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Kiefer T, Lüders C, Völler H, Daeschlein G. Update on the risk assessment of a rehabilitation stay for patients after allogeneic stem cell transplantation. Transpl Immunol 2023; 79:101865. [PMID: 37230394 DOI: 10.1016/j.trim.2023.101865] [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: 11/20/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE High-dose chemotherapy with allogeneic stem cell transplantation is the only chance of cure for many haemato-oncological patients. After such therapy, the immune system is weakened, and the contact with other people should therefore be limited as much as possible. The question arises whether a rehabilitation stay can be recommended to these patients, which risk factors for complications during the rehabilitation stay can be identified, and whether physicians and patients can be provided with decision-making aids as to when the optimal time is to start rehabilitation. METHODS We report about 161 rehabilitation stays of patients after high-dose chemotherapy with allogeneic stem cell transplantation. Premature discontinuation of the rehabilitation was selected as the criterion for a serious complication during the rehabilitation and the underlying reasons were analysed. RESULTS The rate of prematurely terminated rehabilitation stays (13.6%) corresponds to our previous result from 2020. The analysis of the reasons for early termination comes to the conclusion that the rehabilitation stay is only considered as a reason for termination in very few cases, if at all. The risk factors identified for premature termination of the rehabilitation stay were male sex, the period (days) between transplantation and the beginning of the rehabilitation stay, haemoglobin value, platelets and presence of immunosuppressing agent. The most significant risk factor is a decreased platelet count at the time rehabilitation begins. The platelet count, the likelihood that it will improve in the further course and the urgency of the rehabilitation stay can be used to help decide when the optimal time for rehabilitation is given. CONCLUSION Rehabilitation can be recommended to patients after allogeneic stem cell transplantation. Based on various factors, recommendations can be made for the right time for rehabilitation.
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Affiliation(s)
- Thomas Kiefer
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany; Medical University Brandenburg "Theodor Fontane", Germany.
| | | | - Heinz Völler
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany; Universität Potsdam, Professur für Rehabilitationswissenschaften, humanwissenschaftliche Fakultät, Germany
| | - Georg Daeschlein
- Clinic of Dermatology, Immunology and Allergology, Medical Center Dessau, Medical University Brandenburg "Theodor Fontane" Medical Center Dessau, Germany
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Kiefer T, Krahl D, Kohlmann T, Nogai A, Baurmann H, Schüler F, Krüger W, de Wit M, Pink D, Dietz M, Völler H, Buhlert H, Daeschlein G. Does rehabilitation pose a risk to patients suffering from haemato-oncological diseases? Results of a monocentric, retrospective analysis in Germany. Eur J Cancer Care (Engl) 2019; 29:e13201. [PMID: 31808982 DOI: 10.1111/ecc.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.
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Affiliation(s)
- Thomas Kiefer
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Dorothea Krahl
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Thomas Kohlmann
- Institut für Community Medicine, Methods of Community Medicine, Universität Greifswald, Greifswald, Germany
| | - Axel Nogai
- Department of Hematology, Oncology and Tumor Immunology, Charite Medical School, Berlin, Germany
| | - Herrad Baurmann
- Klinik für Hämatologie, Onkologie, Tumorimmunologie und Palliativmedizin, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Schüler
- Abteilung Hämatologie/Onkologie, DRK Krankenhaus Luckenwalde, Luckenwalde, Germany
| | - William Krüger
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany
| | - Maike de Wit
- Klinik für Innere Medizin, Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany.,Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Bad Saarow, Germany
| | - Marion Dietz
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Heinz Völler
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany.,humanwissenschaftliche Fakultät, Universität Potsdam, Potsdam, Germany
| | | | - Georg Daeschlein
- Klinik und Poliklinik für Hautkrankheiten, Universität Greifswald, Greifswald, Germany
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Maltser S, Cristian A, Silver JK, Morris GS, Stout NL. A Focused Review of Safety Considerations in Cancer Rehabilitation. PM R 2017; 9:S415-S428. [PMID: 28942913 PMCID: PMC5627359 DOI: 10.1016/j.pmrj.2017.08.403] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022]
Abstract
Cancer and its treatments introduce various adverse effects that may affect survivors' physical, cognitive and psychological functioning. Frequently both tolerance to activity and exercise are affected as well. Rehabilitation providers should have substantive knowledge about the effect of cancer progression and common side effects associated with antineoplastic treatment to safely integrate rehabilitation interventions. Rehabilitation may mitigate loss of function and disability; however, these patients are among the most medically complex that providers treat. This report provides a focused review that synthesizes the current evidence regarding disease progression and oncology-directed treatment side effects within the context of safety considerations for rehabilitation interventions throughout the continuum of cancer care. Descriptive information regarding the evidence for precautions and contraindications is provided so that rehabilitation providers can promote a safe plan of rehabilitation care. It is incumbent upon but also challenging for rehabilitation providers to stay up to date on the many advances in cancer treatment, and there are many gaps in the literature regarding safety issues. Although further research is needed to inform care, this review provides clinicians with a framework to assess patients with the goal of safely initiating rehabilitation interventions.
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Affiliation(s)
- Susan Maltser
- Department of Physical Medicine and Rehabilitation, Hofstra Northwell School of Medicine, Hempstead, NY; Long Island Jewish Medical Center, Manhasset, NY(∗)
| | - Adrian Cristian
- Department of Rehabilitation Medicine, Northwell-Glen Cove Hospital, Glen Cove, NY(†)
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital Network, Boston, MA; Massachusetts General Hospital, Boston, MA; Physiatry, Brigham and Women's Hospital, Boston, MA(‡)
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, NC(§)
| | - Nicole L Stout
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Office of Strategic Research, Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, MSC 1604, 10 Center Dr, Bethesda, MD 20892-1604(‖).
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