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Evaluation of a Comprehensive Rehabilitation Program for Post-Treatment Patients With Cancer

Sophie Hanssens

Rik Luyten

Christiaan Watthy

Christel Fontaine

Lore Decoster

Catherine Baillon

Fabienne Trullemans

Aisha Cortoos

Jacques De Grève

rehabilitation, quality of life, fatigue, anxiety, depression, distress
ONF 2011, 38(6), E418-E424. DOI: 10.1188/11.ONF.E418-E424

Purpose/Objectives: To evaluate the effects of a rehabilitation program on quality of life, fatigue, fear of movement (kinesiophobia), distress, anxiety, depression, and physical condition.

Design: Pretest/post-test.

Setting: An outpatient rehabilitation setting in the Oncology Centre at the University Hospital Brussels in Belgium.

Sample: 36 patients who had completed cancer treatment with a curative potential.

Methods: Participants completed a questionnaire and underwent a physical test at baseline and at the end of the program. The measurement instruments used included the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30, Functional Assessment of Cancer Therapy-Fatigue, Hospital Anxiety and Depression Scale, RAND-36, Tampa Scale for Kinesiophobia, Distress Barometer, and Tecumseh Step Test.

Main Research Variables: Quality of life, fatigue, kinesiophobia, distress, anxiety, depression, and physical condition.

Findings: Significant improvement was observed in quality of life (p < 0.001), physical condition (p = 0.007), fatigue (p = 0.01), and depression (p = 0.012). In contrast, kinesiophobia (p = 0.229), distress (p = 0.344), and anxiety (p = 0.101) did not change significantly.

Conclusions: A general and significant improvement in all aspects affecting quality of life and rehabilitation was observed, but less so for aspects that might be influenced by prognostic concerns. The relative contribution of the program versus spontaneous recovery and long-term impact need to be determined further in a prospective randomized study.

Implications for Nursing: Multidisciplinary rehabilitation should become part of the total care plan for patients with cancer.

