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Prabhu NS, Maiya GA, Bhat K V. Implementation of physical rehabilitation programs for children with cancer across low- and middle-income countries: A need of the hour perspective. Pediatr Blood Cancer 2024; 71:e30876. [PMID: 38243768 DOI: 10.1002/pbc.30876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Nivedita S Prabhu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Bhat K
- Division of Pediatric Hematology and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Brick R, Padgett L, Jones J, Wood KC, Pergolotti M, Marshall TF, Campbell G, Eilers R, Keshavarzi S, Flores AM, Silver JK, Virani A, Livinski AA, Ahmed MF, Kendig T, Khalid B, Barnett J, Borhani A, Bernard G, Lyons KD. The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review. J Cancer Surviv 2023; 17:1725-1750. [PMID: 35218521 PMCID: PMC8881759 DOI: 10.1007/s11764-022-01181-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.
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Affiliation(s)
- Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Lynne Padgett
- VA Central Office, Health Services Research and Development, 1100 1st St NE, Suite 6, Washington, DC, 20002, USA
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kelley Covington Wood
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Timothy F Marshall
- Ivy Rehab Network, 1311 Mamaroneck Ave, Suite 140, White Plains, NY, 10605, USA
| | - Grace Campbell
- Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences and UPMC Hillman Cancer Center at UPMC Magee, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Rachel Eilers
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Center, 610 University Ave, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
- Brigham and Women's Hospital, 55 Fruit Street, Boston, MA, USA
- Spaulding Rehabilitation Hospital, 55 Fruit Street, Boston, MA, USA
| | - Aneesha Virani
- Department of Rehabilitation Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA, 30342, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, OD, NIH, MSC 1150, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mohammed Faizan Ahmed
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Tiffany Kendig
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Bismah Khalid
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1VT, Canada
| | - Jeremy Barnett
- George Washington University School of Medicine and Health Sciences, 2300 I St. NW, Washington, DC, 20052, USA
| | - Anita Borhani
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Graysen Bernard
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, Building 79/96, 79 13th Street, Boston, MA, 02129, USA
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Qin E, Lim S, Essman M, Howard I. Increasing cancer rehabilitation awareness and referrals in the Veterans Health Administration-A quality improvement initiative. PM R 2023; 15:1292-1299. [PMID: 36695293 DOI: 10.1002/pmrj.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/10/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To expand access to comprehensive rehabilitation services among veterans with cancer by increasing cancer rehabilitation referrals in a Veterans Affairs (VA) hospital. DESIGN A rapid cycle improvement approach based on the Institute of Healthcare Improvement's Model for Improvement was used to assess and optimize the cancer rehabilitation referral process. In this quality improvement project, our cancer rehabilitation workgroup developed an electronic screening tool within the VA electronic patient record system to streamline cancer rehabilitation referrals. Providers could complete an optional Cancer Rehabilitation (CaRe) Screen that consisted of 12 questions related to patient symptoms and function. If the screen was positive, a nonvisit electronic consult was automatically generated and sent to a physiatrist for review. The physiatrist would then triage patients to appropriate services including physiatry, physical therapy, occupational therapy, speech therapy, rehab psychology, and other rehabilitation services. RESULTS A total of 90 referrals were placed between 2019-2021. A total of 84% of the patients referred were male, 73% were white. The top cancer types referred were lung (27%), blood (23%), gastrointestinal (12%), and prostate (10%). There were 19 referrals in 2019, 13 in 2020, and 58 in 2021. The electronic screening tool was implemented in mid-2021. Advanced practice providers placed 48% of consults. Of the referrals placed in 2021, 13% of consults were initiated through the electronic screening tool. The most common rehabilitation-related referrals placed after initial cancer rehabilitation triage included physical therapy (n = 47, 35.1%), physiatry (n = 28, 20.9%), and occupational therapy (n = 24, 17.9%). CONCLUSIONS Implementing an electronic screening tool can streamline cancer rehabilitation referrals and increase access to cancer rehabilitation services for Veterans with cancer. Ongoing work is required to refine the referral process and educate providers and patients on the importance of cancer rehabilitation in the cancer care continuum.
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Affiliation(s)
- Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Sara Lim
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew Essman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Ileana Howard
- Department of Rehabilitation Medicine, Veterans Affairs Puget Sound, Seattle, Washington, USA
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Vaughan VC, Martin P. Multidisciplinary approaches to cancer cachexia: current service models and future perspectives. Expert Rev Anticancer Ther 2022; 22:737-749. [PMID: 35699257 DOI: 10.1080/14737140.2022.2088516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cancer cachexia remains a complex unmet need in oncology, despite its high prevalence and high impact. Patients with cachexia experience numerous complications, including reduced tolerance and effectiveness of anti-cancer therapy, reduced mobility, and reduced functional status, leading to decreased quality of life and survival. AREAS COVERED As the field moves toward greater consensus of definitions and measurements, we highlight tools currently available for identification and staging of cachexia, and the barriers that people with cancer face in timely identification and management of cachexia. Multidisciplinary cachexia service models have emerged to address practice gaps and needs identified by patients and clinicians. Person-centred approaches to cachexia care demonstrate promising improvements in patient outcomes, but controlled trials of service models are lacking. EXPERT OPINION While significant advances have been made in the understanding of cachexia, future trials of clinical service models require standardisation of definitions and outcome measures, with more robust controlled studies to establish the efficacy of proposed best practice. We remain excited with the potential benefit of these innovative models and continue to advocate for implementation of dedicated multidisciplinary cachexia teams to ensure patients and their families receive the right support, in the right place, at the right time.
