Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 2. Impact of Multidisciplinary Rehabilitation and Psychosocial, Sexuality, and Return-to-Work Interventions

Cancer rehabilitation services for older women with breast cancer: Impact on health-related quality of life outcomes

BACKGROUND

Older breast cancer survivors (BCS, age ≥ 65) are vulnerable to experiencing persistent symptoms and associated declines in health-related quality of life (HRQOL). In research trials, cancer rehabilitation interventions (physical or occupational therapy, PT/OT) have been shown to enhance HRQOL, but the impact of community-based PT/OT services for older BCS is unknown. We performed a retrospective, observational study to better understand the impact of PT/OT services on the HRQOL of older BCS.

METHODS

Outcomes and covariates were extracted from the outpatient rehabilitation medical record. HRQOL outcomes included: PROMIS® global physical health (GPH), global mental health (GMH), physical function (PF), and ability to participate in social roles and activities (SRA). Linear mixed-effect models were used to examine change in HRQOL outcomes and explore the influence of patient age and service type (PT/OT). ICD-10 codes were examined and compared between service types to describe the impairments treated.

RESULTS

PT/OT cases (N = 694) were 71.79 ± 5.44 years old and participated in a median of 11 visits (IQR: 7.0-17.25) over 9.71 weeks (IQR: 6.29-15.29). Most (84.4%) attended PT (n = 579; 84%) versus OT (n = 115; 16%). Overall, significant improvement was observed in each HRQOL outcome (GPH: +3.00, p < 0.001; GMH: +1.80, p < 0.001; PF: +1.97, p < 0.001; SRA: +2.34, p < 0.001). Service type influenced only GPH (p = 0.041); mean improvement was +3.24 (SE: 0.290, p < 0.001) for PT cases and + 1.78 for OT cases (SE: 0.651, p = 0.007). PT cases commonly received treatment for weakness/atrophy, pain, walking, and posture; OT cases commonly received treatment for lymphedema and scarring/fibrosis. No age effects were observed.

CONCLUSIONS

In this large study of older BCS who participated in community-based PT/OT services across the United States, we observed significant improvements in HRQOL outcomes that are important to older BCS and their providers. Although more research is needed, these findings suggest that improved access to PT/OT could help address unmet HRQOL needs among this population.

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews

Background

In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes.

Objectives

The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes.

Search Methods

In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023.

Selection Criteria

Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level.

Data Collection and Analysis

Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM.

Stakeholder Involvement

We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it.

Main Results

We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review.

Authors’ Conclusions

This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.

Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States

Compared to adults without cancer, cancer survivors report poorer health-related quality of life (HRQOL), which is associated with negative treatment outcomes and increased healthcare use. Cancer-specialized physical and occupational therapy (PT/OT) could optimize HRQOL; however, the impact among survivors with non-breast malignancies is unknown. This retrospective (2020-2022), observational, study of medical record data of 12 cancer types, examined pre/post-HRQOL among cancer survivors who completed PT/OT. PROMIS® HRQOL measures: Global Health (physical [GPH] and mental [GMH]), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA) were evaluated using linear mixed effect models by cancer type, then compared to the minimal important change (MIC, 2 points). Survivors were 65.44 ± 12.84 years old (range: 19-91), male (54%), with a median of 12 visits. Improvements in GPH were significant (p < 0.05) for all cancer types and all achieved MIC. Improvements in GMH were significant for 11/12 cancer types and 8/12 achieved MIC. Improvements in PF were significant for all cancer types and all achieved the MIC. Improvements in SRA were significant for all cancer types and all groups achieved the MIC. We observed statistically and clinically significant improvements in HRQOL domains for each of the 12 cancer types evaluated.

