Cancer rehabilitation: particularly with aspects on physical impairments

Healthcare Service Disparities in Cancer Rehabilitation and Treatment Costs in Japan: A Cross-Sectional Analysis of National Data

BACKGROUND

Cancer rehabilitation is essential for addressing the physical, psychological, and social challenges associated with cancer treatment. It plays a crucial role in mitigating functional impairment and enhancing recovery. However, the patterns of its utilization in relation to different cancer treatment modalities remain insufficiently understood. This study aimed to analyze the utilization of cancer rehabilitation in Japan and examine its association with surgery, chemotherapy, and radiation therapy.

METHODS

A cross-sectional study was conducted using standardized claims data ratio (SCR) scores from Japan's National Database (NDB) between 2017 and 2021. SCRs for surgery, chemotherapy, radiotherapy, and cancer rehabilitation costs were analyzed across regions. Statistical analyses included repeated-measures analysis of variance (ANOVA) and a mixed-effects model to assess the influence of treatment type on rehabilitation costs.

RESULTS

Surgery showed significant year-to-year differences (p < 0.05), whereas rehabilitation, radiotherapy, and chemotherapy did not. Radiotherapy (p = 0.03) and chemotherapy (p = 0.01) increased rehabilitation costs, whereas the interactions between surgery and chemotherapy (p = 0.03) and between chemotherapy and radiotherapy (p = 0.01) significantly reduced costs, suggesting the potential cost-mitigating potential of multimodal treatment strategies.

CONCLUSIONS

This study demonstrated that although individual cancer treatments increase rehabilitation costs, treatment interactions can help mitigate these financial burdens, highlighting the importance of integrated care. Our findings support the incorporation of rehabilitation, including multidisciplinary approaches, into cancer survivorship care. Further research is needed to optimize rehabilitation planning based on treatment interactions to improve cost-efficiency and clinical outcomes.

Physical and emotional status, quality of life and activities of daily living in terminal cancer: prospective cohort study

OBJECTIVE

Physical functioning (PF), emotional functioning (EF), overall quality of life (QOL) and activities of daily living (ADL) such as walking and toilet transfer are the primary outcomes of dignity in patients with terminal cancer. However, few studies have investigated the association of PF, EF and overall QOL with ADL based on end-of-life stages in patients with cancer who are receiving at-home palliative care.

METHODS

This prospective cohort study included 88 patients with terminal cancer receiving home-based rehabilitation as part of their home-based palliative care at the Mariana Home Nursing Station (Nagoya-city, Aichi, Japan). The variables were measured at 4 and 2 weeks before death of patients. PF, EF and overall QOL scores were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care and ADL were assessed using the Functional Independence Measure-motor items. Multiple regression analysis was used to examine the association, considering the effect of physical symptoms.

RESULTS

PF and overall QOL scores at 4 and 2 weeks before death were significantly associated with toilet transfer and walking scores, even after considering the influence of physical symptoms. EF scores were significantly associated with toilet transfer and walking scores 4 weeks before death, but not 2 weeks before death.

CONCLUSIONS

In addition to managing physical symptoms, supporting ADL such as walking and toilet transfer is necessary to maintain PF, EF and overall QOL in patients with terminal cancer receiving home-based palliative care. This may help preserve their dignity, even in deteriorating general condition.

[Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]

The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.

Muscle strength and psychometric properties of the health-related quality of life in patients with soft tissue sarcoma resection in the thigh

OBJECTIVES

The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL.

METHODS

Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05).

RESULTS

There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024).

CONCLUSIONS

The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.

Usability of Electronic Patient-Reported Outcome Measures for Older Patients With Cancer: Secondary Analysis of Data from an Observational Single Center Study

BACKGROUND

Patient-reported outcomes are considered the gold standard for assessing subjective health status in oncology patients. Electronic assessment of patient-reported outcomes (ePRO) has become increasingly popular in recent years in both clinical trials and practice. However, there is limited evidence on how well older patients with cancer can complete ePRO assessments.

OBJECTIVE

We aimed to investigate how well adult patients with cancer of different age ranges could complete ePRO assessments at home and in a treatment facility and to identify factors associated with the ability to complete questionnaires electronically.

METHODS

This retrospective longitudinal single-center study involved survivors of cancer who participated in inpatient rehabilitation. Patients completed ePRO assessments before rehabilitation at home (T1) and after rehabilitation at the facility (T2). We analyzed the rate of patients who could complete the ePRO assessment at T1 and T2, the proportion of patients who required assistance, and the time it took patients to complete standardized questionnaires. Multivariate logistic regression analyses were conducted to identify predictors of ePRO completion rate and the need for assistance.

RESULTS

Between 2017 and 2022, a total of 5571 patients were included in this study. Patients had a mean age of 60.3 (SD 12.2) years (range 18 to 93 years), and 1135 (20.3%) of them were classified as geriatric patients (>70 years). While more than 90% (5060/5571) of all patients completed the ePRO assessment, fewer patients in the age group of >70 years (924/1135, 81.4% at T1 vs 963/1135, 84.8% at T2) completed the assessment. Approximately 19% (1056/5571) of patients reported a need for assistance with the ePRO assessment at home, compared to 6.8% (304/4483) at the institution. Patients older than 70 years had a significantly higher need for assistance than those in younger age groups. Moreover, a gender difference was observed, with older women reporting a higher need for assistance than men (71-80 years: women requiring assistance 215/482, 44.6% vs men 96/350, 27.4%; P<.001 and >80 years: women 102/141, 72.3% vs men 57/112, 50.9%; P<.001). On average, patients needed 4.9 (SD 3.20) minutes to remotely complete a 30-item questionnaire (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire) and patients in the older age groups took significantly longer compared to younger age groups. Lower age and higher physical functioning were the clearest predictors for both the ePRO completion rate and the need for assistance in the multivariate regression analysis.

