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Spiess AAF, Skempes D, Bickenbach J, Stucki G. Exploration of current challenges in rehabilitation from the perspective of healthcare professionals: Switzerland as a case in point. Health Policy 2021; 126:173-182. [PMID: 34625281 DOI: 10.1016/j.healthpol.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 12/11/2022]
Abstract
Rehabilitation is a health strategy with the potential to mitigate the negative health consequences of population ageing and the rise of noncommunicable diseases. Literature indicates that even in high-income countries rehabilitation services can be improved. The purpose of this study is to engage rehabilitation professionals in Switzerland in identifying and prioritizing current challenges in the development and delivery of rehabilitation services. We conducted a qualitative study consisting of interviews with key informants and a stakeholder consultation. Thirteen interviews were conducted and analysed using inductive thematic analysis. Identified challenges were refined, extended, and prioritized through multi-voting in a workshop attended by a wide range of rehabilitation professional organizations. Final results were subject to further analysis and member checking. We identified nineteen challenges, of which eight were viewed as highly important. Results suggest the need to revise the financing system for rehabilitation services, highlighted a poor integration of rehabilitation in primary care, a lack of academic rehabilitation training, and insufficient funding for research. Finally, we identified a perceived lack of awareness for rehabilitation among policy-makers and the public. This study provides a unique perspective on challenges in rehabilitation practice and policy and offers an opportunity for professionals, policy-makers, and other stakeholders, to influence and guide the rehabilitation service agenda both in Switzerland and in terms of mutual learning also in other countries.
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Affiliation(s)
- Adrian Andrea Flavio Spiess
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland.
| | - Dimitrios Skempes
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland; Swiss Paraplegic Research (SPF), Guido A. Zaech Strasse 4, 6207 Nottwil, Switzerland..
| | - Jerome Bickenbach
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland; Swiss Paraplegic Research (SPF), Guido A. Zaech Strasse 4, 6207 Nottwil, Switzerland..
| | - Gerold Stucki
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland; Swiss Paraplegic Research (SPF), Guido A. Zaech Strasse 4, 6207 Nottwil, Switzerland..
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2
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Skempes D, Kiekens C, Malmivaara A, Michail X, Bickenbach J, Stucki G. Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action. Health Policy 2021; 126:158-172. [PMID: 34281701 DOI: 10.1016/j.healthpol.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.
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Affiliation(s)
- Dimitrios Skempes
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy; Physical and Rehabilitation Medicine, University Hospitals Leuven - Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare and Orton Orthopedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Xanthi Michail
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
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3
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Fernández Rodríguez EJ, Rihuete Galve MI, Cruz Hernández JJ. Impact of a comprehensive functional rehabilitation programme on the quality of life of the oncological patient with dyspnoea. Med Clin (Barc) 2020; 157:10-16. [PMID: 32843213 DOI: 10.1016/j.medcli.2020.05.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dyspnoea is one of leading causes of loss of autonomy in patients with advanced-stage cancer. Pharmacological measures achieve a reduction of the symptom, but without generalizing this improvement to functionality. We propose the inclusion of a comprehensive functional rehabilitation programme. The purpose is to test the efficacy of an integral respiratory rehabilitation programme to improve autonomy levels and relieve cancer-related dyspnoea. METHODS Experimental design, prospective, longitudinal, randomized study based on a parallel fixed allocation scheme using an experimental group and a control group. The intervention group participated in comprehensive functional rehabilitation, while the control group only received standard drug treatment. Single blind masking, but statistical analysis was performed by non-study personnel. RESULTS Final sample of 113 individuals, 52 in the control group and 61 in the experimental group, from the Oncology Unit of the University Hospital Complex of Salamanca. Statistically significant differences (are observed) between the members of both groups in the levels of functionality (p = .000), in the levels of dyspnoea (p =.001) and in the sub-items of the Euro-QOL questionnaire, except in the sub-item related to pain (p = .311). No major adverse effects or side effects are observed. CONCLUSION Non-pharmacological interventions using a comprehensive functional rehabilitation programme improve functionality and relieve dyspnoea in cancer patients.