Current Trends in Occupational Therapy for Adolescent and Young Adult Cancer Survivors: A Scoping Review

Adolescent and young adult cancer survivors experience barriers to occupational participation following cancer treatment. This article aims to identify the scope of occupational therapy evidence for adolescent and young adult cancer survivors. A scoping review of articles cited in CINAHL Complete, MEDLINE (EBSCO), Academic Search Complete, APA PsycINFO, and PubMed was performed. The initial search yielded 391 articles, with eight publications included in the final review. Results revealed a significant lack of age-specific occupational therapy-based resources for adolescent and young adult cancer survivors. Evidence supports the use of self-management, physical activity, therapeutic exercise, activities of daily living training and adaptation, and app-based coaching to improve client outcomes. Further research is required to determine the effectiveness of occupational therapy services, as well as to establish evidence-based guidelines for practice.

Nursing Roles in Cancer Rehabilitation: An Integrative Review

BACKGROUND

Because of cancer survivors' increased need for help and support, cancer rehabilitation should be an essential part of cancer treatment, where focusing on patients' individual needs is essential.

OBJECTIVE

To provide an overview of existing evidence about nurses' roles and participation in cancer rehabilitation, based on both nurses' and patients' perspectives.

METHODS

A systematic search was conducted in PubMed, CINAHL, EMBASE and Cochrane databases for studies published from January 2001-January 2022. Whittemore and Knafl's methodology for data extraction and synthesis was used, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. The review was registered in PROSPERO (CRD42021223683).

RESULTS

Ten qualitative studies and 7 quantitative studies were included, encompassing 306 patients and 1847 clinicians (1164 nurses). Three nursing roles emerged: (1) relationship-forming, in which nurses described ongoing involvement in patients' rehabilitation and patients described nurses as trusted partners; (2) coordinating, in which nurses described a lack of time and resources and a focus on medical treatment, and patients described nurses as expert coordinators; and (3) follow-up, in which patients described nurses as good communicators and trusted partners in their follow-up, and nurses described their natural interest in patients' rehabilitation outcomes during follow-up.

CONCLUSIONS

Patients were comfortable with nurses as trusted partners during cancer rehabilitation. Significant barriers such as lack of time, resources, and education about rehabilitation may negatively influence rehabilitation planning, implementation, and monitoring.

IMPLICATIONS FOR PRACTICE

Clinicians can use the findings to improve cancer rehabilitation with the nurse as a central provider and conduct further research on the coordinating and follow-up roles.

Factors That Influence Occupational Engagement of Young Adults Who Are Cancer Survivors: A Pilot Study

Cancer and its treatment can impact occupational engagement. However, occupational therapy-specific research studying young adult cancer survivors remains limited. The objective of this study to identify the type of occupations that young adult cancer survivors choose to engage in and to understand their decision-making process when choosing these occupations. A mixed-methods explanatory sequential design was used. Eleven participants, nine females and two males, between the ages of 18 and 35, were included. Several occupations were identified for engagement such as activities of daily living, leisure, work, sleep and rest, and health management. The predominant factor that influenced why occupations were chosen was that individuals purposefully selected occupations that allowed them to choose a path toward a more meaningful life. Information gained from this pilot study can be used to inform occupational therapy practitioners regarding services and interventions that promote occupational engagement for young adult cancer survivors.

Men's Lived Experiences of Breast Cancer and Changes in Occupation

Introduction

Male breast cancer is rare and frequently diagnosed at later stages of disease with low survival rates. There is a lack of knowledge of how breast cancer impacts men's occupations.

Objectives

This study is aimed at understanding the lived experiences of men with breast cancer and their changes in occupation. Methodology. Twenty-four men with breast cancer participated in semistructured phone interviews. Data was open-coded and analyzed for themes. Findings. The six major themes are as follows: (1) death as a reality, (2) unique personal insights, (3) social environment, (4) interactions with the healthcare system, (5) decreased engagement in occupations, and (6) finding meaning in new occupations.

Conclusion

The healthcare team can improve the patient experience by discussing and responding to the client's experience throughout the diagnosis, intervention, and survival continuum. The scope of occupational therapy is well suited to address the needs of men with breast cancer to maintain optimal levels of functioning.

