli
- Tobacco Treatment and Prevention Division, Tobacco Policy Research Program, University of Kentucky College of Nursing, Lexington, KY
| | - Yen-Chi Liao
- Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City
| | - Kuen-Daw Tsai
- Department of Internal Medicine, China Medical University Beigang Hospital, Yunlin County
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung City
| | - Ming-Shian Lin
- Physician of Chest and Critical Care Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City
| | - Hsin-Tien Hsu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| |
Collapse
|
12
|
Barriers to Translation of Physical Activity into the Lung Cancer Model of Care. A Qualitative Study of Clinicians' Perspectives. Ann Am Thorac Soc 2018; 13:2215-2222. [PMID: 27689958 DOI: 10.1513/annalsats.201607-540oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Evidence-based clinical practice guidelines recommend physical activity for people with lung cancer, however evidence has not translated into clinical practice and the majority of patients do not meet recommended activity levels. OBJECTIVES To identify factors (barriers and enablers) that influence clinicians' translation of the physical activity guidelines into practice. METHODS Qualitative study involving 17 participants (three respiratory physicians, two thoracic surgeons, two oncologists, two nurses, and eight physical therapists) who were recruited using purposive sampling from five hospitals in Melbourne, Victoria, Australia. Nine semistructured interviews and a focus group were conducted, transcribed verbatim, and independently cross-checked by a second researcher. Thematic analysis was used to analyze data. MEASUREMENTS AND MAIN RESULTS Five consistent themes emerged: (1) the clinicians perception of patient-related physical and psychological influences (including symptoms and comorbidities) that impact on patient's ability to perform regular physical activity; (2) the influence of the patient's past physical activity behavior and their perceived relevance and knowledge about physical activity; (3) the clinicians own knowledge and beliefs about physical activity; (4) workplace culture supporting or hindering physical activity; and (5) environmental and structural influences in the healthcare system (included clinicians time, staffing, protocols and services). Clinicians described potential strategies, including: (1) the opportunity for nurse practitioners to act as champions of regular physical activity and triage referrals for physical activity services; (2) opportunistically using the time when patients are in hospital after surgery to discuss physical activity; and (3) for all members of the multidisciplinary team to provide consistent messages to patients about the importance of physical activity. CONCLUSIONS Key barriers to implementation of the physical activity guidelines in lung cancer are diverse and include both clinician- and healthcare system-related factors. A combined approach to target a number of these factors should be used to inform research, improve clinical services, and develop policies aiming to increase physical activity and improve survivorship outcomes for patients with lung cancer.
Collapse
|
13
|
Chen YJ, Fan JY, Guo SE, Hwang SL, Yang TM. Factors facilitating and hindering the intention to promote pulmonary rehabilitation for patients with COPD among respiratory therapists. Int J Chron Obstruct Pulmon Dis 2017; 12:2695-2702. [PMID: 28979111 PMCID: PMC5602418 DOI: 10.2147/copd.s142124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Pulmonary rehabilitation (PR) is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs) are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients’ knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB) to investigate both the behavioral intentions and the influential factors surrounding PR in RTs. Patients and methods This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs. Results The response rate after excluding respondents with incomplete data was 88.1% (n=379). A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the knowledge, attitudes, subjective norms, self-efficacy, and behavioral intentions components of total PR scores were 63.12%, 71.33%, 68.96%, 66.46%, and 80.29%. The factors significantly affecting RTs’ intentions to suggest PR participation to COPD patients or encourage it were attitudes, subjective norms, and self-efficacy. The total model explained 22.5% of the variance in behavioral intentions. Conclusion The results of the study suggest that RTs strongly intend to promote PR, but are hindered by insufficient knowledge, attitudes, and self-efficacy with regard to it. Applying TPB provided insight into which factors can be addressed, and by whom. For example, enhancing RTs’ self-efficacy can be achieved through PR training via school curricula, further regular continuing education and/or courses, and practical experience.