CONCLUSIONS

This study's results indicate that ePRO assessment is feasible in older individuals with cancer, but older patients may require assistance (eg, from relatives) to complete home-based assessments. It may be more feasible to conduct assessments in-house in this population. Additionally, it is crucial to carefully consider which resources are necessary and available to support patients in using ePRO devices.

Risk of Pathological Fracture and Paralysis during Rehabilitation for Patients with Bone Metastases: A Questionnaire-Based Study

BACKGROUND

Bone metastases can cause severe pain, pathological fractures, and spinal cord paralysis, which interrupt treatment for tumors and cause patients to be bedridden. In this study, we aimed to clarify therapists' problems in the rehabilitation of patients with bone metastases and their countermeasures using the results of questionnaires to therapists and recommend safer and more rational rehabilitation.

METHODS

Questionnaire forms were sent to 21 therapists in our department. The questionnaire was conducted anonymously about problems during the rehabilitation procedure such as the risk of pathological fractures and paralysis.

RESULTS

All of the therapists had strong anxiety (43%) or some anxiety (57%) about the risk of pathological fractures or paralysis during a procedure. However, no therapist responded that this had ever occurred. Many of the respondents had changed a procedure to a milder one (81%) or interrupted a procedure (48%) due to the patient's condition on the day. Therapists chose many options to reduce the risk of pathological fractures and paralysis during the procedure. Among them, "pre-rehabilitation referral to orthopedic surgeon" (86%), "consultation with a doctor about changes in patient's symptoms and findings" (86%), and "regular cooperation between multiple occupations" (67%) were frequently selected.

CONCLUSIONS

Our questionnaire survey of therapists regarding the treatment of patients with bone metastases found that there was considerable anxiety about the risk of pathological fractures and paralysis during treatment. Our findings suggest that it is necessary to strengthen cooperation with multiple occupations, especially those in the orthopedic field.

Priority of the basic and instrumental activities of daily living in older patients with cancer prescribed rehabilitation: a cross-sectional survey

BACKGROUND

There is no information on whether vulnerable older patients with cancer consider basic activities of daily living (BADL) and instrumental activities of daily living (IADL) important outcomes. Our survey aimed to investigate the priority of BADL and IADL in outcomes among vulnerable older patients with cancer.

METHODS

This was a single-center survey in a Japanese cancer center. Eligible patients were ≥ 65 years of age and were prescribed in-hospital rehabilitation while under cancer treatment. Using original self-administered ranking questionnaires, patients were asked to rank outcomes and subdomain of BADL and IADL. High-priority domains were defined as the highest, second-highest, and third-highest priority domains in individuals.

RESULTS

A total of 169 patients were analyzed. The mean age was 74.0 years (standard deviation, 5.1 years) and the number of males was 107 (63%). The order of ranking of high-priority outcomes was BADL and IADL (n = 155), cognitive function (n = 91), mental function (n = 82), nutrition (n = 61), social function (n = 51), comorbidity (n = 39), and life span (n = 28). The top three high-priority independence subdomains of BADL and IADL were toilet use (n = 140), feeding (n = 134), and mobility (n = 69) among the BADL and shopping (n = 93), food preparation (n = 88), and ability to handle finances (n = 85) among the IADL.

CONCLUSIONS

BADL and IADL can be considered the most important health outcomes in clinical trials and in practice among older patients with cancer and physical vulnerabilities.

Associations of Age and Sex with the Efficacy of Inpatient Cancer Rehabilitation: Results from a Longitudinal Observational Study Using Electronic Patient-Reported Outcomes

Cancer rehabilitation is thought to increase the quality of life (QOL) and functioning of cancer survivors. It remains, however, uncertain whether subgroups benefit equally from rehabilitation. We wished to investigate the outcomes of multimodal rehabilitation according to age, sex and functioning. Patients of an Austrian rehabilitation center routinely completed the EORTC QLQ-C30 and the hospital anxiety and depression scale (HADS) questionnaires prior to (T1), and after rehabilitation (T2). To compare the outcomes between age groups (i.e., <40, 41–69, and ≥70 years), sex, and the Norton scale risk status, repeated measures of analyses of variance were calculated. A total of 5567 patients with an average age of 60.7 years were included, of which 62.7% were female. With T1 indicating the cancer survivors’ needs, older and high-risk patients reported lower functioning (all p < 0.001) and a higher symptom burden for most scales (all p < 0.05) before rehabilitation. Regardless of age, sex or risk status, the patients showed at a least small to medium improvement during rehabilitation for anxiety, depression, and most functioning and symptom scales. Some between-group differences were observed, none of which being of a relevant effect size as determined with the Cohen’s d. In conclusion, QOL is improved by rehabilitation in all patients groups, independently from age, sex, or the risk status.

A Psychometric Validation of the Impact on Participation and Autonomy Questionnaire in a Sample of Turkish Cancer Survivors

Community participation and autonomy are two of the vital treatments and rehabilitation outcomes for people with chronic health conditions and disabilities, including people with cancer. The purpose of this study is to investigate psychometric properties of the Impact on Participation and Autonomy Scale (IPA) in a sample of Turkish cancer survivors. An exploratory factor analysis was used to analyze data collected from 186 cancer survivors who completed the IPA, Health Care Climate Questionnaire, Satisfaction with Life Scale, and the Role Functioning subscale of the EORTC Core Quality of Life Questionnaire. In contrast to the original five-factor solution, the results provided a better fit for a three-factor correlated model ( Activities of Daily Living [ADL]/ Instrumental ADL, social relations, and employment and education). The IPA factors were significantly associated with supportive healthcare climate, role functioning, and life satisfaction in the theoretically expected directions, providing support for the nomological construct validity of the Turkish version of the IPA. Overall, the Turkish version of the IPA is a psychometrically sound measure of participation and autonomy that can be used to assess cancer survivors’ levels of community participation for treatment planning and selection of evidence-based healthcare and psychosocial interventions for cancer survivors.