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

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

Understanding Patient Experience with Outpatient Cancer Rehabilitation Care

BACKGROUND

Understanding patient experience is key to optimize access and quality of outpatient cancer rehabilitation (physical or occupational therapy, PT/OT) services.

METHODS

We performed a retrospective mixed-method analysis of rehabilitation medical record data to better understand patient experience and aspects of care that influenced experience. From the medical record, we extracted case characteristics, patient experience data (Net Promoter Survey^®, NPS) and patient-reported outcome (PRO) data. We categorized cases as 'promoters' (i.e., highly likely to recommend rehabilitation) or 'detractors', then calculated NPS score (-100 [worst] to 100 [best]). We identified key themes from NPS free-text comments using inductive content analysis, then used Pearson [r] or Spearman [ρ] correlation to explore relationships between NPS, characteristics, and PRO improvement.

RESULTS

Patients (n = 383) were 60.51 ± 12.02 years old, predominantly women with breast cancer (69.2%), and attended 14.23 ± 12.37 visits. Most were 'promoters' (92%); NPS score was 91.4. Patients described two experiences (themes) that influenced their likelihood to recommend rehabilitation: (1) feeling comfortable with the process and (2) observable improvement in health/functioning, and described attributes of clinic staff, environment and clinical care that influenced themes. Likelihood to recommend rehabilitation was associated with achieving the minimal clinical important difference on a PRO (ρ = 0.21, p < 0.001) and cancer type (ρ = 0.10, p < 0.001).

CONCLUSION

Patients who received specialized cancer PT/OT were highly likely to recommend rehabilitation. Feeling comfortable with the rehabilitation process and making observable improvements in health and/or functioning influenced likelihood to recommend. Rehabilitation providers should leverage the findings of this study optimize access to and quality of cancer rehab services.

Global Research Mapping of Psycho-Oncology Between 1980 and 2021: A Bibliometric Analysis

Background and Aim

Psycho-oncology is a cross-disciplinary and collaborative sub-specialty of oncology that focuses on the psychological, behavioral, ethical, and social aspects of cancer in clinical settings. The aim of this bibliometric study was to analyze and characterize the research productivity and trends in psycho-oncology between 1980 and 2021.

Methodology

In May 2022, the Scopus^® database was searched for psycho-oncology-related publications using predetermined search keywords with specific restrictions. Lotka’s law was applied to check the authors’ productivity, while Bradford’s law was used to assess the core journals in this field. The data was analyzed for different bibliometric indicators in the Biblioshiny package, an RStudio tool for bibliometric analysis.

Results

The initial search resulted in a total of 2,906 publications. Of which, 1,832 publications were included in the final analysis, published between 1980 and 2021. The analyzed publications were written by 7,363 authors from 74 countries and published in 490 journals. There has been a significant increase in psycho-oncology-related publications after 2010. The most productive year was 2021 (n = 365). The annual scientific growth rate was found to be 13.9%. The most relevant leading author in terms of publications was Luigi Grassi from the University of Ferrara, Italy (n = 42). Lotka’s law found that the number of authors declined as the number of papers written increased. The core journals were Psycho-Oncology, Supportive Care in Cancer, and Journal of Psychosocial Oncology. The most frequently used author’s keywords other than searching keywords were cancer, oncology, quality of life, depression, and anxiety. Recent psycho-oncology-related topics included mental health, COVID-19 infection in humans, people, pandemic, and tumor. The University of Sydney was the top-ranked institution. The leading country in terms of publications, citations, corresponding author country, and international collaboration was the United States of America (United States). The United States had the strongest collaboration with Australia and Canada.

Conclusion

The research hotspots include mental health conditions and interventions in cancer patients. We identified international collaboration and research expenditure to be strongly associated with psycho-oncology research productivity. Researchers’ collaboration, which is visible among developed countries, should be extended to low-income countries in order to expand psycho-oncology-related research and understanding.