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Affiliation(s)
| | - Peter Martin
- School of Medicine, Deakin University, Waurn Ponds, Australia.,Barwon Health, Barwon Health Cachexia & Nutrition Support Service, Geelong, Australia
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5
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Sotirova MB, McCaughan EM, Ramsey L, Flannagan C, Kerr DP, O'Connor SR, Blackburn NE, Wilson IM. Acceptability of online exercise-based interventions after breast cancer surgery: systematic review and narrative synthesis. J Cancer Surviv 2021; 15:281-310. [PMID: 32930924 PMCID: PMC7966228 DOI: 10.1007/s11764-020-00931-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE eHealth and mHealth approaches are increasingly used to support cancer survivors. This review aimed to examine adherence, acceptability and satisfaction with Internet-based self-management programmes for post-surgical cancer rehabilitation and to identify common components of such interventions. METHODS Nine electronic databases were searched from inception up to February 15, 2020, for relevant quantitative and qualitative studies evaluating Internet-based cancer rehabilitation interventions. Studies were required to include an exercise or physical activity-based self-management intervention and a measure of adherence, acceptability or user satisfaction with the programme. Two independent reviewers performed all data extraction and quality assessment procedures. Data were synthesized using a narrative approach. RESULTS Six hundred ninety-six potential papers were identified and screened. Eleven met the inclusion criteria. Interventions had wide variations in levels of adherence, but the majority were reported as being acceptable to the users. Increased acceptability and user satisfaction were associated with interventions which were seen as time and cost-efficient, requiring acquisition of minimal or no new skills, which used coherent language, or which provided tailored information. The majority contained behaviour change components such as goal setting. CONCLUSIONS Despite high levels of heterogeneity between studies, Internet-based approaches may be an acceptable method for the delivery of self-management interventions in post-surgical cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS There is a need for further studies exploring factors associated with increased user engagement and usage of digital interventions in cancer rehabilitation settings. These findings should be used to help develop interventions prior to testing their effectiveness in adequately powered randomized controlled trials.
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Affiliation(s)
- Mariya B Sotirova
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK.
| | - Eilís M McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, Northern Ireland, UK
| | - Lucia Ramsey
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Coleraine, Northern Ireland, UK
| | - Daniel P Kerr
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicole E Blackburn
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Iseult M Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
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6
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Vaughan VC, Harrison M, Dowd A, Eastman P, Martin P. Evaluation of a Multidisciplinary Cachexia and Nutrition Support Service- The Patient and Carers Perspective. J Patient Exp 2021; 8:2374373520981476. [PMID: 34179355 PMCID: PMC8205347 DOI: 10.1177/2374373520981476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The Barwon Health Cachexia & Nutrition Support Service (CNSS) is an outpatient service focused on improving clinical outcomes and quality of life for patients with or at high risk of cancer cachexia. Patients see a multidisciplinary team, comprising a palliative medicine physician, physiotherapist, dietitian, and nurse practitioner. This study evaluated the service from patient and carer perspectives. In 2016/17, semistructured interviews were conducted with 12 patients and 9 carers attending the service, focusing on: (1) reflection on experience of the CNSS, and (2) describing how a cachexia-specific service can meet their needs and concerns. Analysis generated 4 superordinate themes: evolving perception of service value, empowerment through person-centered care, communication to patients and carers regarding health/disease information, and the importance of the multidisciplinary team-based approach. Generally, patients and carers reported overall positive experiences with the service, particularly with regard to improved communication and management of the patient. Findings confirmed the patient-centered and individualized approaches were particularly valued. These insights are a critical step in the development of recommendations for future clinical management of cancer cachexia.
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Affiliation(s)
- Vanessa C Vaughan
- School of Medicine, Deakin
University, Waurn Ponds, Victoria, Australia
| | - Meg Harrison
- School of Medicine, Deakin
University, Waurn Ponds, Victoria, Australia
- Barwon Health Cachexia & Nutrition Support Service, Barwon Health,
Geelong, Victoria, Australia
- Palliative Care Department, Barwon Health, North Geelong, Victoria, Australia
| | - Anna Dowd
- Palliative Care Department, Barwon Health, North Geelong, Victoria, Australia
| | - Peter Eastman
- School of Medicine, Deakin
University, Waurn Ponds, Victoria, Australia
- Barwon Health Cachexia & Nutrition Support Service, Barwon Health,
Geelong, Victoria, Australia
- Palliative Care Department, Barwon Health, North Geelong, Victoria, Australia
| | - Peter Martin
- School of Medicine, Deakin
University, Waurn Ponds, Victoria, Australia
- Barwon Health Cachexia & Nutrition Support Service, Barwon Health,
Geelong, Victoria, Australia
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Rammant E, Deforche B, Van Hecke A, Verhaeghe S, Van Ruymbeke B, Bultijnck R, Van Hemelrijck M, Fox L, Pieters R, Decaestecker K, Fonteyne V. Development of a pre- and postoperative physical activity promotion program integrated in the electronic health system of patients with bladder cancer (The POPEYE study): An intervention mapping approach. Eur J Cancer Care (Engl) 2020; 30:e13363. [PMID: 33205552 DOI: 10.1111/ecc.13363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/31/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Uptake of sufficient physical activity before and after radical cystectomy is important to improve physical and psychosocial outcomes in bladder cancer (BC) patients. METHODS In this paper, we describe the development of an evidence-based and theory-informed intervention, guided by the steps of the Intervention Mapping approach, to promote physical activity before and after radical cystectomy in patients with BC. RESULTS The intervention is a home-based physical activity program. The preoperative timeframe of the intervention is 4 or 12 weeks, depending on administration of neoadjuvant chemotherapy. Postoperatively, the intervention will last for 12 weeks. The intervention consists of a digital oncological platform (DOP), several consultations with healthcare professionals, personal booklet and follow-up phone calls. DOP includes information, diaries, visual representation of progress, mailbox, videos of peers and treating physician explaining the benefits of physical activity, photo material of exercises and a walking program with an activity tracker. Individual goals will be set and will be self-monitored by the patient through DOP. Patients will receive alerts and regular feedback. CONCLUSIONS Intervention Mapping ensures transparency of all intervention components and offers a useful approach for the development of behaviour change interventions for cancer patients and for translation of theories into practice.
