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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.
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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
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Fu JB, Raj VS, Guo Y. A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes. PM R 2017; 9:S324-S334. [PMID: 28942907 PMCID: PMC5736373 DOI: 10.1016/j.pmrj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult-based inpatient rehabilitation, and improved communication and coordination with oncology teams.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030(∗).
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation and Levine Cancer Institute, Charlotte, NC(†)
| | - Ying Guo
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡)
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Abstract
Disabling sequelae occur in a majority of patients diagnosed with brain tumor, including glioma, such as cognitive deficits, weakness, and visual perceptual changes. Often, multiple impairments are present concurrently. Healthcare staff must be aware of the "biographic disruption" the patient with glioma has experienced. While prognostic considerations factor into rehabilitation goals and expectations, regardless of prognosis the treatment team must offer cohesive support, facilitating hope, function, and quality of life. Awareness of family and caregiver concerns plays an important role in the overall care. Inpatient rehabilitation, especially after surgical resection, has been shown to result in functional improvement and homegoing rates on a par with individuals with other neurologic conditions, such as stroke or traumatic brain injury. Community integration comprises a significant element of life satisfaction, as has been shown in childhood glioma survivors. Employment is often affected by the glioma diagnosis, but may be ameliorated, when appropriate, by addressing modifiable factors such as depression, fatigue, or sleep disturbance, or by workplace accommodations. Further research is needed into many facets of rehabilitation in the setting of glioma, including establishing better care models for consistently identifying and addressing functional limitations in this population, measuring outcomes of various levels of rehabilitation care, identifying optimal physical activity strategies, delineating the long-term effects of rehabilitation interventions, and exploring impact of rehabilitation interventions on caregiver burden. The effective elements of cognitive rehabilitation, including transition of cognitive strategies to everyday living, need to be better defined.
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Affiliation(s)
- Mary Vargo
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | | | - Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden
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Sliwa JA, Shahpar S, Huang ME, Spill G, Semik P. Cancer Rehabilitation: Do Functional Gains Relate to 60 Percent Rule Classification or to the Presence of Metastasis? PM R 2015; 8:131-7. [PMID: 26146193 DOI: 10.1016/j.pmrj.2015.06.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 06/12/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Literature supporting the benefits of inpatient rehabilitation for cancer patients is increasing. Many cancer patients, however, do not qualify for inclusion in the Centers for Medicare and Medicaid 60% rule and consequently may not receive services. The benefit of inpatient rehabilitation in this specific cancer group has not been investigated and is the focus of this study. OBJECTIVE To investigate functional gains made during inpatient rehabilitation by patients impaired by cancer, and to compare the functional gains made during inpatient rehabilitation for patients impaired by cancer in relation to the presence or absence of metastatic disease and compliance or noncompliance with the Medicare 60% rule. SETTING Freestanding university-affiliated rehabilitation hospital. PARTICIPANTS A total of 176 adult patients admitted for inpatient rehabilitation due to cancer. METHODS Retrospective chart review of patients admitted for inpatient rehabilitation with deficits identified related to cancer. MAIN OUTCOME MEASURES Demographic data including cancer type, presence of metastasis, age, gender, marital status, ethnicity, length of stay (LOS), discharge destination, and transfer to acute care. Functional status including admission and discharge Functional Independence Measure Score (FIM), total, motor, and cognitive FIM gains, total, motor, and cognitive FIM efficiency for the study sample, for patients with and without a diagnosis compliant with the 60% rule and for patients with and without metastatic disease. RESULTS In all, 176 cases met inclusion criteria. An admission coded diagnosis that was compliant with the 60% rule was present in 97 cases (55.1%). In 153 cases, the presence or absence of metastatic disease was known. Metastatic disease was present in 69 cases (45%). All groups (total sample, metastatic versus nonmetastatic, compliant versus noncompliant) made significant functional gains. Patients with a diagnosis noncompliant with the 60% rule had higher admission total FIM (P = .001), discharge total FIM (P = .014), admission motor FIM (P = .005), admission cognitive FIM (P = .008), and discharge cognitive FIM (P < .001) scores than those with a compliant diagnosis. Patients with metastatic disease had higher admission total FIM (P = .026) and admission (P = .001) and discharge (P = .02) cognitive FIM scores than patients with nonmetastatic disease. There were no significant differences between groups regarding total, motor, or cognitive FIM gains or total motor or cognitive FIM efficiencies. Differences in age, length of stay, and admission motor and discharge FIM scores between groups were related to cancer types and source of impairment. CONCLUSION Patients with functional limitations resulting from cancer or its treatment made significant functional gains in inpatient rehabilitation. There were no significant differences in functional gains made by those with or without metastatic disease or those compliant versus noncompliant with the 60% rule. The presence of metastatic disease or a diagnosis not compliant with the 60% rule does not preclude cancer patients from making significant functional gains.