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial

Background: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb’s functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. Methods: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. Results: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η² ≤ 0.080). In the rest of the variables, no significant differences were found. Conclusions: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.

Factors of decisive importance for being in work or not during two years after breast cancer surgery: content analysis of 462 women's open answers

Background

Paid work is one of the most important aspects in life among working-aged women diagnosed with breast cancer. Despite several attempts, no previous study provides a comprehensive overview from the women’s perspective about factors of importance for being able to work or not. Therefore, the aim of this study was to gain knowledge about factors that women themselves state are of decisive importance for being able to work or not during the first two years after breast cancer surgery.

Methods

Data was collected in a two-year follow-up questionnaire within the frame of a prospective cohort study of working-aged women who had undergone breast cancer surgery. 749 were included in the questionnaire study and of the 616 (82%) responding women, 462 (75%) wrote statements on an open-ended question about factors of decisive importance for being able to work or not work during the past two years. The statements were analyzed with content analysis.

Results

Five categories of factors of importance for being able to  work or not were identified, each covering several sub-categories: Health and wellbeing, Contacts and encounters, Flexibility and adjustment possibilities, Socioeconomic consequences from working/not working, and Own motivation and characteristics. A wide variety of factors were mentioned by the women and the findings give a multifaceted picture of many single but interrelated factors of decisive importance for being able to work/not work. The importance of flexibility in the return-to-work process was stressed, as well as the importance of supportive encounters from, e.g., colleagues, managers, as well as relatives.

Conclusions

The results give a comprehensive overview over a variety of different types of factors for being able to return to/remain in work or to not work after breast cancer surgery, adding new knowledge about e.g. the importance of colleagues, and the women’s own preferences or characteristics. These are factors that different stakeholders, both from healthcare but also from the work place and the insurance office, need to be aware of and collaborate around to support women with breast cancer during the period of treatment, rehabilitation and return to work.

Occupational Therapy's Role with Oncology in the Acute Care Setting: A Descriptive Case Study

As individuals with cancer actively undergo medical treatment, they often experience profound impairments and side-effects that impact their physical and psychosocial functioning and well-being. As occupational therapy practitioners working in acute care, challenges when working with those with oncological diseases may include high acuity, impact on multiple body systems, and fluctuating symptom presentation and levels of function. Thus, it is critical for occupational therapy practitioners to be skilled in identifying and addressing the distinct needs of cancer survivors in the acute care setting. This manuscript presents a descriptive case study to highlight occupational therapy's role in cancer rehabilitation in the acute care setting.

Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals' Perceptions

To explore primary care professionals' perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals' knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.

A Qualitative Study of Cancer Survivors' Experienced Outcomes of a Multidimensional Rehabilitation Program in Primary Healthcare

BACKGROUND

Cancer survival rates are increasing, but survival is often followed by several late effects. Cancer survivors' need for complex rehabilitation is well documented, but this is mostly missing in primary healthcare.

OBJECTIVE

The aim of this study was to explore cancer survivors' experienced outcomes of a multidimensional rehabilitation program in primary healthcare.

METHODS

The study used a qualitative method with a descriptive research design. Fifty-six cancer survivors completed a 12-week rehabilitation program built upon the 5 elements of goal setting, physical exercise, psychoeducation, individual follow-up, and peer support. Data were collected at the end of the program via 8 focus group interviews, and systematic text condensation was used to analyze the data.

RESULTS

"Increased coping and participation" was identified as the overarching theme of the participants' experienced outcomes from the program, and this was elaborated by 3 main themes: (1) "increased energy and capacity," (2) "acceptance and understanding," and (3) "structure and hope."

CONCLUSION

The multidimensional rehabilitation program seemed to address cancer survivors' multiple challenges in survivorship. Proximity and accessibility to a local rehabilitation program and professionals' competence seemed to be essential factors for the participants' experienced outcomes of the program.