Investigation of the effects of different nanoparticle additionals on the mechanical properties of silicone elastomer used in maxillofacial prosthesis

Objective: The aim of this study is to evaluate the change in the mechanical properties of silicone elastomer used in the production of maxillofacial prostheses with the addition of 3 different nanoparticles (TiO2-SiO2-ZnO). Material and Method: TiO2-SiO2-ZnO nanoparticles were added to the A part of the M511 Platinum (Technovent Ltd., England) silicone elastomer at a rate of 2% by weight. Test specimens were produced in sizes by ASTM D412 standards for tensile strength and percent elongation, ASTM D624 for tear strength, and ASTM D2240-68 for hardness testing. For each mechanical test, 4 groups were formed together with the control group and 3 other groups to which nanoparticles were added, and a total of 132 samples were produced, 11 samples for each group (n=11), (N=132). The data of tensile strength, elongation percentage, and tear strength tests were analyzed by Shapiro Wilk's and/or Kolmogorov Smirnov/Mann Whitney U, Kruskal Wallis-H tests; for the hardness test, the values ​​in each group showed a normal distribution within themselves, hardness test was analyzed with Oneway ANOVA/Tukey HSD tests. Results: The addition of TiO2 and SiO2 to the silicone elastomer significantly increased the tensile strength compared to the other groups (p

Factors Impacting Functioning Level of Cancer Survivors in Turkey

The purpose of this study was to investigate the relationships between demographic variables, personal factors, impairment-related variables, and functioning levels of cancer survivors in Turkey. Data for this study were collected from a major oncology institute and a nonprofit cancer organization in Turkey. Hierarchical regression analyses were conducted to investigate the sequential effect of demographic variables (i.e., age, gender, income, and education), personal factors (i.e., core self-evaluations, purpose in life, and religiosity), and impairment-related variables (i.e., pain, fatigue, perceived stress, and sleep disturbance) on the functioning level of Turkish cancer survivors (i.e., physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning). The results indicated that impairment-related variables explained a significant amount of variance in functioning scores above and beyond demographic and personal factors. Pain intensity and perceived stress were most prominent factors impacting functioning levels of Turkish cancer survivors. Pain and stress self-management training, psychotherapy and counseling, physical activity and exercise, and cognitive remediation training are recommended interventions to increase the functioning level and well-being of cancer survivors.

Functional outcomes of cancer patients in an acute inpatient setting at King Fahad Medical City

[Purpose] Cancer survivors have functional impairments that adversely affect patients’ quality of life (QoL). Acute rehabilitation helps to reduce disability and improves QoL in cancer survivors. This study investigated the potential improvement in mobility levels and QoL of cancer patients during acute inpatient physical therapy (PT) from admission to discharge. [Participants and Methods] This was a cross-sectional study conducted at King Fahad Medical City, Riyadh. Acute inpatient cancer survivors (n=99) were assessed at their admission and discharge. The primary outcome measure was the AM-PAC “6-Clicks” Basic Mobility, Functional Assessment of Cancer Therapy-General (FACT-G7) and the Karnofsky Performance Scale (KPS). [Results] Overall, 82.8% of cancer patients were discharged home. There were significant improvements in all the three outcome measures for all the patients from admission to discharge. Patients who were discharged home exhibited significantly better improvement in all the scales. Factors that predicted discharge mobility and quality of life were discharge destination, number of PT sessions, and baseline admission scores. [Conclusion] The study found that acute inpatient cancer rehabilitation helps to improve mobility and QoL. Rehabilitation programs available in Saudi Arabia are limited, and it is important to integrate the cancer rehabilitation model into the oncology services.

Health-related quality of life in adults with tetralogy of Fallot repair: a systematic review and meta-analysis

BACKGROUND

With the advancement in diagnostics and clinical management, patients with Tetralogy of Fallot (ToF) are surviving till adulthood. Hence, assessing the impact of ToF repair on health-related quality of life (HRQOL) of these patients is becoming increasingly important. The objective of this paper is to conduct a systematic review and meta-analysis of the HRQOL in patients who have undergone ToF repair.

METHODS

A systematic search was conducted using PubMed, CINAHL, Medline and Web of Science databases. Studies that compared the HRQOL of adult patients (mean age ≥ 18 years) who had previously undergone ToF repair with healthy controls were included. Analysis was done via Revman V5.3 using a random effects model.

RESULTS

The 16 studies (15 using SF-36) included in the meta-analysis, comprised 1818 patients and 50,265 healthy controls. There was a higher proportion of males (59%). The mean ages at surgery and at HRQOL assessment were 5.37 years and 30.3 years, respectively. We found that repaired ToF patients had a statistically significantly lower score in the physical component summary (SMD = - 0.92 CI = - 1.54, - 0.30) and physical functioning (SMD = - 0.27 CI = - 0.50, - 0.03) compared to healthy controls. However, these patients had statistically significantly higher scores in the bodily pain domain (SMD = 0.35 CI = 0.12, 0.58) and social functioning (SMD = 0.23 CI = 0.01, 0.46), while there was no significant difference in other domains.

CONCLUSION

Overall, physical domain of HRQOL was statistically significantly lower in repaired ToF patients compared to healthy controls. However, repaired ToF patients scored significantly higher on bodily pain and Social Functioning. There was additionally no difference in the HRQOL between the two groups in other domains of HRQOL.