Collapse
Affiliation(s)
- Yun-Ju Chen
- Division of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China
| | - Jun-Yu Fan
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China
| | - Su-Er Guo
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China.,Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China.,Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China
| | - Su-Lun Hwang
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China.,Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China
| | - Tsung-Ming Yang
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Granger CL, Connolly B, Denehy L, Hart N, Antippa P, Lin KY, Parry SM. Understanding factors influencing physical activity and exercise in lung cancer: a systematic review. Support Care Cancer 2016; 25:983-999. [PMID: 27900549 DOI: 10.1007/s00520-016-3484-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite evidence and clinical practice guidelines supporting physical activity (PA) for people with lung cancer, this evidence has not translated into clinical practice. This review aims to identify, evaluate and synthesise studies examining the barriers and enablers for patients with lung cancer to participate in PA from the perspective of patients, carers and health care providers (HCPs). METHODS Systematic review of articles using electronic databases: MEDLINE (1950-2016), CINAHL (1982-2016), EMBASE (1980-2016), Scopus (2004-2016) and Cochrane (2016). Quantitative and qualitative studies, published in English in a peer-reviewed journal, which assessed the barriers or enablers to PA for patients with lung cancer were included. Registered-PROSPERO (CRD4201603341). RESULTS Twenty-six studies (n = 9 cross-sectional, n = 4 case series, n = 11 qualitative) including 1074 patients, 23 carers and 169 HCPs were included. Barriers and enablers to PA were identified (6 major themes, 18 sub-themes): Barriers included patient-level factors (physical capability, symptoms, comorbidities, previous sedentary lifestyle, psychological influences, perceived relevance), HCP factors (time/knowledge to deliver information) and environmental factors (access to services, resources, timing relative to treatment). Enablers included anticipated benefits, opportunity for behaviour change and influences from HCPs and carers. CONCLUSION This systematic review has identified the volume of literature demonstrating that barriers and enablers to PA in lung cancer are multidimensional and span diverse factors. These include patient-level factors, such as symptoms, comorbidities, sedentary lifestyle, mood and fear, and environmental factors. These factors should be considered to identify and develop suitable interventions and clinical services in attempt to increase PA in patients with lung cancer.
Collapse
Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia. .,Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia. .,Institute for Breathing and Sleep, Bowen Centre, 145 Studley Road, Hiedelberg, VIC, 3084, Australia.
| | - Bronwen Connolly
- Guy's and St. Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, Strand, London, WC2R 2LS, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.,Centre of Human and Aerospace Physiological Sciences, King's College London, Strand, London, WC2R 2LS, UK
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.,Institute for Breathing and Sleep, Bowen Centre, 145 Studley Road, Hiedelberg, VIC, 3084, Australia
| | - Nicholas Hart
- Guy's and St. Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, Strand, London, WC2R 2LS, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.,Division of Asthma, Allergy and Lung Biology, King's College London, Strand, London, WC2R 2LS, UK
| | - Phillip Antippa
- Department of Thoracic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Kuan-Yin Lin
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry Street, Parkville, VIC, 3010, Australia
| |
Collapse
|
16
|
Lehto RH. Symptom burden in lung cancer: management updates. Lung Cancer Manag 2016; 5:61-78. [PMID: 30643551 PMCID: PMC6310300 DOI: 10.2217/lmt-2016-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/20/2016] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.
Collapse
Affiliation(s)
- Rebecca H Lehto
- C-344 Bogue, College of Nursing, Michigan State University, East Lansing, MI 48824-1317, USA
| |
Collapse
|
17
|
Wang H, Liu X, Rice SJ, Belani CP. Pulmonary Rehabilitation in Lung Cancer. PM R 2016; 8:990-996. [PMID: 27060645 DOI: 10.1016/j.pmrj.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 12/25/2022]
Abstract
Lung cancer remains a challenging disease with high morbidity and mortality despite targeted therapy. Symptom burden related to cancer impairs quality of life and functional status in patients with lung cancer and in survivors. Pulmonary rehabilitation has been recognized as an effective, noninvasive intervention for patients with chronic respiratory disease. It is well established that pulmonary rehabilitation benefits patients with chronic obstruction pulmonary disease through improved exercise capacity and symptoms. Evidence is increasing that the benefit of pulmonary rehabilitation can be applied to patients with lung cancer. Comprehensive pulmonary rehabilitation has made its way as a cornerstone of integrated care for patients with lung cancer. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Hongmei Wang
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Xin Liu
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Shawn J Rice
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Chandra P Belani
- Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, 500 University Dr, Hershey, PA 17033
| |
Collapse
|
18
|
Bayly JL, Lloyd-Williams M. Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review. Support Care Cancer 2016; 24:2359-2379. [DOI: 10.1007/s00520-015-3066-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
|
19
|
Rivas-Perez H, Nana-Sinkam P. Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: A review. Respir Med 2015; 109:437-42. [DOI: 10.1016/j.rmed.2015.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/30/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
|
20
|
Williams AC, Reckamp K, Freeman B, Sidhu R, Grant M. Sexuality, lung cancer, and the older adult: an unlikely trio? J Adv Pract Oncol 2014; 4:331-40. [PMID: 25032012 PMCID: PMC4093438 DOI: 10.6004/jadpro.2013.4.5.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case Study Mrs. L. is a 60-year-old retired female teacher with stage IIIA squamous cell carcinoma of the lung, status postchemoradiation. She recently developed radiation pneumonitis, which was managed conservatively, and she did not require steroids. Mrs. L. has noted some progression of her underlying dyspnea. She is monitoring her oxygen saturation at home, and most of the time it is in the range of 94% to 96%. On one occasion only, her oxygen dropped to 88% and rapidly improved to the mid-90s. Her cough has improved for the past 4 to 6 weeks. She denies sputum production, congestion, or fever. Mrs. L. does not require a walker and uses a wheelchair only for long distances. She has occasional, slight dysphagia. A recent CT scan shows stable disease, and she is to return to the clinic in 2 months for restaging and possible further chemotherapy. Mrs. L. and her husband have been married for 33 years, and they have been very close. Until recently, they have continued to be sexually active and very intimate with each other. Since Mrs. L.'s diagnosis, and during treatment, the couple have become extremely stressed and psychologically spent. The act of sexual intercourse has ceased, yet they have attempted to remain close and maintain open communication. In addition to Mrs. L.'s increasing dyspnea, she has also suffered a great deal of fatigue and depression, along with alopecia and vaginal atrophy, due to the chemotherapy and radiation treatments. Both Mr. and Mrs. L. are very distressed over the change in their sexual lives. Mr. L. has mentioned that he now feels more like a "nursemaid" than a husband or lover. Mrs. L. has made concerted efforts to maintain intimacy with her husband, but her fatigue is profound. She has taken to sleeping in the living room, sitting up on the couch, as it relieves her dyspnea to some degree.