IMPLICATION FOR PRACTICE

A multidimensional rehabilitation program integrated in a Healthy Life Centre in primary healthcare may be beneficial for cancer survivors' coping and participation in everyday life. Cancer nurses play a crucial role in initiating and facilitating such programs.

Community-Engaged Research to Address Health Disparities of Indigenous Women With Disabilities

INTRODUCTION

To address health disparities among underserved populations, occupational therapists can participate in community-engaged research and practice to improve access to preventive health services.

METHODS

This study used grounded theory and participant observation approaches to identify lessons learned from a community-engaged research project to improve cancer screening rates for Indigenous women with an intellectual and/or developmental disability (IDD). Audio recordings of meetings with a community advisory board (AB) were analyzed with an inductive coding approach, and results were member checked with AB members. The AB members (N = 8) were involved in statewide Indigenous health, cancer, and disability activities. Six of the eight AB members identified as Indigenous.

RESULTS

Key themes highlighted within the Indigenous research framework included reflection, relationship building, project planning, and project execution. Results of this phase of the research project highlight the importance of codesigning research projects with Indigenous communities.

CONCLUSION

The findings have limited transferability to other research contexts. However, this study highlights the need for future research on best practices for occupational therapists to participate in community-engaged research projects to address health disparities in underserved populations, such as Indigenous women with IDD.

Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm

PURPOSE

Participation in exercise or rehabilitation services is recommended to optimize health, functioning, and well-being across the cancer continuum of care. However, limited knowledge of individual needs and complex decision-making are barriers to connect the right survivor to the right exercise/rehabilitation service at the right time. In this article, we define the levels of exercise/rehabilitation services, provide a conceptual model to improve understanding of individual needs, and describe the development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm.

METHODS

From literature review, we synthesized defining characteristics of exercise/rehabilitation services and individual characteristics associated with safety and efficacy for each service. We developed a visual model to conceptualize the need for each level of specialized care, then organized individual characteristics into a risk-stratified algorithm. Iterative review with a multidisciplinary expert panel was conducted until consensus was reached on algorithm content and format.

RESULTS

We identified eight defining features of the four levels of exercise/rehabilitation services and provide a conceptual model of to guide individualized navigation for each service across the continuum of care. The EXCEEDS algorithm includes a risk-stratified series of eleven dichotomous questions, organized in two sections and ten domains.

CONCLUSIONS

The EXCEEDS algorithm is an evidence-based decision support tool that provides a common language to describe exercise/rehabilitation services, a practical model to understand individualized needs, and step-by-step decision support guidance. The EXCEEDS algorithm is designed to be used at point of care or point of need by multidisciplinary users, including survivors. Thus, implementation may improve care coordination for cancer exercise/rehabilitation services.

A systematic review of rehabilitation and exercise recommendations in oncology guidelines

Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.

Managing employment among pre-retirement aged cancer survivors

Introduction

Successfully maintaining (managing) paid employment can be a challenge as people negotiate the cancer care pathway and survivorship. Little research explores the influence of age on this situation. The purpose of this project was to explore the role of age in managing employment for survivors from age 45 to 64 years.

Method

A qualitative descriptive design was conducted to explore the intersection of age and managing employment for cancer survivors. In-depth semi-structured interviews were conducted with 19 United States cancer survivors (lung, breast, colorectal). Interviews were conducted in person or by phone. Verbatim transcripts were analyzed using thematic analysis. Codes were grouped by categories, incorporated into separate topical files, and then aggregated into broader emergent themes.

Findings

Survivors are not just “returning” to work after treatment. They are often managing work both during and after treatment. Age may have benefits but can also provide barriers to positive survivorship and employment experiences. Fulfilling the role of employee and maintaining a worker identity was a strong driver for many participants. Again, this was potentially both a support and a barrier. It was discovered that health care providers provided little support to facilitate employment.