Relationship between Heart Rate Variability and Functional Fitness in Breast Cancer Survivors: A Cross-Sectional Study

Background: Breast cancer is the most common malignancy among women worldwide. The treatments may also cause neuromuscular and skeletal disorders; therefore, the aim of this study was to verify the existence of a relationship between heart rate variability and different functional fitness parameters in women survivors of breast cancer. Methods: This cross-sectional study included 25 women survivors of breast cancer, with a mean ± SD age, height, and body mass of 50.8 ± 8.8 years, 1.6 ± 0.7 m, and 67.1 ± 12.3 kg, respectively. Patients underwent measurements of heart rate variability with time and frequency domain analyses, as well as a “30 s chair-stand test”, “6 min walking test”, “timed up and go test”, and “ball throwing test”. Results: A multiple linear regression analysis showed that from the heart rate variability frequency domain, high frequency explained 21% (R² = 0.21) of the “30 s chair-stand test” performance. Conclusion: The findings of this study highlight high frequency as a predictor of “30 s chair-stand test” performance, regardless of age and time after diagnosis, suggesting its usefulness as a clinical indicator of functionality in breast cancer survivors. This study presents a straightforward and non-invasive methodology predicting functional fitness in women breast cancer survivors potentially applicable to clinical practice.

Sarcopenia versus cancer cachexia: the muscle wasting continuum in healthy and diseased aging

Muscle wasting is one of the major health problems in older adults and is traditionally associated to sarcopenia. Nonetheless, muscle loss may also occur in older adults in the presence of cancer, and in this case, it is associated to cancer cachexia. The clinical management of these conditions is a challenge due to, at least in part, the difficulties in their differential diagnosis. Thus, efforts have been made to better comprehend the pathogenesis of sarcopenia and cancer cachexia, envisioning the improvement of their clinical discrimination and treatment. To add insights on this topic, this review discusses the current knowledge on key molecular players underlying sarcopenia and cancer cachexia in a comparative perspective. Data retrieved from this analysis highlight that while sarcopenia is characterized by the atrophy of fast-twitch muscle fibers, in cancer cachexia an increase in the proportion of fast-twitch fibers appears to happen. The molecular drivers for these specificmuscle remodeling patterns are still unknown; however, among the predominant contributors to sarcopenia is the age-induced neuromuscular denervation, and in cancer cachexia, the muscle disuse experienced by cancer patients seems to play an important role. Moreover, inflammation appears to be more severe in cancer cachexia. Impairment of nutrition-related mediators may also contribute to sarcopenia and cancer cachexia, being distinctly modulated in each condition.

Return to Work and Quality of Life in Disease-Free Adult Patients with Soft-Tissue and Bone Sarcoma of the Extremity

Treatment of extremital sarcoma patients may be associated with significant functional disabilities and psychosocial distress affecting return to work (RtW) and quality of life (QoL). In this exploratory study we prospectively investigated the RtW rate, explored biomedical and psychosocial predictors of RtW, and compared generic QoL with Swiss population norms. Forty people (89 %) returned to work. Full-time employment before sarcoma diagnosis, high educational level, and low tumor grade showed an increased probability of RtW. The median age was lower in patients who returned to work, and they reported less fear of progression. Generic QoL (SF-36) was reduced in almost all dimensions when compared to a normative Swiss population. Physical functioning and fear of progression have to be addressed in the rehabilitation process.

Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members

CONTEXT

In end-of-life care, rehabilitation for patients with cancer is considered to be an important means for improving patients' quality of death and dying.

OBJECTIVES

To determine whether the provision of rehabilitation for patients with cancer in palliative care units is associated with the achievement of a good death.

METHODS

This study involved a cross-sectional, anonymous, and self-report questionnaire survey of families of patients with cancer who died in palliative care units in Japan. We evaluated the short version of Good Death Inventory (GDI) on a seven-point scale. A logistic regression model was used to calculate the propensity score. Covariates included in this model were survey year, patients' characteristics, and families' characteristics. The associations between rehabilitation and GDI were tested using trend tests after propensity score matching adjustment.

RESULTS

Of the 1965 family caregivers who received the questionnaires, available data were obtained from 1008 respondents (51.2%). Among them, 285 (28.2%) cases received rehabilitation in palliative care units. There was no difference in total GDI score between the groups with and without rehabilitation. In exploratory analyses, patients receiving rehabilitation were significantly more likely to feel maintaining hope and pleasure (mean 4.50 [SE 0.10] vs. 4.05 [0.11], respectively; effect size [ES] 0.31; P = 0.003), good relationships with medical staff (mean 5.67 [SE 0.07] vs. 5.43 [0.09], respectively; ES 0.22; P = 0.035), and being respected as an individual (mean 6.08 [SE 0.06] vs. 5.90 [0.07], respectively; ES 0.19; P = 0.049) compared with patients not receiving rehabilitation.

CONCLUSION

Rehabilitation in palliative care units may contribute to several domains of quality of death and dying, particularly maintaining hope and pleasure. Further research is needed to investigate whether palliative rehabilitation contributes to the achievement of a good death.

The efficacy of specialised rehabilitation using the Op-reha Guide for cancer patients in palliative care units: protocol of a multicentre, randomised controlled trial (JORTC-RHB02)

BACKGROUND

Although rehabilitation is recommended for terminal cancer patients, the specific components and methods of such programs are poorly documented. No studies to date have examined the effectiveness of rehabilitation for terminal cancer patients. This study aims to evaluate the efficacy of a new intervention for rehabilitation therapists, using the Op-reha Guide (Guide to Optimal and Patient-Centred Rehabilitation Practice for Patients in Palliative Care Units [PCUs]) in rehabilitation practice. This guide consists of recommended actions and attitudes for rehabilitation therapists and aims to optimise therapists' actions according to the patient's needs and condition. It shares goals with terminal cancer patients to maintain their activities of daily living (ADL).