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Affiliation(s)
- Eduardo José Fernández Rodríguez
- Servicio de Oncología Médica del Complejo Asistencial Universitario de Salamanca, Salamanca, España; Departamento de Enfermería y Fisioterapia. Universidad de Salamanca, Salamanca, España; Investigador Área Cáncer. Instituto de Investigación Biomédica de Salamanca, Salamanca, España.
| | - María Isabel Rihuete Galve
- Servicio de Oncología Médica del Complejo Asistencial Universitario de Salamanca, Salamanca, España; Departamento de Enfermería y Fisioterapia. Universidad de Salamanca, Salamanca, España; Investigador Área Cáncer. Instituto de Investigación Biomédica de Salamanca, Salamanca, España
| | - Juan Jesús Cruz Hernández
- Servicio de Oncología Médica del Complejo Asistencial Universitario de Salamanca, Salamanca, España; Investigador Área Cáncer. Instituto de Investigación Biomédica de Salamanca, Salamanca, España; Departamento de Medicina. Universidad de Salamanca, Salamanca, España
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Kørup AK, Wehberg S, Hvidt EA, Hvidt NC, Fitchett G, Hansen DG. Age‐stratified validation of the functional assessment of chronic illness
therapy‐spiritual well‐being
based on a large cohort of Danish cancer survivors. Psychooncology 2020; 29:1217-1223. [DOI: 10.1002/pon.5412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/27/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Alex K. Kørup
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Department of Mental Health Kolding‐VejleRegion of Southern Denmark Vejle Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
| | - Elisabeth A. Hvidt
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Department for the Study of CultureUniversity of Southern Denmark (SDU) Odense Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
- Academy of Geriatric Cancer Research (AgeCare)Odense University Hospital Odense Denmark
| | - George Fitchett
- Department of Religion Health and Human Values, College of Health SciencesRush University Chicago Illinois USA
| | - Dorte Gilså Hansen
- Research Unit of General Practice, Institute of Public HealthUniversity of Southern Denmark (SDU) Odense Denmark
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Witte H, Handberg C. An assessment of survivorship care needs of patients with colorectal cancer: The experiences and perspectives of hospital nurses. J Clin Nurs 2019; 28:4310-4320. [PMID: 31294502 DOI: 10.1111/jocn.14995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/30/2019] [Accepted: 06/30/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To describe and analyse hospital nurses' experiences and perspectives of needs assessment in relation to colorectal cancer patients' survivorship care and rehabilitation needs. METHOD The methodology and design of this study was phenomenological-hermeneutic, and the analysis was performed by Ricoeur's theory of interpretation. Twelve hospital nurses working within the care of patients with colorectal cancer participated in four focus group interviews between February-March 2018. Focus group interviews were recorded, transcribed and analysed. The study adhered to the COREQ checklist. RESULTS Our analysis showed that nurses experienced challenges and barriers in conducting needs assessment. These challenges were described in three main themes. Encountering paradigms brought to light the difficulties relating to implementation of needs assessment into daily practice in the complex context of a hospital setting. Patient involvement could be challenging because of insufficient involvement and inadequate health literacy of patients in relation to needs assessment. A negative attitude towards systematic needs assessment among nurses could present a barrier because of their role as gatekeepers. CONCLUSION The findings point to important elements that are necessary to consider when planning cancer survivorship care in the hospital setting so that all patients experience the best possible cancer trajectory. These insights can guide future clinical practice in the endeavour to ensure more systematic initiatives towards cancer rehabilitation. RELEVANCE TO CLINICAL PRACTICE Based on our findings, cancer survivorship care needs assessment in the hospital setting should encompass specific guidelines on needs assessment and systematic implementation of these guidelines by involving hospital management, nurses and patients through use of visionary information and communication. Implementation of these guidelines would be supported by securing knowledge on cancer survivorship care for all hospital health professionals. Health literacy should be considered in formulating guidelines that enhance involvement of patients by use of patient-centred communication.