Conclusion

Age is a factor that is poorly understood but influences both health and personal aspects of the experience of managing paid employment during and after cancer treatment. Occupational therapy practitioners should acknowledge this important role in addressing cancer survivorship.

Women's Experiences After Ovarian Cancer Surgery: Distress, Uncertainty, and the Need for Occupational Therapy

IMPORTANCE

Despite the growing literature on the association of functional, physical, and quality-of-life (QOL) deficits with poor postoperative outcomes, there is a gap in the literature identifying women's occupational performance needs after ovarian cancer surgery.

OBJECTIVE

To describe the experiences of women hospitalized after ovarian cancer surgery to identify potential areas for intervention. Goals were to (1) identify functional needs and limitations at time of discharge as measured by the typical acute care occupational therapy evaluation and semistructured interview and (2) understand the women's perspectives of their needs for occupational therapy and a safe return to home.

DESIGN

Single-arm, cross-sectional descriptive study. Mixed-methods data collection and analysis.

SETTING

Academic cancer center.

PARTICIPANTS

Women with ovarian cancer (N = 11) who had completed surgery.

INTERVENTION

Semistructured interviews and patient-reported outcome measures (PROMs) completed postsurgery.

OUTCOMES AND MEASURES

PROMs included the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List, the PROMIS® Global Physical Health (GPH) and Global Mental Health (GMH) scales, and the Possibilities for Activity Scale-Women (PActS-W).

RESULTS

The mean NCCN Distress score was 6.0 (standard deviation [SD] = 3.1, with the top three concerns being pain (80%), worry (80%), and fatigue (78%). Mean GPH and GMH T scores were 38.0 (SD = 8.8) and 48.2 (SD = 8.4), respectively. Women scored a mean of 39.2 (SD = 11.2, range = 26-58) on the PActS-W. Thematic analyses found that the women were uncertain about potential functional limitations and significantly distressed.

CONCLUSION AND RELEVANCE

Women with ovarian cancer experienced high levels of uncertainty and distress after surgery. Integrating in-home or community-based occupational therapy into routine care could decrease functional distress and uncertainty and help women manage concerns related to pain, worry, and fatigue.

WHAT THIS ARTICLE ADDS

This study suggests that occupational therapy evaluation and intervention are needed to decrease distress and improve QOL of women upon discharge after ovarian cancer surgery.

Impact of cancer and cancer-related treatments on participation restrictions

Introduction

The purpose of this research was to describe participation restrictions in younger and older adult cancer survivors post treatment.

Method

Younger adult cancer survivors ( n = 20) and older adult cancer survivors ( n = 21) completed questionnaires and a semi-structured interview of satisfaction with daily life activities and self-reported health outcomes in a single visit. Reports were based on recall during treatment and current perspectives post treatment.

Results

Despite general health short forms revealing health within normal limits, semi-structured interview approaches revealed dissatisfaction with occupational performance in both younger and older adult cancer survivors. Older adults reported persistent dissatisfaction with instrumental activities from diagnosis through post treatment compared to younger adult cancer survivors. Older adults received fewer referrals for cancer rehabilitation services (19%) compared to younger adult cancer survivors (50%).

Conclusion

Dissatisfaction with daily life activities persists several years post cancer diagnosis in older and younger adult cancer survivors, despite self-reported health within normal limits. Impairment-based short forms may lack sensitivity to detect activity limitations and participation restrictions conveyed through in-depth assessment. Adoption of more comprehensive screening methods may be needed for timely referral to cancer-based occupational therapy services.

Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO)

PURPOSE

Adverse effects of breast cancer treatment can negatively affect survivors’ work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment.

METHODS

We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates.

RESULTS

Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91).

CONCLUSION

Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.