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    Aaronson, N.K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N.J., … de Haes, J.C. (1993). The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365-376. doi:10.1093/jnci/85.5.365
    Apolone, G., Filiberti, A., Cifani, S., Ruggiata, R., & Mosconi, P. (1998). Evaluation of the EORTC QLQ-C30 questionnaire: A comparison with SF-36 Health Survey in cohort of Italian long-survival cancer patients. Annals of Oncology, 9, 549-557.
    Bauwens, S., Baillon, C., Distelmans, W., & Theuns, P. (2008). The "Distress Barometer": Validation of method of combining the Distress Thermometer with a rated complaint scale. Psycho-Oncology, 18, 534-542. doi:10.1002/pon.1425
    Berglund, G., Bolund, C., Gustavsson, U.L., & Sjödén, P.O. (1993). Starting again: A comparison study of a group rehabilitation program for cancer patients. Acta Oncologica, 32(1), 15-21. doi:10.3109/02841869309083879
    Bjelland, I., Dahl, A.A., Haug, T.T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69-77. doi:10.1016/S0022-3999(01)00296-3
    Cadmus, L.A., Salovey, P., Yu, H., Chung, G., Kasl, S., & Irwin, M.L. (2009). Exercise and quality of life during and after treatment for breast cancer: Results of two randomized controlled trials. Psycho-Oncology, 18, 343-352. doi:10.1002/pon.1525
    Cella, D.F., Tulsky, D.S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., … Brannon, J. (1993). The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570-579.
    Courneya, K.S. (2003). Exercise in cancer survivors: An overview of research. Medicine and Science in Sports and Exercise, 35, 1846-1852.
    Curt, G.A., Breitbart, W., Cella, D., Groopman, J.E., Horning, S.J., Itri, L.M., … Vogelzang, N.J. (2000). Impact of cancer-related fatigue on the lives of patients: New findings from the Fatigue Coalition. Oncologist, 5, 353-360. doi:10.1634/theoncologist.5-5-353
    De Grève, J., Fontaine, C., Torosian, K., Meulemans, A., De Meirleir, L., Gerlo, E., & De Waele, A. (2005). Prospective study of fatigue and metabolic parameters in patients with early breast cancer (EBC) receiving concomitant radiotherapy and anthracycline-based adjuvant chemotherapy. Journal of Clinical Oncology, 23, 90.
    Ganz, P.A., Kwan, L., Stanton, A.L., Krupnick, J.L., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2004). Quality of life at the end of primary treatment of breast cancer: First results from the moving beyond cancer randomized trial. Journal of the National Cancer Institute, 96, 376-387. doi:10.1093/jnci/djh060
    Gotay, C.C., Holup, J.L., & Pagano, I. (2002). Ethnic differences in quality of life among early breast and prostate cancer survivors. Psycho-Oncology, 11, 103-113. doi:10.1002/pon.568
    Goubert, L., Crombez, G., Van Damme, S., Vlaeyen, J.W., Bijttebier, P., & Roelofs, J. (2004). Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: Invariant two-factor model across low back pain patients and fibromyalgia patients. Clinical Journal of Pain, 20, 103-110. doi:10.1097/00002508-200403000-00007
    Hays, R.D., & Morales, L.S. (2001). The RAND-36 measure of health-related quality of life: Health-related quality of life in clinical studies. Annals of Medicine, 33, 350-357. doi:10.3109/07853890109002089
    King, M.T. (1996). The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Quality of Life Research, 5, 555-567. doi:10.1007/BF00439229
    Kolden, G.G., Strauman, T.J., Ward, A., Kuta, J., Woods, E., Schneider, K.L., … Mullen, B. (2002). A pilot study of group exercise training (GET) for women with primary breast cancer: Feasibility and health benefits. Psycho-Oncology, 11, 447-456. doi:10.1002/pon.591
    Korstjens, I., Mesters, I., van der Peet, E., Gijsen, B., & van den Borne, B. (2006). Quality of life of cancer survivors after physical and psychosocial rehabilitation. European Journal of Cancer Prevention, 15, 541-547. doi:10.1097/01.cej.0000220625.77857.95
    May, A.M., Korstjens, I., van Weert, E., van den Borne, B., Hoekstra-Weebers, J.E., van der Schans, C.P., … Ros, W. (2009). Long-term effects on cancer survivors' quality of life of physical training versus physical training combined with cognitive-behavioral therapy: Results from a randomized trial. Supportive Care in Cancer, 17, 653-663.
    McLachlan, S.A., Devins, G.M., & Goodwin, P.J. (1998). Validation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ C-30) as a measure of psychosocial function in breast cancer patients. European Journal of Cancer, 34, 510-517. doi:10.1016/S0959-8049(97)10076-4
    McNeely, M.L., Campbell, K.L., Rowe, B.H, Klassen, T.P., Mackey, J.R., & Courneya, K.S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175, 34-41. doi:10.1503/cmaj.051073
    Mutrie, N., Campbell, A.M., Whyte, F., McConnachie, A., Emslie, C., Lee, L., … Ritchie, D. (2007). Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ, 334, 517. doi:10.1136/bmj.39094.648553.AE
    Osborn, R.L., Demoncada, A.C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. International Journal of Psychiatry in Medicine, 36, 13-34. doi:10.2190/EUFN-RV1K-Y3TR-FK0L
    Pollock, M., Gaesser, G.A., & Butcher, J.D. (1998). ACSM Position Stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine and Science in Sports and Exercise, 30, 975-991. doi:10.1097/00005768-199806000-00032
    Rogers, L.Q., Hopkins-Price, P., Vicari, S., Markwell, S., Pamenter, R., Courneya, K.S., … Verhulst, S. (2009). Physical activity and health outcomes three months after completing a physical activity behavior change intervention: Persistent and delayed effects. Cancer Epidemiology, Biomarkers and Prevention, 18, 1410-1418. doi:10.1158/1055-9965.EPI-08-1045
    Schneider, C.M., Hsieh, C.C., Sprod, L.K., Carter, S.D., & Hayward, R. (2007). Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer, 110, 918-925. doi:10.1002/cncr.22862
    Segal, R.J., Reid, R.D., Courneya, K.S., Malone, S.C, & Parliament, M.B., Scott, C.G., … Wells, G.A. (2003). Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology, 21, 1653-1659. doi:10.1200/JCO.2003.09.534
    Smith, B.A., Neidig, J.L., Nickel, J.T., Mitchell, G.L., Para, M.F., & Fass, R.J. (2001). Aerobic exercise: Effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults. AIDS, 15, 693-701. doi:10.1097/00002030-200104130-00004
    Spinhoven, P., Ormel, J., Sloekers, P.P., Kempen, G.I., Speckens, A.E., & Van Hemert, A.M. (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27, 363-370.
    van Harten, W.H., van Noort, O., Warmerdam, R., Hendricks, H., & Seidel, E. (1998). Assessment of rehabilitation needs in cancer patients. International Journal of Rehabilitation Research, 21, 247-257.
    van Weert, E., Hoekstra-Weebers, J.E., May, A.M., Korstjens, I., Ros, W.J., & van der Schans, C.P. (2008). The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. Patient Education and Counseling, 71, 169-190. doi:10.1016/j.pec.2007.11.027
    Yadav, R. (2007). Rehabilitation of surgical cancer patients at University of Texas M.D. Anderson Cancer Center. Journal of Surgical Oncology, 95, 361-369. doi:10.1002/jso.20775
    Yellen, S.B., Cella, D.F., Webster, K., Blendowski, C., & Kaplan, E. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain and Symptom Management, 13, 63-74. doi:10.1016/S0885-3924(96)00274-6
    Young-McCaughan, S., Mays, M.Z., Arzola, S.M., Yoder, L.H., Dramiga, S.A., Leclerc, K.M., … Nowlin, M.U. (2003). Research and commentary: Change in exercise tolerance, activity and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program. Oncology Nursing Forum, 30, 441-454. doi:10.1188/03.ONF.441-454