METHODS

This study uses a multicentre, prospective, randomised controlled trial (RCT) design with two parallel groups in PCUs where specialised rehabilitation will be routinely performed for terminal cancer patients by rehabilitation therapists. Participants will be randomised (1:1) to intervention (the Op-reha Guide) and control groups (usual rehabilitation). We will then conduct an observational study in PCUs that do not perform specialised rehabilitation for terminal cancer patients; this will be considered the usual care group, and the efficacy of usual rehabilitation will be quantitatively evaluated. Inclusion criteria are hospitalisation in PCU, European Cooperative Oncology Group Performance Status of 2 or 3, and clinical estimation of life expectancy of 3 weeks or more. Patients with severe symptom burden will be excluded. We hypothesise that the Op-reha Guide will be more effective in maintaining the ADL of terminal cancer patients hospitalised in PCUs than usual rehabilitation. The primary endpoint is defined as the change in (total) modified Barthel Index from baseline to Day 22. Quality of life will be a secondary endpoint. In total, 135 patients will be recruited from 16 Japanese sites between July 2019 and December 2021.

DISCUSSION

This will be the first trial to evaluate the efficacy of specialised rehabilitation for terminal cancer patients hospitalised in PCUs, and will contribute to the evidence on the efficacy of implementing rehabilitation for terminal cancer patients.

TRIAL REGISTRATION

UMIN-CTR, UMIN000037298 R000042525 (date of registration 7 July 2019).

Utility and relevance of modified lateral trapezius myocutaneous flap as a locoregional reconstructive option for medium-sized ablative defects in head and neck cancer-our experience

PURPOSE

Lateral trapezius myocutaneous (LTMC) flap has been used less frequently for defects pertaining to head and neck cancer ablative surgical defects. This study is to assess the utility of LTMC flap with a new modification of the flap design.

METHODS

This is a retrospective study using LTMC flap with modifications as a reconstructive option for intraoral & extraoral skin defects in head and neck cancer patients following ablative surgery, from August 2014 to October 2019 in a tertiary care hospital. The original technique of LTMC flap was modified for better results and outcomes.

RESULTS

Thirty-five patients underwent lateral trapezius flap reconstruction for ablative defects of oral cavity, laryngopharynx, neck and parotid. Twenty-three patients (65.71%) underwent adjuvant radiation/radiation-chemotherapy while one patient defaulted. Two patients (5.71%) had major flap failure. After the loss of flap in these patients, the operative technique was further modified for better results. However, the disadvantage of using this flap is shoulder disability. Nonetheless in the present study, the disability was reduced after modifying the operating technique by preserving the spinal accessory nerve.

CONCLUSION

The present study demonstrated minimal functional loss, low morbidity with satisfactory results, thus also reducing treatment cost. Thus, LTMC is a reliable reconstructive option in head and neck cancer patients for medium-sized defects.

Transcriptome analysis and functional identification of adipose-derived mesenchymal stem cells in secondary lymphedema

BACKGROUND

Secondary lymphedema is a common condition that affects patients with malignant tumors. Conservative treatments fail to provide lasting relief because they do not address the underlying pathological accumulation of excessive fat. Our aim is to clarify the molecular mechanisms of abnormal adipogenic differentiation in lymphedema adipose tissue.

METHODS

We compared the proliferation and adipogenesis potential of adipose-derived mesenchymal stem cells (ASCs) from the lymphedema adipose tissue from liposuction specimens of 10 patients with extremity lymphedema with that of ASCs from adipose tissue from the normal upper abdomen of the same patients. Transcriptome analysis were performed to identify the differences between the two kinds of ASCs. Cyclin-dependent kinase 1 (CDK1) inhibitors were used to treat the abnormal ASCs in lymphedema adipose tissue.

RESULTS

Our results demonstrate that significant functional and transcriptomic differences exist between the two kinds of ASCs. Up-regulated genes were mainly involved in cell proliferation and division while down-regulated genes were mainly associated with immune responses and inflammatory as well as osteogenic and myogenic differentiation. Furthermore, we find that the excessive proliferation and adipogenesis of ASCs from lymphedema adipose tissue returned to the normal phenotype by CDK1 inhibitors. ASCs from lymphedema adipose tissues have higher immunosuppressive effect and the cytokines related to immunosuppressive was significantly up-regulated.

CONCLUSIONS

In conclusion, lymphedema-associated ASCs had more rapid proliferation and a higher adipogenic differentiation capacity. CDK1 may be a key driver of proliferation and adipogenic differentiation in these cells, which might expound the accumulation of adipose tissue extensively observed in secondary lymphedema. ASCs from lymphedema adipose tissues showed immunomodulation dysfunction and immunomodulation may play an important role in the pathogenesis of lymphedema.

Neurochemical supplementation in patients with depressed levels of participation after brain tumor surgery: Rationale and preliminary results

A unique challenge in some brain tumor patients is the fact that tumors arising in certain areas of the brain involve the neural structures of consciousness or alertness, limiting the patient's ability to participate in rehabilitation following surgery. A critical question is whether neurostimulant therapy can help patients participate in rehabilitation efforts. We performed a retrospective review of all patients undergoing brain tumor surgery by the senior author from 2012 to 2018. We limited this study to patients with tumors occupying critical structures related to consciousness, alertness, and motor initiation. A combination of methylphenidate and levodopa/carbidopa was used to monitor the progress of patients through neurorehabilitation efforts. We identified 101 patients who experienced an inability to participate in rehabilitation (ITPR) in the post-operative period. Of these, 86 patients (85%) were treated with methylphenidate and levodopa/carbidopa. Cases of ITPR were related to dysfunction of the brainstem (12/86 cases, 14%), thalamus (17/86 cases, 20%), hypothalamus (14/86 cases, 16%), basal ganglia (13/86 cases, 15%), and medial frontal lobe (30/86 cases, 35%). Of the 86 individuals treated, 47/86 patients (55%) showed early improvement in their ability to participate with rehabilitation. At three month follow-up, 58/86 patients (67%) had returned to living independently or were at least interactive and cooperative during follow-up examination. This feasibility report suggests that combined therapy with methylphenidate and levodopa/carbidopa may help patients participate in neurorehabilitation efforts in the immediate post-operative period following brain tumor surgery. Randomized, controlled clinical trials are needed to explore this concept more thoroughly.