A Secure Occupational Therapy Framework for Monitoring Cancer Patients' Quality of Life

Once diagnosed with cancer, a patient goes through a series of diagnosis and tests, which are referred to as "after cancer treatment". Due to the nature of the treatment and side effects, maintaining quality of life (QoL) in the home environment is a challenging task. Sometimes, a cancer patient's situation changes abruptly as the functionality of certain organs deteriorates, which affects their QoL. One way of knowing the physiological functional status of a cancer patient is to design an occupational therapy. In this paper, we propose a blockchain and off-chain-based framework, which will allow multiple medical and ambient intelligent Internet of Things sensors to capture the QoL information from one's home environment and securely share it with their community of interest. Using our proposed framework, both transactional records and multimedia big data can be shared with an oncologist or palliative care unit for real-time decision support. We have also developed blockchain-based data analytics, which will allow a clinician to visualize the immutable history of the patient's data available from an in-home secure monitoring system for a better understanding of a patient's current or historical states. Finally, we will present our current implementation status, which provides significant encouragement for further development.

Kidney cancer survivorship care: Patient experiences in a Canadian setting

INTRODUCTION

The incidence of kidney cancer (KCa) in Canada is rising. Despite this, there is a shortage of research assessing KCa care experiences. This study aims to explore the current experiences of KCa survivors related to treatment and management, information provision, and barriers to care.

METHODS

A cross-sectional, descriptive study of KCa patients was conducted online and through various cancer centers across Canada. English- and French-speaking adults who received a KCa diagnosis and were currently undergoing treatment or had completed treatment in Canada were eligible to participate.

RESULTS

In total, 368 surveys were completed. Ten percent of respondents had not yet received treatment, 29% were receiving treatment, and 56% had completed treatment. Most respondents (72%) had localized KCa (stage 0-3) at diagnosis. Sixty-one percent of respondents reported that their doctors discussed various treatment options with them and 24% reported discussing applicable clinical trials. Most (85%) respondents received information about their KCa and 36% discussed where to get information about their disease and support. The most commonly reported barriers to care were side effects (26%), system delays (26%), not having access to certain treatments (25%), and financial burden (24%). More participants in Central Region and Quebec (p=0.004) and rural/suburban (p=0.014) areas reported lacking access to certain treatments and KCa experts.

CONCLUSIONS

This was the first large-scale study to explore access to care experiences of Canadian KCa survivors. Results show examples of good patient-centered care and provide new practical information that can inform efforts to improve patient-centered care for KCa patients.

Gaps and delays in survivorship care in the return-to-work pathway for survivors of breast cancer-a qualitative study

Introduction

The number of survivors of breast cancer (bca) in Canada has steadily increased thanks to major advances in cancer care. But the resulting clientele face new challenges related to survivorship. The lack of continuity of care and the side effects of treatment affect the resumption of active life by survivors of bca, including return to work (rtw). The goal of the present article was to outline gaps and delay in survivorship care in the rtw pathway of survivors of bca.

Methods

This qualitative interpretative descriptive study recruited 9 survivors of bca in the province of Quebec. Interviews were conducted at the end of cancer treatments (n = 9), 1 month before rtw (n = 9), and after rtw (n = 5). In an iterative process, a content analysis was performed.

Results

The interviews highlighted gaps in survivorship care and the paucity of dedicated resources for cancer survivors. Participants received neither a survivorship care plan nor information about cancer survivorship (for example, transition to a new normal, side effects, rtw).

Conclusions

Support for survivors of bca resuming their active lives has to be optimized. We suggest that health professionals have to intervene at 1, 3, and 6 months after cancer treatment. At those points, survivors of bca need support for side-effects management, the rtw decision, resource navigation, and reintegration of daily activities. Also, delay in clinical pathways seems to be longer, and much attention is needed to accompany the transition to a "normal life" after cancer.