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Affiliation(s)
- Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Unit Health Promotion, Ghent University, Ghent, Belgium.,Department of Movement and Sport Sciences, Physical Activity, Nutrition and Health Research Unit, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
| | - Barbara Van Ruymbeke
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Louis Fox
- School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Ronny Pieters
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Karel Decaestecker
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Ray H, Beaumont A, Loeliger J, Martin A, Marston C, Gough K, Bordia S, Ftanou M, Kiss N. Implementation of a Multidisciplinary Allied Health Optimisation Clinic for Cancer Patients with Complex Needs. J Clin Med 2020; 9:E2431. [PMID: 32751451 PMCID: PMC7465605 DOI: 10.3390/jcm9082431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
This study examined the feasibility of implementing a multidisciplinary allied health model of care (MOC) for cancer patients with complex needs. The MOC in this retrospective study provided up to eight weeks of nutritional counselling, exercise prescription, fatigue management and psychological support. Implementation outcomes (acceptability, adoption, fidelity and appropriateness) were evaluated using nine patient interviews, and operational data and medical records of 185 patients referred between August 2017 and December 2018. Adoption, including intention to try and uptake, were acceptable: 88% of referred patients agreed to screening and 71% of eligible patients agreed to clinic participation. Fidelity was mixed, secondary to inpatient admissions and disease progression interrupting patient participation. Clinician compliance with outcome assessment was variable at program commencement (dietetic, 95%; physiotherapy, 91%; occupational therapy, 33%; quality of life, 23%) and low at program completion (dietetic, 32%; physiotherapy, 13%; occupational therapy, 10%; quality of life, 11%) mainly due to non-attendance. Patient interviews revealed high satisfaction and perceived appropriateness. Adoption of the optimisation clinic was acceptable. Interview responses suggest patients feel the clinic is both acceptable and appropriate. This indicates a multidisciplinary model is an important aspect of comprehensive, timely and effective care. However, fidelity was low, secondary to the complexities of the patient cohort.
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Affiliation(s)
- Hannah Ray
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Anna Beaumont
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Jenelle Loeliger
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Alicia Martin
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Celia Marston
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
| | - Karla Gough
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (K.G.); (S.B.)
| | - Shilpa Bordia
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (K.G.); (S.B.)
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia;
| | - Nicole Kiss
- Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia; (A.B.); (J.L.); (A.M.); (C.M.); (N.K.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria 3220, Australia
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Defining a new model of interdisciplinary cancer cachexia care in regional Victoria, Australia. Support Care Cancer 2019; 28:3041-3049. [DOI: 10.1007/s00520-019-05072-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022]
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10
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Lyons KD, Newman RM, Sullivan M, Pergolotti M, Braveman B, Cheville AL. Employment Concerns and Associated Impairments of Women Living With Advanced Breast Cancer. Arch Rehabil Res Clin Transl 2019; 1:100004. [PMID: 33543044 PMCID: PMC7853337 DOI: 10.1016/j.arrct.2019.100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To describe the clinical and personal factors associated with work status, distress regarding work status, and the desire to resume employment and receive help to address work challenges reported by women living with advanced breast cancer. Design Descriptive statistics and univariate and multivariate logistic regression were used to explore factors related to employment challenges in this secondary analysis of an existing dataset. Setting Participants were recruited from an outpatient oncology clinic specializing in breast cancer at a free-standing comprehensive cancer center. Participants English-speaking women older than 18 years living with metastatic breast cancer with intact mental status and Karnofsky Performance Scale scores between 40 and 90 (N=163). Intervention Not applicable. Main Outcome Measures Dependent variables included (1) continued employment if working at the time of cancer diagnosis; (2) interest in resuming employment if working at the time of cancer diagnosis and now no longer working; (3) distress regarding vocational limitations; and (4) interest in receiving help to resume work. Results Seventy percent of the sample was working before their cancer diagnosis (n=114), yet only 21% (n=35) was working when surveyed. Lower functional status and higher symptom burden were strongly and consistently associated with lack of work retention, distress related to vocational role limitations, and desire for help in addressing limitations (all P values<.01). Conclusions With more people living longer with metastatic cancer, there is a need to assess and support survivors’ desire and capacity to maintain employment. Participants’ reduced employment was strongly associated with potentially actionable clinical targets (ie, higher symptom burden and lower functional status) that fall within cancer rehabilitation’s mission.
