Aspects of cancer rehabilitation: an Austrian perspective

Clinical questions on rehabilitation in cancer patients with skeletal metastasis: a content analysis of the multidisciplinary tumor board records

PURPOSE

Cancer rehabilitation addresses the functional needs of patients who have various impairments. Disease control is a critical oncological consideration, while physical intervention increased weights of importance in several situations. To identify the clinical status that necessitates active physical intervention in cancer patients with skeletal metastasis, we performed a content analysis in the multidisciplinary tumor board (MDTB) records.

METHODS

From January 2017 to September 2019, the MDTB discussed 168 consecutive patients with skeletal metastasis. We reviewed the MDTB records and asked responsible physicians to frame clinical questions. Based on these data, we identified the predictor valuables with the association to rehabilitation-related clinical questions using univariate and multivariate analyses. Moreover, we investigated a predictor of the change in Barthel index (BI) scores using univariate analyses.

RESULTS

Rehabilitation-related questions arose more frequently in older patients (p = 0.011), in patients with slow-growth vs. rapid-growth tumor (p = 0.002), and in patients with skeletal-related events (p = 0.001) at MDTB. The tumor growth speed was associated with the change in BI scores, as slower-growth tumors had the benefit of BI gains (p = 0.017).

CONCLUSIONS

Regarding rehabilitation in patients with skeletal metastasis, we should pay attention to three parameters: occurrence of skeletal events, patient age, and growth speed of tumors. Rehabilitation-related questions may reflect patients' functional needs that occur more frequently in patients with pathological fractures or neurological symptoms, older patients, and patients with slow-growth tumors.

Relevant parameters for recommendations of physical activity in patients suffering from multiple myeloma : A pilot study

Purpose

This pilot study aimed to describe physical performance, self-reported physical activity, health-related quality of life, anxiety and depression in patients who were assigned from Austrian self-help groups for multiple myeloma patients. These parameters were then discussed in the context of clinical decision-making concerning the recommended type of regular physical activity and exercise.

Methods

Members of the self-help groups were invited to participate. Physical performance and physical activity were assessed with the 6 min walk test (6MWT), handgrip strength test, timed up and go test (TUG), Tinetti performance oriented mobility assessment (POMA), falls efficacy scale (FES), international physical activity questionnaire (IPAQ), health-related quality of life (EORTC QLQ-C30) and the hospital anxiety and depression scale (HADS).

Results

A total of 40 patients (female:male = 15:25, mean age: 63.8 ± 9.0 years, range 41–80 years) were identified. In total 20 (50%) reached the performance of healthy peers in the tests 6MWT, handgrip strength, TUG and POMA, while 50% showed at least 1 result below the reference value or cut-off-point for each test. Self-reported activity levels were high. Patients showed a tendency to overestimate the risk of falling but a case by case analysis revealed a tendency for underestimating the actual performance in the respective tests (TUG, POMA).

Conclusion

The performance of healthy peers was reached by a substantial number of the participants in tests of physical performance and they reported high levels of physical activity. Nevertheless, they tended to overestimate the specific risk of falling. Patients with notably impaired physical performance might be suitable to perform regular physical activity and exercise in an individual therapy, whereas those with good physical performance are suited for training in exercise groups; however, individual contraindications and clinical considerations should be noted in a multiprofessional and interdisciplinary setting.

Role of physical medicine for cancer rehabilitation and return to work under the premise of the "Wiedereingliederungsteilzeitgesetz"

Background

With the intention of enabling people a phased return to work after long-term sick leave the so-called “Wiedereingliederungsteilzeitgesetz” (WIETZ) was implemented in Austria on 1 July 2017.

Methods

To explore the overall awareness about the WIETZ and the value of physical modalities together with further supporting measures in return to work of cancer survivors, a survey by using a self-constructed questionnaire was performed in 30 experts 6 months after the WIETZ came into force.

Results

The awareness of Austrian specialists regarding the WIETZ seems to be excellent. Regarding expert opinions, return to work in cancer survivors is notable hampered in workplaces with great physical stress even in times of the WIETZ, whereas for professions in offices and banks it is easier to return to work, with and without WIETZ. The highest impact on return to work seems to be due to exercise, as an intervention of the field of physical medicine and rehabilitation to improve sensorimotor functions and to increase endurance capacity as well as muscular strength.

Conclusion

Early information about cancer rehabilitation and the WIETZ seems to be necessary to facilitate return to work of cancer survivors. Furthermore, exercise interventions seem to be the most important measures from the field of physical medicine and rehabilitation.