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Affiliation(s)
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Handberg C, Svendsen ML, Maribo T. A Cross-Sectional Study Evaluating Potential Differences in the Need for Cancer Survivorship Care in Relation to Patients' Socioeconomic Status. J Clin Med Res 2019; 11:515-523. [PMID: 31236171 PMCID: PMC6575116 DOI: 10.14740/jocmr3871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background There seems to be inequity within cancer survivorship care in primary care settings related to gender, shorter education, and early poor health, but there is uncertainty regarding the character of the needs in hospital and in primary care settings and whether there is inequity regarding meeting these needs. This study aims to describe potential differences in needs among patients in hospital and in primary care settings, and to assess the need for survivorship care and rehabilitation in patients with cancer in relation to socioeconomic status. Methods In a cross-sectional study including patients in hospital (n = 89) and primary care settings (n = 99), information from needs assessments was linked with population-based data on socioeconomic status via unique personal identification numbers. The association between socioeconomic status and stated needs was analyzed separately for patients in hospital and primary care settings, with adjustment for age and gender. Results A total of 90% patients expressed one or more needs in the physical area, 51% in the emotional area, and 40% in the practical area. Patients in primary care expressed more needs than patients in hospital. Men expressed more needs than women in primary care (adjusted odds ratio (OR) (95% confidence interval (CI)): 2.66 (1.04 - 6.79)). The results indicate that higher socioeconomic status is associated with fewer stated needs. Conclusions This study suggests that the association between gender and stated needs may depend on healthcare setting and confirms that higher socioeconomic status in relation to civil status, educational level, income, and labor market status is associated with fewer stated needs.
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Affiliation(s)
- Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | | | - Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Wright P, Wilding S, Watson E, Downing A, Selby P, Hounsome L, Wagland R, Brewster DH, Huws D, Butcher H, Mottram R, Kearney T, Allen M, Gavin A, Glaser A. Key factors associated with social distress after prostate cancer: Results from the United Kingdom Life after Prostate Cancer diagnosis study. Cancer Epidemiol 2019; 60:201-207. [PMID: 31071525 DOI: 10.1016/j.canep.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND More men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa. METHODS The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18-42 months post diagnosis of PCa. Men (n = 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n = 111) and 100% of all Health Boards in Northern Ireland (n = 5), Scotland (n = 14) and Wales (n = 6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to 'socially distressed'/'not socially distressed' groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries. RESULTS Response rate 60.8% (n = 35 823) of whom 97% (n = 29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of 'socially distressed' men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR): 11.58 [95% CI 9.16-14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61-6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area. CONCLUSION Most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.
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Affiliation(s)
- Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, UK.