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Affiliation(s)
- Kathleen Doyle Lyons
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Psychiatry, Dartmouth College, Hanover, New Hampshire
| | - Robin M Newman
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
| | | | | | | | - Andrea L Cheville
- Physical Medicine and Rehabilitation Department, Mayo Clinic, Rochester, Minnesota
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Lyons KD, Padgett LS, Marshall TF, Greer JA, Silver JK, Raj VS, Zucker DS, Fu JB, Pergolotti M, Sleight AG, Alfano CM. Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation. CA Cancer J Clin 2019; 69:113-126. [PMID: 30457670 DOI: 10.3322/caac.21549] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.
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Affiliation(s)
- Kathleen D Lyons
- Scientist, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Assistant Professor of Psychiatry, Department of Psychiatry, Dartmouth College, Hanover, NH
| | - Lynne S Padgett
- Health Psychologist, Washington DC Veterans Affairs Medical Center, Washington, DC
| | - Timothy F Marshall
- Assistant Professor, School of Physical Therapy, Kean University, Union, NJ
| | - Joseph A Greer
- Program Director, Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital, Boston, MA
- Assistant Professor of Psychology, Harvard Medical School, Boston, MA
| | - Julie K Silver
- Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
- Associate in Physiatry, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA
| | - Vishwa S Raj
- Associate Professor, Director of Oncology Rehabilitation, Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Department of Supportive Care, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - David S Zucker
- Medical Director & Program Leader, Cancer Rehabilitation Services, Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Jack B Fu
- Associate Professor, Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mackenzi Pergolotti
- Director of Research, ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA
| | - Alix G Sleight
- Postdoctoral Fellow, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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Feldstain A, MacDonald N, Bhargava R, Chasen M. Reported distress in patients living with advanced cancer: changes pre-post interdisciplinary palliative rehabilitation. Support Care Cancer 2017; 25:3191-3197. [DOI: 10.1007/s00520-017-3728-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
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13
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Santa Mina D, Petrella A, Currie KL, Bietola K, Alibhai SMH, Trachtenberg J, Ritvo P, Matthew AG. Enablers and barriers in delivery of a cancer exercise program: the Canadian experience. ACTA ACUST UNITED AC 2015; 22:374-84. [PMID: 26715869 DOI: 10.3747/co.22.2650] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. METHODS Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. RESULTS Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. CONCLUSIONS Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada.
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Affiliation(s)
- D Santa Mina
- Princess Margaret Cancer Centre, Toronto, ON; ; University of Guelph-Humber, Toronto, ON; ; University of Toronto, Toronto, ON
| | - A Petrella
- Princess Margaret Cancer Centre, Toronto, ON
| | - K L Currie
- Princess Margaret Cancer Centre, Toronto, ON
| | - K Bietola
- University of Guelph-Humber, Toronto, ON
| | - S M H Alibhai
- University of Toronto, Toronto, ON; ; University Health Network, Toronto, ON
| | - J Trachtenberg
- Princess Margaret Cancer Centre, Toronto, ON; ; University of Toronto, Toronto, ON
| | - P Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON; ; Cancer Care Ontario, Toronto, ON
| | - A G Matthew
- Princess Margaret Cancer Centre, Toronto, ON; ; University of Toronto, Toronto, ON
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An interdisciplinary palliative rehabilitation intervention bolstering general self-efficacy to attenuate symptoms of depression in patients living with advanced cancer. Support Care Cancer 2015; 24:109-117. [DOI: 10.1007/s00520-015-2751-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/22/2015] [Indexed: 12/20/2022]
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15
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Chasen M, Bhargava R, MacDonald N. Rehabilitation for patients with advanced cancer. CMAJ 2014; 186:1071-5. [PMID: 25047989 DOI: 10.1503/cmaj.131402] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Martin Chasen
- Division of Palliative Care (Chasen, Bhargava), Élisabeth-Bruyère Hospital; Department of Medicine (Chasen, Bhargava), University of Ottawa; Bruyère Research Institute (Chasen, Bhargava, MacDonald); Department of Medicine (Chasen), The Ottawa Hospital, Ottawa, Ont.; Department of Oncology (MacDonald), McGill University, Montréal, Que.