Collapse
|
21
|
Holm LV, Hansen DG, Kragstrup J, Johansen C, Christensen RD, Vedsted P, Søndergaard J. Influence of comorbidity on cancer patients' rehabilitation needs, participation in rehabilitation activities and unmet needs: a population-based cohort study. Support Care Cancer 2014; 22:2095-105. [PMID: 24643775 DOI: 10.1007/s00520-014-2188-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/02/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to investigate possible associations between cancer survivors' comorbidity status and their (1) need for rehabilitation, (2) participation in rehabilitation activities and (3) unmet needs for rehabilitation in a 14-month period following date of diagnosis. METHODS We performed a population-based cohort study including incident cancer patients diagnosed from 1 October 2007 to 30 September 2008 in two regions in Denmark. Fourteen months after diagnosis, participants completed a questionnaire measuring different aspects and dimensions of rehabilitation. Individual information on comorbidity was based on hospital contacts from 1994 and until diagnosis, subsequently classified according to the Charlson comorbidity index. Logistic regression analyses were used to explore the association between comorbidity and outcomes for rehabilitation. Analyses were conducted overall and stratified for gender, age and cancer type. RESULTS A total of 3,439 patients responded (70%). Comorbidity at all levels was statistically significant associated with a physical rehabilitation need, and moderate to severe comorbidity was statistically significant associated with a need in the emotional, family-oriented and financial areas as well as participation in physical-related rehabilitation activities. Stratified analyses showed that significant results in most cases were related to being older than 65 years or having colorectal or prostate cancer. CONCLUSIONS Comorbidity at all levels was significantly associated with needs for physical rehabilitation. Moderate to severe comorbidity was further associated with other areas of need and participation in physical area activities. This should be taken into account when planning rehabilitation interventions for cancer survivors. Differences among subgroups could help target interventions and should be explored further.
Collapse
Affiliation(s)
- Lise Vilstrup Holm
- Research Centre for Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, JB Winsløws Vej 9A, 5000, Odense C, Denmark,
| | | | | | | | | | | | | |
Collapse
|
22
|
Predeger EJ, O'Malley M, Hendrix T, Parker NM. Oncology rehabilitation outcomes over time: a mixed-methods approach. Oncol Nurs Forum 2014; 41:E56-63. [PMID: 24578086 DOI: 10.1188/14.onf.e56-e63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate an oncology rehabilitation program over time. DESIGN A cross-sectional, retrospective program evaluation using a mixed-methods approach. SETTING An outpatient oncology rehabilitation program housed in an urban, hospital-based comprehensive cancer center in Alaska. SAMPLE 102 cancer survivors who had completed a 10-week oncology rehabilitation program (mean time since completion was 2.5 years). METHODS Participants completed a mailed, 28-item retrospective survey to collect perceived activity level recalled at various points in time as well as program perceptions. Open-ended questions elicited narrative comments about motivators and barriers. The Medical Outcomes Study (MOS) SF-36® was completed before and after the program. MAIN RESEARCH VARIABLES Health-related quality of life, perceived health status, activity level, motivators, barriers, and program perceptions. FINDINGS A small increase in level of activity from precancer to the current time (postrehabilitation) (z = -3.1, p < 0.01) was reported. Most and least helpful motivators emerged from the narrative data, resulting in the shared interpretation of "I have my life back." CONCLUSIONS Program motivators were effective in helping cancer survivors maintain some increased activity and retain positive perceptions well after the completion of the program. IMPLICATIONS FOR NURSING Survivors who complete a rehabilitation program retain a sense of restoration and caring, and some engage in physical activity over time. Adapting the program based on insights into the survivor perspective may assist oncology rehabilitation clinicians to promote optimum physical activity and sustain healthful change.
Collapse
|