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, UK
| | | | - David H Brewster
- Deanery of Molecular, Genetic and Population Health Sciences, University of Edinburgh, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK
| | | | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK; Leeds Teaching Hospitals NHS Trust, UK
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Oksbjerg Dalton S, Halgren Olsen M, Moustsen IR, Wedell Andersen C, Vibe-Petersen J, Johansen C. Socioeconomic position, referral and attendance to rehabilitation after a cancer diagnosis: A population-based study in Copenhagen, Denmark 2010-2015. Acta Oncol 2019; 58:730-736. [PMID: 30905247 DOI: 10.1080/0284186x.2019.1582800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Implementation of new cancer services may lead to socioeconomic differences in uptake and despite reports of more unmet needs among patients with low socioeconomic position studies have found that these patients receive less rehabilitation. We aimed to investigate associations between indicators for socioeconomic position and referral as well as attendance to rehabilitation for cancer. Methods: Through the Danish Cancer Registry, we identified all persons diagnosed with cancer in Copenhagen municipality 2010-2015 and obtained information on referral to and visits at the municipal rehabilitation center from municipal records. We linked the population with information on socioeconomic information and vital status through national registries. Associations were analyzed using multivariate Cox regression models. Results: Among 13,059 persons diagnosed with cancer a total of 2523 were referred for rehabilitation within 2.5 years from diagnosis. Compared to persons with short education, men and women with long education and men with medium education had higher adjusted hazard ratios (HR) for being referred to rehabilitation (Long: HR-men, 1.30 (95% CI: 1.06-1.59) and HR-women, 1.33 (95% CI: 1.15-1.53; Medium: HR-men, 1.23 (95% CI: 1.02-1.49)). Both men and women with children living at home had higher HR of referral (HR-men, 1.23 (95% CI: 1.00-1.52) and HR-women, 1.28 (95% CI: 1.11-1.48)). Among patients referred to rehabilitation, 81% attended a visitation consultation. Long education was associated with attendance in both genders while in men, medium education and in women high income, respectively was associated with attendance. Conclusion: Clear socioeconomic differences in referral and attendance to rehabilitation services indicate that socioeconomic inequality exists in patients' transition from cancer treatment into post-treatment care. Systematic needs assessment and clarification of wish for rehabilitation should be a requisite for all cancer patients independent of their socioeconomic position.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Maja Halgren Olsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ida Rask Moustsen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Christoffer Johansen
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
- Castle late effects unit, Oncology Clinic, Rigshospitalet, Copenhagen, Denmark
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Paterson C, Primeau C, Nabi G. A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. Eur J Oncol Nurs 2018; 37:65-73. [PMID: 30473053 DOI: 10.1016/j.ejon.2018.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Men with metastatic prostate cancer experience high levels of unmet supportive care needs in current healthcare delivery. We set out to determine the effectiveness of a multimodality supportive care (ThriverCare) intervention on the prevalence of unmet supportive care needs for men and their partner/caregivers. METHODS A prospective parallel group, pilot randomised controlled pilot trial in 4 hospitals in Scotland. 38 participants with radiologically proven metastatic prostate cancer disease and 10 partners/caregivers were recruited into the study. A two arm 1:1 study design compared the usual standard of care (SC) approach to SC plus ThriverCare intervention. The primary outcome was the Supportive Care Needs Survey at 3 months of intervention. RESULTS There was no statistical significant difference in the prevalence of unmet supportive care needs between the intervention group and the usual SC group at baseline p = 0.112, however a statistically significant difference was observed at 3 months, indicating that the prevalence of unmet supportive care needs were less in the intervention group (1.13, SD 2.5) compared to the usual SC (6.17, SD 7.05), p = 0.002. CONCLUSION ThriverCare appears to improve the supportive care experience of men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. Our results accentuate that no longer one size of care delivery fits all, care must be responsive and adaptable to meet the individual needs of people affected by cancer to thrive.
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Affiliation(s)
- Catherine Paterson
- School of Nursing and Midwifery, Robert Gordon University, Garthdee, Aberdeen, AB10 7QG, United Kingdom.