| | - Ravi Bhargava
- Division of Palliative Care (Chasen, Bhargava), Élisabeth-Bruyère Hospital; Department of Medicine (Chasen, Bhargava), University of Ottawa; Bruyère Research Institute (Chasen, Bhargava, MacDonald); Department of Medicine (Chasen), The Ottawa Hospital, Ottawa, Ont.; Department of Oncology (MacDonald), McGill University, Montréal, Que
| | - Neil MacDonald
- Division of Palliative Care (Chasen, Bhargava), Élisabeth-Bruyère Hospital; Department of Medicine (Chasen, Bhargava), University of Ottawa; Bruyère Research Institute (Chasen, Bhargava, MacDonald); Department of Medicine (Chasen), The Ottawa Hospital, Ottawa, Ont.; Department of Oncology (MacDonald), McGill University, Montréal, Que
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16
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Mayo NE, Moriello C, Scott SC, Dawes D, Auais M, Chasen M. Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: a pilot randomized trial. Clin Rehabil 2014; 28:1198-209. [PMID: 24917586 DOI: 10.1177/0269215514536209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Mechanisms for cancer related fatigue suggest that exercise but “not too much and not too little” could be effective. This study aimed to investigate feasibility and estimate the potential effects of a walking exercise program in people with advanced cancer and fatigue. Design: A pilot randomized trial. Setting: McGill University Health Centre (MUHC), Montreal, Canada. Subjects: People with advanced cancer undergoing interdisciplinary assessment and rehabilitation with a fatigue level of 4 to 10 on a visual analogue scale. Interventions: An 8-week fatigue-adapted, walking intervention, facilitated using a pedometer (STEPS), and offered at the same time as or after rehabilitation. Measures: Measures of fatigue, physical function and well-being were administered at entry, and 8, 16 and 24 weeks. Generalized estimating equations (GEE) estimated the odds of response for people receiving the STEPS program in comparison to the odds of response in the controls (odds ratio, OR). Results: Twenty-six persons were randomized to three groups: during rehabilitation, after rehabilitation, and usual care. For the fatigue measures the OR for STEPS offered at any time using an intention-to-treat approach was 3.68 (95%CI: 1.05-12.88); for the physical function measures, the OR was 1.40 (95%CI: 0.41- 4.79) and 2.36 (95%CI: 0.66-8.51) for the well-being measures. Conclusion: Fifty percent of eligible people were able to participate. This small trial suggests that a personalized exercise program reduces fatigue and that 100 people are needed in a full strength trial.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University Health Center (MUHC), MUHC Research Institute, Canada
| | - Carolina Moriello
- Division of Clinical Epidemiology, McGill University Health Center (MUHC), MUHC Research Institute, Canada
| | - Susan C Scott
- Division of Clinical Epidemiology, McGill University Health Center (MUHC), MUHC Research Institute, Canada
| | - Diana Dawes
- Department of Family Practice, Faculty of Medicine,The University of British Columbia, Canada
| | - Mohammad Auais
- Ivey International Centre for Health Innovation, University of Western Ontario, London, Ontario, Canada
| | - Martin Chasen
- Division of Palliative Care, University of Ottawa, Canada
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17
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Xu YJ, Cheng JCH, Lee JM, Chen CCH. Management of Malnutrition in Esophageal Cancer Patients. JOURNAL OF CANCER RESEARCH AND PRACTICE 2014. [DOI: 10.1016/s2311-3006(16)30019-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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18
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Abstract
Today, most oncologists would agree that Anderson’s statement is common sense and subscribe to its expressed wisdom. [...]
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Affiliation(s)
- N Macdonald
- Department of Oncology, Faculty of Medicine, McGill University, Montreal, QC
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19
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Chasen MR, Feldstain A, Gravelle D, Macdonald N, Pereira J. An interprofessional palliative care oncology rehabilitation program: effects on function and predictors of program completion. ACTA ACUST UNITED AC 2013; 20:301-9. [PMID: 24311945 DOI: 10.3747/co.20.1607] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND After treatment, patients with active cancer face a considerable burden from the effects of both the disease and its treatment. The Palliative Rehabilitation Program (prp) is designed to ameliorate disease effects and to improve the patient's functioning. The present study evaluated predictors of program completion and changes in functioning, symptoms, and well-being after the program. METHODS The program received referrals for 173 patients who had finished anticancer therapy. Of those 173 patients, 116 with advanced cancer were eligible and enrolled in the 8-week interprofessional prp; 67 completed it. Measures of physical, nutritional, social, and psychological functioning were evaluated at entry to the program and at completion. RESULTS Participants experienced significant improvements in physical performance (p < 0.000), nutrition (p = 0.001), symptom severity (p = 0.005 to 0.001), symptom interference with functioning (p = 0.003 to 0.001), fatigue (p = 0.001), and physical endurance, mobility, and balance or function (p = 0.001 to 0.001). Reasons that participants did not complete the prp were disease progression, geographic inaccessibility, being too well (program not challenging enough), death, and personal or unknown reasons. A normal level of C-reactive protein (<10 mg/L, p = 0.029) was a predictor of program completion. CONCLUSIONS Patients living with advanced cancers who underwent the interprofessional prp experienced significant improvement in functioning across several domains. Program completion can be predicted by a normal level of C-reactive protein.
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Affiliation(s)
- M R Chasen
- Department of Palliative Medicine, Bruyère Continuing Care, Ottawa, ON. ; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON. ; School of Psychology, University of Ottawa, Ottawa, ON
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20
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Gagnon B, Murphy J, Eades M, Lemoignan J, Jelowicki M, Carney S, Amdouni S, Di Dio P, Chasen M, Macdonald N. A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer. ACTA ACUST UNITED AC 2013; 20:310-8. [PMID: 24311946 DOI: 10.3747/co.20.1612] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cancer can affect many dimensions of a patient's life, and in turn, it should be targeted using a multimodal approach. We tested the extent to which an interdisciplinary nutrition-rehabilitation program can improve the well-being of patients with advanced cancer. METHODS Between January 10, 2007, and September 29, 2010, 188 patients with advanced cancer enrolled in the 10-12-week program. Body weight, physical function, symptom severity, fatigue dimensions, distress level, coping ability, and overall quality of life were assessed at the start and end of the program. RESULTS Of the enrolled patients, 70% completed the program. Patients experienced strong improvements in the physical and activity dimensions of fatigue (effect sizes: 0.8-1.1). They also experienced moderate reductions in the severity of weakness, depression, nervousness, shortness of breath, and distress (effect sizes: 0.5-0.7), and moderate improvements in Six Minute Walk Test distance, maximal gait speed, coping ability, and quality of life (effect sizes: 0.5-0.7) Furthermore, 77% of patients either maintained or increased their body weight. CONCLUSIONS Interdisciplinary nutrition-rehabilitation can be advantageous for patients with advanced cancer and should be considered an integrated part of standard palliative care.