Longer Times of Receipt of Adjuvant Endocrine Therapy Correspond to Improved Functional Capacity and Lower Adiposity in Women Receiving Adjuvant Therapy

PURPOSE

To study the use of functional capacity (FC) level and duration of aromatase inhibitor (AI) therapy with adiposity parameters in women with breast cancer.

PATIENTS AND METHODS

FC was evaluated through the Health Assessment Questionnaire, which was assessed by classification and divided into 3 groups: G1 = mild to moderate difficulty, G2 = moderate to severe disability, and G3 = severe or very severe disability. Body mass, height, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Bioelectrical impedance analysis was used to calculate body fat (BF) and fat-free mass. The women were divided into 2 time groups (T1 and T2), which were determined by the median months of AI use (T1 ≤ 29.5 and T2 > 29.5 months).

RESULTS

Impaired FC and adiposity parameters were significantly positively correlated. In addition, physical exercise was significantly lower in women assessed as G2 and G3 compared to those assessed as G1. The effect of FC on BMI, BF, and WC was also verified, as was the effect of the duration of AI receipt on BMI and BF. Women at T1 had significantly greater functional disability, BMI, and BF values. In addition, although not statistically significant, women in T1 who were assessed as G3 presented higher BMI, WC, and BF values than those in T2.

CONCLUSION

Adiposity above the recommended parameters and impaired FC were associated with the shortest time of receipt of adjuvant endocrine therapy with AI.

Comparative Study Between the Effects of Kinesio Taping and Pressure Garment on Secondary Upper Extremity Lymphedema and Quality of Life Following Mastectomy: A Randomized Controlled Trial

BACKGROUND

Breast cancer stands out among the most widely recognized forms of cancer among women. It has been observed that upper extremity lymphedema is one of the most risky and prevalent complication following breast cancer surgery that prompts functional impairment, psychological, and social problems.

PURPOSE

To compare the effects of Kinesio taping and the application of the pressure garment on secondary lymphedema of the upper extremity.

METHODS

66 women were randomly allocated to the Kinesio taping (KT) group (n=33) and pressure garment (PG) group (n=33). The KT group received Kinesio taping application (2 times per week for 3 weeks), while the PG group received pressure garment (20- 60 mmHg) for at least 15-18 hours per day for 3 weeks. The outcome measures were limb circumference, Shoulder Pain and Disability Index questionnaire (SPADI), hand grip strength, and quality of life at the baseline and end of intervention.

RESULTS

The sum of limb circumferences, SPADI, hand grip strength, and quality of life significantly improved after treatment in the KT group (P<0.05). While the PG group showed no significant improvement in SPADI, hand grip strength, physical, role, pain, and fatigue score p>0.05, while the sum of limb circumferences significantly decreased (P<0.05). Significant differences were observed between the KT and PG groups at the end of the intervention (P<0.05).

CONCLUSION

KT had significant changes in limb circumference, SPADI, hand grip strength and overall quality of life than PG in the treatment of subjects diagnosed with lymphedema after mastectomy.

Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center

Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.

Rehabilitation for cancer patients at Black Lion hospital, Addis Ababa, Ethiopia: a cross-sectional study

Background

In Ethiopia, there were greater than 2000 adult and 200 pediatric cancer patients annually in 2010, but the estimated number of cancer patients were increasing. Oncologic rehabilitation treatment may result in improved physical and mental impairment. There is a paucity of information about rehabilitation service utilization among cancer patients in Ethiopia. Hence, the purpose of this study was to assess the rehabilitation service for cancer patient and associated factors at Black Lion hospital, Addis Ababa, Ethiopia.

Methods

A hospital-based cross-sectional quantitative study was conducted from March to April 2014. Convenient sampling method was employed to recruit the study participants. Interviewer administered questionnaire was used to collect data. Data were entered into EPI data version 3.1 and exported to SPSS (16.0) software for analysis. Descriptive analysis, binary and multiple logistic regression were carried out. Significance association was interpreted using adjusted odds ratio at 95% confidence interval and p-value less than 0.05.

Result

A sample of 423 patients aged 18 years and older were involved in the study. Breast cancer (25%), colorectal cancer (20.6%), cervical cancer (14.7%), lymphoma (7.7%), lung (7.2%), leukemia (5.4%), kidney (3.6%) and prostate cancer (2.6%) were the common forms of cancer diagnosed at cancer unit of the Black Lion Hospital. Twenty six percent of cancer patients received rehabilitation service at least once. The main rehabilitation services given were nutritional and psychological support. Unavailability of supplies, lack of professionals and cost of service were among the barriers to receiving rehabilitation services.

Conclusion

Only a few cancer patients received cancer rehabilitation services. Increasing the knowledge of the professionals, stocking cancer units with necessary supplies, and other comprehensive programs are needed.

Rehabilitation for Cancer Patients

Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary health care. Although not without limitations, the International Classification of Functioning, Disability and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their healthcare systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well.

Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy

Background Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness. Objectives Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors. Methods Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO2 peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique. Results Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group. Conclusion AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.

Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 1. Impact of Physical Activity and Symptom Management Interventions

This article is the first part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the importance of physical activity and symptom management. Strong evidence supports the use of exercise for cancer-related fatigue and indicates that lymphedema is not exacerbated by exercise. Moderate evidence supports the use of yoga to relieve anxiety and depression and indicates that exercise as a whole may contribute to a return to precancer levels of sexual activity. The results of this review support inclusion of occupational therapy in cancer rehabilitation and reveal a significant need for more research to explore ways occupational therapy can positively influence the outcomes of cancer survivors. Part 2 of the review also appears in this issue.

Prevalence of unmet needs and correlated factors in advanced-stage cancer patients receiving rehabilitation

PURPOSE

Although rehabilitation for patients with cancer is currently being provided throughout all phases of the disease, including the advanced stage, much remains unknown about the needs of such patients. The aims of this study were to identify the supportive care and unmet needs of cancer patients receiving rehabilitation interventions and to investigate the factors associated with those unmet needs.