| | - Charlotte Primeau
- School of Nursing and Midwifery, Robert Gordon University, Garthdee, Aberdeen, AB10 7QG, United Kingdom
| | - Ghulam Nabi
- School of Medicine, University of Dundee, Dundee, DD1 9SY, United Kingdom
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Truccolo I, Mazzocut M, Cipolat Mis C, Bidoli E, Zotti P, Flora S, Mei L, Apostolico M, Drace C, Ravaioli V, Conficconi A, Cocchi S, Cervi E, Gangeri L, De Paoli P. Patients and caregivers' unmet information needs in the field of patient education: results from an Italian multicenter exploratory survey. Support Care Cancer 2018; 27:2023-2030. [PMID: 30191387 PMCID: PMC6499737 DOI: 10.1007/s00520-018-4439-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
Abstract
Patient education and empowerment (PEE) is aimed at improving competence of patients during their clinical path and enabling healthcare providers with specific communication strategies. We investigated the interest of Italian Cancer Research & Care Centers (CRCI) users (patients and caregivers) in being involved in PEE activities. An anonymous questionnaire addressed to users was distributed between June 2013 and February 2014. The questionnaire gathered information on the following: health-related topics; 13 different PEE initiatives/modalities of learning already active at CRCI; personal demographic data; the willingness to be more involved in the organization of health services provided and in which context; and five preferred info-educational activities. Frequency distribution and chi-square analysis were computed. Statistical significance (p value) was set at < 0.05. A total of 875 (29%) users responded to the 3000 distributed questionnaires. The first three priorities of interest were “early diagnosis” (18%), “prevention” (17%), and “diagnosis explanation” (13%). The first three priorities on informational activity were as follows: “classes on cancer-related topics with healthcare professionals” (28%); “cancer information service” (22%); “drug information point” (7%). Forty-nine percent of the respondents stated that they would like to be involved in the organization of PEE activities, particularly caregivers and users older than 55 years of age. The preferred educational activities were “classes on cancer-related topics with healthcare professionals” and “cancer information service” on a face-to-face modality. Patients were more interested than caregivers in “prevention.” The extension of PEE programs to all CRCI users into routine care will be the next step of the present research.
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Affiliation(s)
- Ivana Truccolo
- Scientific & Patients' Library, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, I-33081, Aviano, Italy.
| | - Mauro Mazzocut
- Scientific & Patients' Library, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, I-33081, Aviano, Italy
| | - Chiara Cipolat Mis
- Scientific & Patients' Library, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, I-33081, Aviano, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Paola Zotti
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Silvia Flora
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Luigina Mei
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Mauro Apostolico
- Centro di Ateneo per le Biblioteche-C.A.B, University of Padua, Padua, Italy
| | - Christina Drace
- Scientific Directorate, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valentina Ravaioli
- Public Relation, Media and Communication Office, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola(FC), Italy
| | - Alice Conficconi
- Public Relation, Media and Communication Office, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola(FC), Italy
| | - Simone Cocchi
- Medical Library, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Cervi
- Medical Library, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Gangeri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo De Paoli
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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11
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Kristiansen M, Adamsen L, Piil K, Halvorsen I, Nyholm N, Hendriksen C. A three-year national follow-up study on the development of community-level cancer rehabilitation in Denmark. Scand J Public Health 2017; 47:511-518. [PMID: 29212431 DOI: 10.1177/1403494817746535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Scandinavian cancer care policies emphasise community-level rehabilitation services, but little is known about changes in service provision over time. This follow-up study explores development in these services in Danish municipalities, focusing on availability, utilisation and organisation of services, including existing opportunities and challenges. Methods: A national survey among all 98 Danish municipalities was conducted in 2013 (baseline) and repeated in 2016 (follow-up). The electronic questionnaire comprised closed- and open-ended questions. Data were analysed using descriptive statistics and content analysis. Results: A total of 93 municipalities responded (95% response rate) and the services offered primarily comprised group physical activity, dietary advice, smoking cessation and individual counselling on physical activity. The number of patients enrolled was below the estimated number needing rehabilitation in Denmark. Inequality in utilisation by ethnicity, age and gender was reported. Key challenges for the delivery of services were: inadequate referral and recruitment procedures; lack of needs assessment tools; obstacles to ensuring collaboration and referral of patients between hospitals and municipalities; and inadequate evidence on the rehabilitation's effect. Key recommendations include ensuring collaboration between municipalities; provision of diagnosis-specific group-based activities; services focusing on physical activity; and gender-specific activities directed particularly at men. Conclusions: This study, which highlights improvements in the provision of community-level cancer rehabilitation, recommends that more effort be made to ensure equality in utilisation across patient groups, improved integration of municipal-level services into cancer care trajectories, more uniform documentation of service delivery and the enforcement of patient outcomes to gradually build a more robust evidence base for community-level cancer rehabilitation.