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Affiliation(s)
- B Gagnon
- Department of Family Medicine and Emergency Medicine, Université Laval, Centre de recherché du Le Centre hospitalier universitaire de Québec, Quebec City, QC
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21
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Ma L, Poulin P, Feldstain A, Chasen M. The association between malnutrition and psychological distress in patients with advanced head-and-neck cancer. Curr Oncol 2013; 20:e554-60. [PMID: 24311956 PMCID: PMC3851352 DOI: 10.3747/co.20.1651] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Malnutrition and psychological distress are often seen in patients with head-and-neck cancer, but little is known about the interrelationships between those two symptoms. The present study examined the relationship between malnutrition and psychological distress in patients with advanced head-and-neck cancer. METHODS Using the Patient-Generated Subjective Global Assessment, 99 patients with advanced-stage head-and-neck cancer were screened for nutrition status. The patients were also screened for psychosocial distress (using the Distress Thermometer) and for psychosocial issues (using the Problem Checklist). Any relationship between malnutrition and psychosocial distress was determined by regression and correlation analysis. We also used t-tests to compare distress levels for patients with and without specific nutrition-related symptoms. RESULTS The study group included 80 men and 19 women [mean age: 58.4 ± 10.9 years (range: 23-85 years)]. The correlation between poorer nutrition status and level of psychological distress was significant r = 0.37 (p < 0.001). Specifically, reduced food intake and symptoms were both positively associated with distress: r = 0.27 and r = 0.29 respectively, both significant at p < 0.01. After controlling for the effects of psychosocial problems and pain, nutrition status remained a significant predictor of distress, explaining 3.8% of the variance in the distress scores of the patients (p < 0.05). CONCLUSIONS Malnutrition and symptoms were strongly related to distress in patients with advanced head-and-neck cancer. Our results suggest the need for further research into the complex relationship between nutrition status and distress and into the management of both nutrition and distress in cancer care.
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Affiliation(s)
- L. Ma
- Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - P. Poulin
- Psychosocial Oncology Program, The Ottawa Hospital Health Institute, Ottawa, ON
| | - A. Feldstain
- School of Psychology, University of Ottawa, Ottawa, ON
| | - M.R. Chasen
- Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
- Division of Palliative Care, The Ottawa Hospital Cancer Centre, Ottawa, ON
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22
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Payne C, Larkin P, McIlfatrick S, Dunwoody L, Gracey J. Exercise and nutrition interventions in advanced lung cancer: a systematic review. Curr Oncol 2013; 20:e321-37. [PMID: 23904771 PMCID: PMC3728061 DOI: 10.3747/co.20.1431] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED In this systematic review, we sought to evaluate the effect of physical activity or nutrition interventions (or both) in adults with advanced non-small-cell lung cancer (nsclc). METHODS A systematic search for relevant clinical trials was conducted in 6 electronic databases, by hand searching, and by contacting key investigators. No limits were placed on study language. Information about recruitment rates, protocol adherence, patient-reported and clinical outcome measures, and study conclusions was extracted. Methodologic quality and risk of bias in each study was assessed using validated tools. MAIN RESULTS Six papers detailing five studies involving 203 participants met the inclusion criteria. Two of the studies were single-cohort physical activity studies (54 participants), and three were controlled nutrition studies (149 participants). All were conducted in an outpatient setting. None of the included studies combined physical activity with nutrition interventions. CONCLUSIONS Our systematic review suggests that exercise and nutrition interventions are not harmful and may have beneficial effects on unintentional weight loss, physical strength, and functional performance in patients with advanced nsclc. However, the observed improvements must be interpreted with caution, because findings were not consistent across the included studies. Moreover, the included studies were small and at significant risk of bias. More research is required to ascertain the optimal physical activity and nutrition interventions in advanced inoperable nsclc. Specifically, the potential benefits of combining physical activity with nutrition counselling have yet to be adequately explored in this population.