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Affiliation(s)
- James A Sliwa
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, 345 E. Superior Street, Room 1509, Chicago, IL 60611(∗).
| | - Samman Shahpar
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, Chicago, IL(†)
| | - Mark E Huang
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, Chicago, IL(‡)
| | - Gayle Spill
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, Chicago, IL(§)
| | - Patrick Semik
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Rehabilitation Institute of Chicago, Chicago, IL(‖)
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Nelson M, Palmer JL, Fu J, Williams JL, Yadav R, Guo Y. Hyponatraemia in cancer patients on an inpatient rehabilitation unit. Eur J Cancer Care (Engl) 2013; 23:363-9. [PMID: 24127815 DOI: 10.1111/ecc.12140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Abstract
This study identifies the incidence of hyponatraemia in cancer patients on an inpatient rehabilitation unit and examines the association between admission hyponatraemia and rehabilitation length of stay (LOS), functional outcome, and survival. After institutional review committee's approval, we retrospectively reviewed medical records of 295 consecutive patients who were admitted to this inpatient cancer rehabilitation unit between 27 January 2009 through 31 July 2010 in a tertiary cancer centre. The incidence of hyponatraemia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na < 130 mEq/L) hyponatraemia was 11 and 15 days, respectively, which was significantly longer than patients with eunatraemia (10 days; P = 0.03). Functional Independence Measure gain for ambulation and transfers during inpatient rehabilitation stay was not significantly different between three different patient groups. We concluded that large portion of patients who require acute inpatient rehabilitation presented with hyponatraemia, which is associated with prolonged rehabilitation LOS. Whether aggressive management of hyponatraemia will shorten rehabilitation stay needs further study.
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Affiliation(s)
- M Nelson
- Frazier Rehab Institute, University of Louisville, Louisville, KY, USA
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Inpatient rehabilitation improved functional status in asthenic patients with solid and hematologic malignancies. Am J Phys Med Rehabil 2011; 90:265-71. [PMID: 21273895 DOI: 10.1097/phm.0b013e3182063ba6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare functional outcomes in asthenic patients with hematologic malignancies with those of asthenic patients with solid tumors after inpatient rehabilitation. We hypothesized that asthenic patients with hematologic malignancies are less likely than patients with solid tumors to make functional improvement after rehabilitation. DESIGN The records of 60 asthenic cancer patients (30 consecutive patients with solid tumors and 30 consecutive patients with hematologic malignancies) who underwent inpatient rehabilitation at a comprehensive cancer center between October 2005 and October 2007 were retrospectively reviewed. Patients with focal neurologic deficits were excluded. All patients admitted to the inpatient rehabilitation unit received 3 hrs of more of therapy per weekday. The main outcomes included total, motor, and cognitive Functional Independence Measure (FIM) scores, hospital and rehabilitation length of stay, and FIM efficiency. RESULTS The mean total FIM score significantly improved in patients with solid tumors (mean, 15; range, -6 to 38) and in patients with hematologic malignancies (mean, 17; range, -3 to 27); however, between-group differences in FIM scores were not significant (P = 0.31). The solid tumor patients were significantly older than the hematologic malignancy patients (71 ± 11 vs. 64 ± 12 yrs; P = 0.02), but the mean rehabilitation lengths of stay were the same for each group (9.5 days; P = 0.82). The mean FIM efficiency in the hematologic malignancy group was higher than that of the solid tumor group (1.9 vs.1.4; P = 0.049). CONCLUSIONS Asthenic patients with solid tumors or hematologic malignancies could benefit from inpatient rehabilitation and make significant functional gain.
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Inpatient Rehabilitation of Patients with Cancer: Efficacy and Treatment Considerations. PM R 2011; 3:746-57. [DOI: 10.1016/j.pmrj.2011.05.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 02/14/2011] [Accepted: 05/22/2011] [Indexed: 11/19/2022]
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Hackman D. “What's the point?” exploring rehabilitation for people with 1° CNS tumours using ethnography: Patients' perspectives. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:201-17. [DOI: 10.1002/pri.506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Revised: 11/08/2010] [Accepted: 11/14/2010] [Indexed: 11/05/2022]
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Radiation, chemotherapy, and symptom management in cancer-related cognitive dysfunction. Curr Pain Headache Rep 2010; 13:271-6. [PMID: 19586589 DOI: 10.1007/s11916-009-0043-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with cancer are concerned about their ability to interact with friends and family and to perform activities associated with daily living. The combined effects of the disease process, its treatment with surgery, radiation, and chemotherapy, and the medications used to manage symptoms may all impact cognitive function. Minimizing the effect of each treatment modality on cognitive processing requires an understanding of how these treatment modalities may impact cognition.