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Affiliation(s)
| | - Lis Adamsen
- 1 Department of Public Health, University of Copenhagen, Denmark.,2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karin Piil
- 2 The University Hospitals Centre for Health Research (UCSF) and Center for Integrated Rehabilitation for Cancer Patients (CIRE), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ida Halvorsen
- 1 Department of Public Health, University of Copenhagen, Denmark
| | - Nanna Nyholm
- 1 Department of Public Health, University of Copenhagen, Denmark
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12
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Handberg C, Jensen CM, Maribo T. Lack of Needs Assessment in Cancer Survivorship Care and Rehabilitation in Hospitals and Primary Care Settings. J Clin Med Res 2017; 9:864-871. [PMID: 28912923 PMCID: PMC5593434 DOI: 10.14740/jocmr3160w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/25/2017] [Indexed: 11/21/2022] Open
Abstract
Background Formalized and systematic assessment of survivorship care and rehabilitation needs is prerequisite for ensuring cancer patients sufficient help and support through their cancer trajectory. Patients are often uncertain as to how to express and address their survivorship care and rehabilitation needs, and little is known about specific, unmet needs and the plans necessary to meet them. There is a call for both ensuring survivorship care and rehabilitation for cancer patients in need and further for documenting the specific needs related to the cancer disease and its treatment. Thus the aim of this study was to describe specific survivorship care and rehabilitation needs and plans as stated by patients with cancer at hospitals when diagnosed and when primary care survivorship care and rehabilitation begins. Methods Needs assessment forms from cancer patients at two hospitals and two primary care settings were analyzed. The forms included stated needs and survivorship care and rehabilitation plans. All data were categorized using the International Classification of Functioning, Disability and Health (ICF). Results Eighty-nine patients at hospitals and 99 in primary care, stated their needs. Around 50% of the patients completed a survivorship care and rehabilitation plan. In total, 666 (mean 7.5) needs were stated by hospital patients and 836 (mean 8.0) by those in primary care. The needs stated were primarily within the ICF component “body functions and structure”, and the most frequent needs were (hospitals/primary care) fatigue (57%/67%), reduced muscle strength (55%/67%) and being worried (37%/36%). Conclusions The results underpin an urgent need for a systematic procedure to assess needs in clinical practice where cancer patients are being left without survivorship care and rehabilitation needs assessment. Gaining knowledge on needs assessment and the detailed description of needs and plans can facilitate targeted interventions. The findings indicate an urgent need to change the practice culture to be systematic in addressing and identifying survivorship care needs among patients with cancer. Further the findings call for considering the development of a new needs assessment form with involvement of both patients and healthcare professionals.