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Affiliation(s)
- C. Payne
- All Ireland Institute of Hospice and Palliative Care, and the HSC R&D Division, Public Health Agency, Northern Ireland
- Institute of Nursing and Health Research, University of Ulster, Northern Ireland
| | - P.J. Larkin
- Clinical Nursing (Palliative Care), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin and Our Lady’s Hospice and Care Services, Dublin, Republic of Ireland
| | - S. McIlfatrick
- Institute of Nursing and Health Research, University of Ulster, Northern Ireland
| | - L. Dunwoody
- Psychology Research Institute, University of Ulster, Northern Ireland
| | - J.H. Gracey
- Institute of Nursing and Health Research, University of Ulster, Northern Ireland
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23
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Egan MY, McEwen S, Sikora L, Chasen M, Fitch M, Eldred S. Rehabilitation following cancer treatment. Disabil Rehabil 2013; 35:2245-58. [PMID: 23488617 DOI: 10.3109/09638288.2013.774441] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Cancer survivorship is increasing. However, life-saving treatments often leave people with physical, cognitive and emotional sequelae that contribute to activity and participation limitations. The purpose of this review is to summarize current evidence regarding rehabilitation interventions to address problems during survivorship. METHOD Best evidence synthesis. The review took as its starting point a systematic review of patient needs and supportive care interventions following cancer treatment. The study team identified the needs which could be addressed by rehabilitation and suggested others not originally included. Then they built on the earlier review's conclusions regarding effective intervention through extraction of results from subsequent systematic reviews and randomized controlled trials. RESULTS Evidence regarding the effectiveness of potential rehabilitation interventions was reviewed for physical functioning, fatigue, pain, sexual functioning, cognitive functioning, depression, employment, nutrition and participation. With the exception of physical rehabilitation interventions following breast cancer, this literature tends to focus on psychoeducational interventions, which have demonstrated limited effectiveness for rehabilitation outcomes. CONCLUSIONS Most of the knowledge available regarding potential rehabilitation interventions comes from psychosocial oncology literature. While there are limitations, this literature provides an excellent starting point to examine the potential effectiveness of rehabilitation interventions within cancer survivorship programs. IMPLICATIONS FOR REHABILITATION Good evidence exists for the use of exercise/physical rehabilitation in reducing fatigue after treatment for most cancers, and improving upper extremity functioning following treatment for breast cancer. Preliminary evidence exists in a number of areas that may be improved by rehabilitation interventions, such as pain, sexual functioning, cognitive functioning and return to work, but further research is needed. No intervention studies addressing participation limitations were identified. Rehabilitation professionals are encouraged to take the lead in exploring participation limitations among cancer survivors and developing suitable interventions.
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Affiliation(s)
- Mary Y Egan
- Bruyere Research Institute , Ottawa, ON , Canada
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24
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Biochemical parameters in patients suffering from head and neck cancer. Effect of nutritional support. Preliminary study. Proc Nutr Soc 2013. [DOI: 10.1017/s0029665113000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Watkins F, Tulloch S, Bennett C, Webster B, McCarthy C. A multimodal, interdisciplinary programme for the management of cachexia and fatigue. Int J Palliat Nurs 2012; 18:85-90. [PMID: 22399046 DOI: 10.12968/ijpn.2012.18.2.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.
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Affiliation(s)
- Frances Watkins
- Adelaide Hills Community Health Service, South Australia, Australia
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26
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Eades M, Murphy J, Carney S, Amdouni S, Lemoignan J, Jelowicki M, Nadler M, Chasen M, Gagnon B. Effect of an interdisciplinary rehabilitation program on quality of life in patients with head and neck cancer: Review of clinical experience. Head Neck 2012; 35:343-9. [DOI: 10.1002/hed.22972] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/12/2022] Open
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Giannousi Z, Gioulbasanis I, Pallis AG, Xyrafas A, Dalliani D, Kalbakis K, Papadopoulos V, Mavroudis D, Georgoulias V, Papandreou CN. Nutritional status, acute phase response and depression in metastatic lung cancer patients: correlations and association prognosis. Support Care Cancer 2011; 20:1823-9. [PMID: 21959842 DOI: 10.1007/s00520-011-1282-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/12/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Cancer cachexia is a metabolic syndrome related with poor outcome. Cytokines play a key role in the pathophysiology of that syndrome. The aim of this study was to investigate the potential correlations between nutritional status, systemic inflammation, and psychological distress in cancer patients. The prognostic significance of the recorded parameters was also assessed. PATIENTS AND METHODS Patients with metastatic lung cancer were eligible. Mini Nutritional Assessment (MNA) was used for the evaluation of nutritional status, Glasgow Prognostic Score (GPS) for the estimation of systemic inflammation, and Hospital Anxiety and Depression Scale (HADS) for psychological assessment. RESULTS Totally, 122 patients were enrolled (71.3% with NSCLC and 28.7% with SCLC). The following correlations were observed: MNA and GPS (r = 0.289, p = 0.001), MNA and HADS (depression scale) (r = 0.275, p = 0.002), GPS and HADS (depression scale) (r = 0.256, p = 0.004), and GPS and HADS (anxiety scale) (r =0.194, p =0.033). In univariate analysis, GPS (p = 0.002) and MNA (p = 0.010) emerged as significant predictors of survival. In multivariate analysis, both MNA (p = 0.032) and GPS (p = 0.020) retained their importance. CONCLUSIONS This study highlights the associations between nutritional status, systemic inflammation, and psychological distress, supporting their common underlying pathophysiological mechanisms and further suggesting the necessity of a holistic anti-cachectic approach.
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Affiliation(s)
- Zoe Giannousi
- Department of Medical Oncology, University General Hospital of Heraklion, Stavrakia and Voutes, Heraklion, 71110, Crete, Greece.