METHODS

A total of 45 patients with cancer receiving rehabilitation interventions participated in this study between June 2013 and December 2015. Measures included the Japanese version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34), the Functional Independence Measure (FIM), the Hospital Anxiety and Depression Scale (HADS), and various other medico-social factors.

RESULTS

The mean age of the cancer patients was 66.6 years, the mean (±standard deviation) FIM score was 111.8 (±16.1), and the mean HADS score was 13.9 (±8.2). The patients had a mean of 17.4 (±10.3) unmet needs. The top ten unmet needs related to rehabilitation intervention included seven psychological needs, two health system and information needs, and one physical and daily living need. Multiple regression analysis revealed that psychological distress (HADS ≥11), marital status, and sex were significantly associated with physical and daily living needs.

CONCLUSIONS

These results suggest that psychosocial factors are important in understanding the supportive care and unmet needs of cancer patients receiving rehabilitation interventions.

The functional capacity and quality of life of women with advanced breast cancer

BACKGROUND

The rehabilitation needs of patients with metastatic breast cancer (MBC) are poorly studied. The primary aim of the study was to evaluate the functional capacity of women with MBC and quality of life (QoL).

METHODS

The present study is an open, non-randomized, prospective cross-sectional observation study. The functional capacity of 128 MBC patients with ongoing cancer treatments, were studied in Helsinki University Hospital (HUS): Peak expiratory flow (PEF), dynamic and static balance, 6 minute walking distance (6MWD), 10 meter walking, sit-to-stand test, repeated squat, grip strength, shoulder movement, pain, and QoL by Beck's depression scale (BDI), health assessment questionnaire (HAQ), RAND SF-36 and EORTC QLQ-30 items.

RESULTS

The walking capacity was compromised in half and the strength of the lower extremities in one-third of the patients. PEF was below the normal reference in 55 %, static balance in 62 % and dynamic balance in 73 % (≤60 year olds) and 81 % (≥61 year olds). The grip power was lowered in 44/30 % of the patients (right/left) and the shoulder movement was restricted in 30 %. Some disability in physical functioning experienced 55 % (HAQ) and 37 % felt depressive (BDI). The QoL (RAND SF-36) was poor especially in the field of physical, role and social functioning and bodily pain (<0.001). Pain, depression, and a poor 6MWD results independently determined the physical component of QoL (p < 0.001).

CONCLUSIONS

The functional capacity of patients with MBC was significantly lowered. This, in association with distressing symptoms like pain and depression causes a vicious circle further leading to functional disabilities and impaired QoL.

'I am actually doing something to keep well. That feels really good': Experiences of exercise within hospice care

Background: Patients with advanced cancer frequently experience functional impairment and reduced quality of life. Therapeutic exercise can provide benefit and be made accessible through the use of tailored programmes. Most studies examining exercise programmes for people with advanced cancer have used quantitative outcome measures and focussed on objective physical function, therefore offer a limited perspective on the experience of exercise participation.

Methods: This qualitative study explored patients' experiences of an exercise programme within a palliative care setting. The interviews focussed on the perceived impact on all aspects of quality of life.

Results: Nine people with advanced cancer, attending a hospice-based exercise programme, completed a one-to-one interview with a senior physiotherapist to explore the physical, emotional, and social impacts of their participation. Interviews were audiotaped, transcribed verbatim and analysed using interpretive phenomenological analysis. Patients reported an awareness of the positive physical, psychological, and social consequences of exercising. Their experiences reflected on all dimensions of quality of life, the impact of others and the sense of meaning gained through participation in exercise.

Conclusion: Our findings highlight that exercise in palliative care should not be viewed solely a physical intervention, but one that has potential to enhance many aspects of patients' quality of life.

Cancer rehabilitation in Austria--aspects of Physical Medicine and Rehabilitation

In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.

Supervised physical exercise to improve the quality of life of cancer patients: the EFICANCER randomised controlled trial

Background

The optimal form of exercise for individuals with cancer has yet to be identified, but there is evidence that exercise improves their quality of life. The aim of this study is to assess the efficacy and efficiency of an innovative physical exercise programme, for individuals undergoing chemotherapy for breast, gastrointestinal or non-small cell lung tumours, for improving quality of life, reducing level of fatigue, and enhancing functional capacity over time.

Design/Methods

We will conduct a clinical trial in 66 patients with stage IV breast, gastrointestinal or non-small cell lung cancer, recruited by the Department of Oncology of the referral hospital from 4 primary care health centres of the Basque Health Service (Osakidetza). These patients will be randomised to one of two groups. The treatment common to both groups will be the usual care for cancer: optimized usual drug therapies and strengthening of self-care; in addition, patients in the intervention group will participate in a 2-month exercise programme, including both aerobic and strength exercises, supervised by nurses in their health centre. The principal outcome variable is health-related quality of life, measured blindly with the 30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire and Short Form-36 four times: at baseline, and 2, 6 and 12 months later. The secondary outcome variables are fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire), functional capacity (6-Minute Walk Test and cardiorespiratory test), muscle strength (hand-held dynamometry and sit-to-stand test), radiological response to treatment (Response Evaluation Criteria In Solid Tumors) and progression-free and overall survival. Age, sex, diagnosis, chemotherapy regimen, Eastern Cooperative Oncology Group performance status and smoking status will be considered as predictive variables. Data will be analysed on an intention-to-treat basis, comparing changes at each time point between groups, adjusting for baseline values by analysis of covariance.

Discussion

As well as achieving the objectives set, this study will provide us with information on patient perception of the care received and an opportunity to develop a project based on collaborative action between the primary care and oncology professionals.

Trial registration

ClinicalTrials.gov Identifier: NCT01786122 Registration date: 02/05/2013.

Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy

INTRODUCTION

Men with advanced prostate cancer (APC) undergoing androgen deprivation therapy (ADT) often experience distressing sexual side effects. Sexual bother is an important component of adjustment. Factors associated with increased bother are not well understood.

AIMS

This study sought to describe sexual dysfunction and bother in APC patients undergoing ADT, identify socio-demographic and health/disease-related characteristics related to sexual bother, and evaluate associations between sexual bother and psychosocial well-being and quality of life (QOL).

METHODS

Baseline data of a larger psychosocial intervention study was used. Pearson's correlation and independent samples t-test tested bivariate relations. Multivariate regression analysis evaluated relations between sexual bother and psychosocial and QOL outcomes.

MAIN OUTCOME MEASURES

The Expanded Prostate Cancer Index Composite sexual function and bother subscales, Center for Epidemiologic Studies Depression Scale, Functional Assessment of Cancer Therapy--General, and Dyadic Adjustment Scale were the main outcome measures.

RESULTS

Participants (N = 80) were 70 years old (standard deviation [SD] = 9.6) and reported 18.7 months (SD = 17.3) of ADT. Sexual dysfunction (mean = 10.1; SD = 18.0) was highly prevalent. Greater sexual bother (lower scores) was related to younger age (β = 0.25, P = 0.03) and fewer months of ADT (β = 0.22, P = 0.05). Controlling for age, months of ADT, current and precancer sexual function, sexual bother correlated with more depressive symptoms (β = -0.24, P  = 0.06) and lower QOL (β = 0.25, P = 0.05). Contrary to hypotheses, greater sexual bother was related to greater dyadic satisfaction (β = -0.35, P = 0.03) and cohesion (β = -0.42, P = 0.01).

CONCLUSIONS

The majority of APC patients undergoing ADT will experience sexual dysfunction, but there is variability in their degree of sexual bother. Psychosocial aspects of sexual functioning should be considered when evaluating men's adjustment to ADT effects. Assessment of sexual bother may help identify men at risk for more general distress and lowered QOL. Psychosocial interventions targeting sexual bother may complement medical treatments for sexual dysfunction and be clinically relevant, particularly for younger men and those first starting ADT.

Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

Introduction

Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT).

Aim of the study

The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment.

Material and methods

The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I secondary lymphedema. Kinesiology Taping was applied to a total of 14 randomly selected women. The remaining 14 patients constituted a control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software.

Results

A significant reduction in the extent of lymphedema (p = 0.0009) was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36).

Conclusions

Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods.

Rehabilitation for cancer patients

Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary healthcare. Although not without limitations, the International Classification of Functioning, Disability, and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their health care systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well.

Quality of life issues in head and neck cancer

Head and neck cancer (HNC) constitutes approximately 3% of all cancers in the UK, with in excess of 8500 new cases annually. Management of HNC depends on site, extent, histology, previous medical history and patient choice. A multidisciplinary approach is required to optimize patient wellbeing, owing to the significant functional and psychosocial implications that can impact on quality of life. Members of the dental team, to include the general dental practitioner, have a key role in patient care; therefore the dental team should be knowledgeable in the short-term and longer-term implications and how this impacts on quality of life.

CLINICAL RELEVANCE

This article offers the dental team with an overview of how HNC and the various treatments, such as surgery, radiotherapy and chemotherapy, impact upon quality of life, both in the short-term and longer-term.

How relatives of patients with head and neck cancer experience pain, disease progression and treatment: a qualitative interview study

PURPOSE

This study of relatives to patients with head and neck cancer (HNC) treated with radiotherapy describes how the relatives experienced the patient's situation, especially with respect to pain, and how the relatives themselves experienced the situation.

METHODS

Semi-structured interviews of 21 relatives to HNC patients who suffered from pain were conducted, and a qualitative content analysis was performed.

RESULTS

The relatives experienced that the patients suffered from physical, psychological, and social pain. A dark picture consisting of lack of participation and knowledge, psychological distress, and lack of support were reported. Thus, a main category: relatives struggle with loved one's pains related to head and neck cancer treatment and with their own demanding situation - was based on the following four categories: inability to relieve and comprehend the physical suffering of the patients; overwhelming emotions were experienced that affect the patients and the relatives themselves; in need of support from the health care service; and altered daily activities and family roles due to illness and treatment.

CONCLUSION

In patients physical, psychological, and social pain were prominent and in relatives psychological distress, lack of knowledge and support were experienced. Thus, to reduce pain and anxiety in patients and relatives, the health care professionals should provide relevant knowledge about pain management. The health care professionals should also provide educational interventions that address the psychological and social factors that impact pain for HNC patients and their relatives. Well-thought supporting care and easily accessible information about practical concerns should be offered to HNC patients and their relatives.

Quality of life in cancer rehabilitation: the role of life goal adjustment

OBJECTIVE

A cancer diagnosis affects patients' quality of life (QOL) as well as their pursuit of life goals. However, numerous studies have shown surprisingly stable QOL measures in cancer patients over time. We propose that life goal adjustment can act as the missing link in explaining this response shift. Thus, the aim of this study was to examine associations between life goal adjustment and patients' QOL at baseline and over the course of 20 months.

METHODS

Eighty-six cancer patients were recruited during rehabilitation and reassessed at follow-up 20 months later. Life goals were measured using the Life Goals Questionnaire and analyzed in relation to global QOL as assessed with the World Health Organization Quality of Life Questionnaire - Short Form.

RESULTS

The overall attainment of life goals was associated with QOL. Moreover, over a period of 20 months, perceived QOL and goal attainment remained stable, whereas importance of life goals decreased. Lesser importance and improved goal attainment were predictors of increases in QOL.

CONCLUSIONS

Results suggest that downgrading unattainable goals and making more progress in accomplishing attainable goals may be possible mechanisms of response shift as an adaption to illness. Thus, integrating life goal adjustment into rehabilitation services for cancer patients seems to be worthwhile to enhance an adaptive self-regulation and QOL.