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Affiliation(s)
- Charlotte Handberg
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
| | - Charlotte Maria Jensen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
| | - Thomas Maribo
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
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13
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Ng HS, Roder D, Koczwara B, Vitry A. Comorbidity, physical and mental health among cancer patients and survivors: An Australian population-based study. Asia Pac J Clin Oncol 2017; 14:e181-e192. [PMID: 28371441 DOI: 10.1111/ajco.12677] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Abstract
AIM To assess the prevalence of comorbidities and measures of physical and mental health among the cancer patients and survivors compared with the general population. METHODS Data collected by the Australian Bureau of Statistics from 2011-2012 National Health Survey were utilized for this cross-sectional study. Comparisons were made between adults aged 25 years and over with history of cancer (n = 2170) and those respondents who did not report having had a cancer (n = 11 592) using logistic regression models. Analyses were repeated according to cancer status (current cancer vs. cancer survivor). RESULTS People with history of cancer had significantly higher odds of reporting mental and behavioral problems (overall cancer group adjusted odds ratio 1.36, 95 percent confidence interval 1.20-1.54; current cancer 2.53, 1.97-3.27; cancer survivor 1.20, 1.05-1.38), circulatory conditions (overall cancer group 1.25, 1.12-1.39; current cancer 1.38, 1.08-1.76; cancer survivor 1.22, 1.09-1.38), musculoskeletal conditions (overall cancer group 1.37, 1.24-1.52; current cancer 1.66, 1.30-2.12; cancer survivor 1.33, 1.19-1.48) and endocrine system disorders (overall cancer group 1.19, 1.06-1.34; current cancer 1.29, 1.00-1.66; cancer survivor 1.17, 1.04-1.33) compared with the noncancer group. Cancer patients and survivors were more likely to report poor health status, a higher level of distress, and a greater number of chronic conditions compared with the noncancer group. CONCLUSION Poor health and comorbidity is more prevalent among cancer patients and survivors than the noncancer population. Our results further support the need to develop models of care that effectively address multiple chronic conditions experienced by the cancer population.
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Affiliation(s)
- Huah Shin Ng
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, Centre of Population Health Research, School of Health Sciences, University of South Australia, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Australia
| | - Agnes Vitry
- School of Pharmacy and Medical Sciences, University of South Australia, Australia
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14
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Pergolotti M, Williams GR, Campbell C, Munoz LA, Muss HB. Occupational Therapy for Adults With Cancer: Why It Matters. Oncologist 2016; 21:314-9. [PMID: 26865588 PMCID: PMC4786355 DOI: 10.1634/theoncologist.2015-0335] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/28/2015] [Indexed: 11/17/2022] Open
Abstract
Adults with cancer may be at risk for limitations in functional status and quality of life (QOL). Occupational therapy is a supportive service with the specific mission to help people functionally engage in life as safely and independently as possible with the primary goal of improving QOL. Unfortunately, for people with cancer, occupational therapy remains underused. The overall purpose of this review is to provide an understanding of what occupational therapy is and its relevance to patients with cancer, highlight the reasons to refer, and, last, provide general advice on how to access services.
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Affiliation(s)
- Mackenzi Pergolotti
- Gillings School of Global Public Health, Department of Health Policy and Management, Cancer Care Quality Training Program University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, Geriatric Oncology Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Grant R Williams
- Lineberger Comprehensive Cancer Center, Geriatric Oncology Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claudine Campbell
- Memorial Sloan Kettering Cancer Center, Department of Occupational Therapy, New York, New York, USA
| | - Lauro A Munoz
- MD Anderson Cancer Center, Department of Occupational Therapy, Houston, Texas, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, Geriatric Oncology Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Diaz A, Bernardes CM, Garvey G, Valery PC. Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need. Eur J Cancer Care (Engl) 2016; 25:242-53. [PMID: 26918689 DOI: 10.1111/ecc.12471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/28/2022]
Abstract
Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey.