Catalyzing Research to Optimize Cancer Survivors' Participation in Work and Life Roles

Participation refers to a state of health in which a person is able to fully engage in roles and life situations. Adults living with and beyond cancer often report persistent participation restrictions that affect their productivity and quality of life. The American Occupational Therapy Foundation convened a group of scientists from seven different disciplines in a Planning Grant Collective (PGC) to stimulate research to identify scalable ways to preserve and optimize participation among cancer survivors. Participants identified challenges, prioritized solutions, and generated novel research questions that move beyond symptom and impairment mitigation as outcomes to identify interventions that improve participation in roles and life situations. This article summarizes the PGC discussion and recommendations regarding three challenges: (a) the dynamic and multi-faceted nature of participation, (b) a need to integrate the concept of participation within the culture of oncology, and (c) identification of priority areas in which new lines of research regarding participation would be most impactful.

Cancer survivorship: an integral part of Europe's research agenda

Cancer survivorship has traditionally received little prioritisation and attention. For a long time, the treatment of cancer has been the main focus of healthcare providers’ efforts. It is time to increase the amount of attention given to patients’ long‐term well‐being and their ability to return to a productive and good life. This article describes the current state of knowledge and identifies research areas in need of development to enable interventions for improved survivorship for all cancer patients in Europe. The article is summed up with 11 points in need of further focus.

Occupational therapy practice in oncology care: Results from a survey

The everyday landscape of occupational therapy (OT) in oncology is underexplored, hindering targeted improvements. The purpose of the present study was to identify the OT interventions commonly provided and reimbursed in oncology. A survey utilizing snowball sampling was disseminated online to OT working in oncology care; 167 surveys were received from 21 states in the United States. Results found that over 90% of therapists reported focusing on physical impairment, weakness, fatigue, and activities of daily living. Interventions for emotional/social support, self-advocacy, quality of life, lifestyle management, and cognitive impairment were not directly billed. More than 90% of therapists reported that, in the absence of barriers, they would address quality of life, emotional difficulties, lifestyle management, and home safety. Overall, the findings suggested that OT in the United States primarily provide physical interventions for oncology patients. However, they also provide psychosocial services and client/caregiver education, but often do not bill directly for this care. Reimbursement structures should be modified to allow for the direct billing of mental/psychosocial and educational interventions in OT for cancer care.

Long-Term Quality of Life and Nutritional Status of Patients with Head and Neck Cancer

Disease and therapy of head and neck cancer impair quality of life (QOL). QOL varies profoundly during therapy and follow-up.

AIM

We sought to monitor QOL and nutritional status of patients before, during and after therapy (AT).

PATIENTS AND METHODS

This study evaluates QOL by using the EORTC-questionnaires QLQ-C30 and H&N35, body weight and plasma albumin up to two years AT.

RESULTS

Chemoradiotherapy is the period of the most profound QOL-impairment. Postoperative QOL almost reaches preoperative levels just before adjuvant therapy and does not differ significantly from pretherapeutic QOL. Long-term QOL is not significantly deteriorated. Patients have an average weight loss of 17%. Nutritional supplements are used continuously. Xerostomia and sticky saliva are chronic symptoms that persist AT.

CONCLUSIONS

QOL is an important parameter for the evaluation of therapy success. Head and neck cancer and its therapy cause permanent xerostomia, sticky saliva and need of nutritional supplements. Adequate patient information, psychooncological counseling, analgesia and nutritional support may alleviate QOL impairment.

The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer

BACKGROUND

People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'.

AIM

To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life.

DESIGN AND INTERVENTION

A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities.

SETTING/PARTICIPANTS

Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life.

RESULTS

A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed.

CONCLUSION

In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.

Advancing psychosocial care in cancer patients

Cancer is a devastating disease causing significant psychological problems among patients and their families. In the past few decades, there have been growing implementation and dissemination of screening methods for the psychological consequences of cancer, including distress, depression, anxiety, post-traumatic stress, and demoralisation. Also, guidelines for the management of psychological distress have been developed and endorsed by a number of scientific cancer associations. This review examines some of the most significant related issues, also focusing on recent advances in psychosocial and psychopharmacological interventions as a part of a mandatory, integrated, and comprehensive approach to cancer care.