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Palacio A, Calmels P, Genty M, Le-Quang B, Beuret-Blanquart F. Oncology and physical medicine and rehabilitation. Ann Phys Rehabil Med 2009; 52:568-78. [PMID: 19720573 DOI: 10.1016/j.rehab.2009.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 05/29/2009] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cancer patients are living longer with deficiencies and functional impairments requiring often typically a care in physical medicine and rehabilitation (PMR). OBJECTIVE To examine the care of cancer patients in PMR. METHOD Investigation made with a questionnaire diffused from the e-mail listing of the Société Française de Médecine Physique et de Réadaptation. RESULTS Sixty-seven answers received. Fifty-seven centers take care of cancer patients. On average, 4% of cancer patients are hospitalised in PMR. Spinal cord injuries and hemiplegias are the most common impairments. Forty-two percent of the PMR units take the patients in all the stages of cancer treatment. Working relationships between PMR and oncology units are formalized only eight times out of 52. In case of health degradation, relationships with a palliative care unit are frequent but not generalized. Eighty-five percent of the centers think that PMR is not enough developed in oncology. CONCLUSIONS In spite of its limited character, this investigation shows that the PMR units take these patients. Situations where PMR has an important role in the follow-up of cancer patients are multiple and publications have showed its interest, especially on the limitations of activities. It is important to make better known the interest of PMR in oncology units but also to develop specific care within PMR units.
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Affiliation(s)
- A Palacio
- CRMPR Les Herbiers, CHU de Rouen, 111, rue Herbeuse, 76230 Bois-Guillaume, France.
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Eva G, Paley J, Miller M, Wee B. Patients' constructions of disability in metastatic spinal cord compression. Palliat Med 2009; 23:132-40. [PMID: 19073781 DOI: 10.1177/0269216308099959] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Metastatic spinal cord compression (MSCC) is characterised by poor prognosis and serious physical disability. Patients have complex rehabilitation needs, but the evidence on rehabilitation is sparse. This study aimed to ascertain the constructions placed upon disability by patients with MSCC. The method consisted of a series of nine process-tracing, longitudinal case studies, involving 58 interviews with 9 patients, 6 carers and 29 staff in one National Health Service region. A context-mechanism-outcome configuration was adopted as a conceptual basis for data collection, together with a constant comparative method of data analysis. Patients' orientation to disability incorporated two apparently inconsistent attitudes. Patients acknowledged that their situation had changed and that their future plans would need to accommodate altered circumstances. However, they also resisted the idea of themselves as disabled, wanting to retain an image of themselves as resourceful and resilient. Patients used a number of strategies to reconcile the tension between these two positions. The illusions incorporated into the 'failure to acknowledge' pole of this orientation are self-protective and, like other positive illusions, have psychological benefits. Providing effective and acceptable support to patients living with disability relies on professional responses that are able to sustain patients' sense of their own competence.
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Affiliation(s)
- G Eva
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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Catt S, Chalmers A, Fallowfield L. Psychosocial and supportive-care needs in high-grade glioma. Lancet Oncol 2008; 9:884-91. [DOI: 10.1016/s1470-2045(08)70230-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fayolle-Minon I, Condemine A, Phaner V, Calmels P. Médecine physique et de réadaptation et cancérologie : réflexion éthique à partir de cas cliniques. ACTA ACUST UNITED AC 2008; 51:201-6. [DOI: 10.1016/j.annrmp.2008.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 10/17/2007] [Accepted: 01/08/2008] [Indexed: 11/26/2022]
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Dalal S, Del Fabbro E, Bruera E. Symptom control in palliative care--Part I: oncology as a paradigmatic example. J Palliat Med 2006; 9:391-408. [PMID: 16629570 DOI: 10.1089/jpm.2006.9.391] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Achieving the best quality of life for patients and their families when a disease becomes progressive and no longer remains responsive to curative therapy is the primary goal of palliative care. A comprehensive care plan focusing on control of physical symptoms as well as psychological, social, and spiritual issues then becomes paramount in that context. Symptom assessment and treatment are a principle part of palliative care. This paper is the first of three in a series addressing non-pain symptoms, which are frequently encountered in the palliative care populations. The most frequent non-pain symptoms are constipation, chronic nausea and vomiting, anorexia, dyspnea, fatigue, and delirium. As symptoms are subjective, their expression varies from patient to patient, depending on the individual patient's perception and on other factors such as psychosocial issues. While symptoms are addressed individually, patients frequently have multiple coexisting symptoms. Generally told, once the intensity of a symptom has been assessed, it is necessary to assess the symptom in the context of other symptoms such as pain, appetite, fatigue, depression, and anxiety. Given that fact, adopting a multidimensional assessment allows for formulation of a more effective therapeutic strategy. More pertinently, this paper highlights the management of non-pain symptoms as an integral part of patient care and reviews the pathophysiologies, causes, assessment, and management of constipation, chronic nausea, and vomiting, each of which is common among the palliative care population.
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Affiliation(s)
- Shalini Dalal
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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