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Affiliation(s)
- A Diaz
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia
| | - C M Bernardes
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia.,QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia
| | - P C Valery
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia.,QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
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16
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Holla JFM, van de Poll-Franse LV, Huijgens PC, Mols F, Dekker J. Utilization of supportive care by survivors of colorectal cancer: results from the PROFILES registry. Support Care Cancer 2016; 24:2883-92. [PMID: 26842528 DOI: 10.1007/s00520-016-3109-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/26/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE In an equitable healthcare system, healthcare utilization should be predominantly explained by patient-perceived need and clinical need factors. This study aims to analyze whether predisposing, enabling, and need factors are associated with the utilization of supportive care (i.e., dietary care, oncological nursing care, physical therapy, psychological care, or participation in a rehabilitation program consisting of an exercise component and a psycho-educational component) among survivors of colorectal cancer in the Netherlands. METHODS Cross-sectional data of 3957 survivors of colorectal cancer (1-11 years after diagnosis) were used. Clinical data from the Eindhoven Cancer Registry were linked to questionnaire data from the PROFILES registry. Regression analyses were used to examine which predisposing, enabling, and need factors were associated with self-reported utilization of supportive care. RESULTS Utilization of supportive care was primarily associated with younger age, patient-perceived need (i.e., lower physical health, anxious mood, depressive mood, and fatigue), and clinical need (i.e., tumor stage, radiotherapy, chemotherapy, comorbidity, having a stoma and lower BMI) factors. CONCLUSIONS In the Netherlands, utilization of supportive care by survivors of colorectal cancer is primarily associated with younger age, patient-perceived need, and clinical need factors. Apart from the association with younger age, the utilization of supportive care services seems to be quite equitable. Further research is needed to determine whether there is indeed inequity in the provision of supportive care to older survivors, or whether older survivors are less in need of supportive care.
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Affiliation(s)
- Jasmijn F M Holla
- Amsterdam Rehabilitation Research Center
- Reade, Dr. Jan van Breemenstraat 2, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.
| | - Lonneke V van de Poll-Franse
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Peter C Huijgens
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Department of Hematology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Floortje Mols
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Joost Dekker
- Amsterdam Rehabilitation Research Center
- Reade, Dr. Jan van Breemenstraat 2, PO Box 58271, 1040 HG, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Bondil P, Habold D. Développement de l’oncosexualité et de l’oncofertilité en France : pourquoi maintenant ? Aspects culturels et psychosociologiques. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-015-0547-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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18
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Bayly JL, Lloyd-Williams M. Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review. Support Care Cancer 2016; 24:2359-2379. [DOI: 10.1007/s00520-015-3066-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
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Ho MY, McBride ML, Gotay C, Grunfeld E, Earle CC, Relova S, Tsonis M, Ruan JY, Chang JT, Cheung WY. A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer. Psychooncology 2015; 25:1470-1476. [DOI: 10.1002/pon.3988] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/22/2015] [Accepted: 08/21/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Maria Y. Ho
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Mary L. McBride
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Carolyn Gotay
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Eva Grunfeld
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Craig C. Earle
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Sharon Relova
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Miranda Tsonis
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Jenny Y. Ruan
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Jennifer T. Chang
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
| | - Winson Y. Cheung
- Division of Medical Oncology, British Columbia Cancer Agency; University of British Columbia; Vancouver Canada
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Salakari MRJ, Surakka T, Nurminen R, Pylkkänen L. Effects of rehabilitation among patients with advances cancer: a systematic review. Acta Oncol 2015; 54:618-28. [PMID: 25752965 DOI: 10.3109/0284186x.2014.996661] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In parallel with the rising incidence of cancer and improved treatment, there is a continuous increase in the number of patients living with cancer as a chronic condition. Many cancer patients experience long-term disability and require continuous oncological treatment, care and support. The aim of this review is to evaluate the most recent data on the effects of rehabilitation among patients with advanced cancer. MATERIAL AND METHODS A systematic review was conducted according to Fink's model. Only randomized controlled trials (RCTs) published in 2009-2014 were included. Medline/PubMed and Cochrane databases were searched; five groups of keywords were used. The articles were evaluated for outcome and methodological quality. RESULTS Thirteen RCTs (1169 participants) were evaluated. Most studies were on the effects of physical exercise in patients with advanced cancer (N = 7). Physical exercise was associated with a significant improvement in general wellbeing and quality of life. Rehabilitation had positive effects on fatigue, general condition, mood, and coping with cancer. CONCLUSIONS Rehabilitation is needed also among patients with advanced disease and in palliative care. Exercise improves physical performance and has positive effects on several other quality of life domains. More data and RCTs are needed, but current evidence gives an indication that rehabilitation is suitable and can be recommended for patients living with advanced cancer.
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