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What to eat when off treatment and living with involuntary weight loss and cancer: a systematic search and narrative review. Support Care Cancer 2010; 19:1-17. [DOI: 10.1007/s00520-010-0964-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
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29
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MacDonald N. Cancer Rehabilitation: Principles and Practice. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Establishing a cancer nutrition rehabilitation program (CNRP) for ambulatory patients attending an Australian cancer center. Support Care Cancer 2010; 19:445-54. [DOI: 10.1007/s00520-010-0834-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
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Abstract
Literature demonstrating the importance of social relationships for cancer survivorship is accumulating. Building on that literature, the term “Healing Ties” refers to the scientific and popular factors supporting the idea that relationships and community are essential for healing. However, difficulties arise in assessing the effect of social support for survivorship. The current paper reviews the role in survivorship of social support, with respect to the explanatory model provided by neuro-oncology and psycho-neuro-immunology. Taking cognizance of the importance of social relationships, the model of cancer rehabilitation aims, through its interdisciplinary framework, to restore a sense of well-being and to facilitate healing by optimizing the capability for full social relationships and engagement with the world.
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Affiliation(s)
- H D Braude
- Biomedical Ethics Unit, McGill University, Montreal, QC
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32
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A retrospective study of the role of an occupational therapist in the cancer nutrition rehabilitation program. Support Care Cancer 2009; 18:1589-96. [PMID: 19956981 DOI: 10.1007/s00520-009-0782-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 11/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study was to determine how frequently each domain of activity was addressed and how frequently specific interventions were used by an occupational therapist (OT) with cancer patients who attended an 8-week Cancer Nutrition and Rehabilitation (CNR) program. METHODS Sixty-two patients with cancer were assessed. All received interventions by the OT within the CNR program. The following activity domains: (1) self-care, (2) productivity, and (3) leisure that were addressed during appointments with the OT were recorded following each visit. Seven categories of interventions were predetermined and their use was recorded using a checklist. RESULTS Descriptive statistics were conducted and revealed that 36% of the therapist's time was spent assessing patients' functional capacity while 64% was spent providing interventions. The OT's interventions addressed leisure and exercise (54%), productive activities such as housework and paid employment (32%), and basic activities of daily living (14%). The frequency of specific interventions provided were as follows: 40% in teaching of energy conservation and activity management techniques, 33% in goal setting/support and counseling, 9% in cognitive retraining/stimulation, 6% in communication with community agencies, and 4% in teaching of joint and bone protection techniques, help with management of neuropathies, and education on scar management respectively. CONCLUSION It is suggested that OTs practicing in oncology use a variety of interventions to better address productive and leisure activities. The data suggests that limitations in these areas were more prevalent than in self-care activities. Further study is needed to examine OT interventions in oncology.
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Eades M, Chasen M, Bhargava R. Rehabilitation: long-term physical and functional changes following treatment. Semin Oncol Nurs 2009; 25:222-30. [PMID: 19635401 DOI: 10.1016/j.soncn.2009.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the life altering issues that survivors of a head and neck cancer report post treatment and discuss multidimensional rehabilitation approaches. DATA SOURCES Published journal articles, literature reviews, research reports, book chapters. CONCLUSION Survivors and their family caregivers encounter many changes during the first 3 months following treatment for head and neck cancer, placing them at risk of multiple adjustment difficulties. Progressive weight loss, loss of energy, strength, muscle endurance and decreased functioning severely compromise healthy adjustment and quality of life. IMPLICATIONS FOR NURSING PRACTICE Nurses can help patients and family identify survivorship issues to be managed at home. Planning, exploring, coaching, practicing skills with survivors and their family caregivers, providing specific information, and linking them with resources can help them bridge this transition into extended survivorship.
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Affiliation(s)
- Margaret Eades
- McGill University Health Centre, Royal Victoria Hospital site, Montreal, Quebec, Canada.
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A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer. Support Care Cancer 2009; 17:1345-51. [DOI: 10.1007/s00520-009-0684-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
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Thomas-Maclean R, Towers A, Quinlan E, Hack TF, Kwan W, Miedema B, Tilley A, Graham P. "This is a kind of betrayal": a qualitative study of disability after breast cancer. Curr Oncol 2009; 16:26-32. [PMID: 19526082 PMCID: PMC2695715 DOI: 10.3747/co.v16i3.389] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We proposed to document the effect of arm morbidity and disability in 40 Canadian women who were 12-24 months post breast cancer surgery. METHODS We completed 40 qualitative interviews as one component of a multidisciplinary national longitudinal study of arm morbidity after breast cancer (n = 745) involving four research sites (Fredericton/Saint John, Montreal, Winnipeg, Surrey). During semi-structured interviews, participants who had reported arm morbidity and disability in earlier surveys were asked to discuss the effects of these conditions on everyday life. RESULTS The interviewees reported making major adjustments to paid and unpaid work, which often involved the assistance of family members, thus demonstrating the effect of disability. Interview data resulted in the creation of a model that addresses arm morbidity and disability, and that holds implications for health care professionals. CONCLUSIONS Based on the interview findings, we conclude that a robust measure of disability after breast cancer should be developed. In the absence of a validated measure of the effect of disability, evaluating qualitative responses to questions about everyday activities could provide the impetus for provision of physical therapy and emotional support.
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Affiliation(s)
- R Thomas-Maclean
- Department of Sociology, University of Saskatchewan, Saskatoon, SK.
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