The Dutch cancer rehabilitation & survivorship care
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1 The Dutch cancer rehabilitation & survivorship care from practice-based intervention to evidence-based guidelines Brigitte CM Gijsen, MSc associate director National program Cancer rehabilitation & survivorship care Comprehensive Cancer Centre the Netherlands
2 CCCN & cancer survivorship Cancer survivors: in % increase up to 4% of Dutch population Dutch Cancer Registry, Survival rates IKA, Dutch Cancer Society Comprehensive Cancer Centre (CCCN) National expertise centre in oncology on 8 locations National Programme: rehabilitation & survivorship care Practice-based intervention evidence-based guidelines
3 Cancer rehabilitation 1996: Rehabilitation programme Recovery & Stability needs assessment: 25% rehab Design: oncology & rehabilitation practice-based protocols to meet patients needs 12 weeks programme physical training 2x/wk & psycho education 1x/wk group programme, individual tailored goal: improve patients quality of life
4 Evaluation : National database, N=1398 pre-test/post-test Evaluation: N=658, 78% female, age (51) Effects: increase quality of life, decrease fatigue Rehabilitation is feasible in heterogeneous groups Patient satisfaction: 8.9 (0-10) Korstjens, Velthuis : Multicenter trial RCT: physical training vs physical training + problem solving therapy N=209, 62 controls, 86% female, age (50) Rehabilitation short/long-term positive effects Effect training = effect training + problem solving Korstjens, May, Weert
5 Implementation & dissemination Nationwide network: 1998: 2 centres 2010: 68 centres ± 300 professionals 2002: Foundation Recovery & Stability Organized collaboration CCCN & rehabilitation centres & patients associations Implementation and financing of cancer rehabilitation
6 Quality care system Quality criteria Network Coordination Protocols Quality monitor Licences Brand name Professional education Finances Communication
7 Facts & figures rehabilitation system 2010, Patients in rehabilitation Licensed health centres Quality monitor in centres Professionals in course/symposia / 163 Website s unique visitors 34,761 34,319 Brochures 30,000 30,000 Newsletter s subscribers Structural finances in national health insurance system Sinds 2010
8 Guideline cancer rehabilitation National evidence-based guideline development Multidisciplinary, multicenter rehabilitation Working groups: professionals & patients perspectives Guideline recommendations Rehabilitation care in all phases of cancer During and after cancer treatment: physical training In palliative phase: training focus quality of life Tailored supportive care
9 Guideline cancer survivorship care Cancer aftercare in 1st year after treatment New cancer manifestations Detection only in case of improved survival Cancer side effects Systematic detection and treatment Cancer survivorship care plan: Individual tailored Coordination of cancer after care
10 Modular cancer rehabilitation, tailored care in all phases of cancer
11 Integrated cancer survivorship care guided Self management Network: quality care expertise research Oncology care hospital Cancer survivorship plan Patient Primary care physiotherapy psychology Multidisciplinary rehabilitation care hospital rehabilitation centre
12 Patients perspectives Survivorship or prolonged survival Quality of life Participation I am looking forward to the future, the rehabilitation showed me the way.
13 References Korstjens et al, European Journal Cancer prevention, 2006 Earle, Cancer Control, 2006 Hewitt, Greenfield, Stovall. IOM, Washington, DC, 2006 Korstjens et al, European Journal Cancer Care, 2007 Dutch Health Council, 2007 Mc Cabe, Jacobs. Semin Oncol Nurs., 2008 Ganz. Semin Oncol Nurs., 2008 Ganz, Hahn. J Clin Oncol, 2008 May et al, Acta Oncologica, 2008 May et al, Psycho-Oncology, 2008 Weert et al Patient Education and Counseling, 2008 Korstjens et al, Psychosomatic Medicine, 2008 Grunfeld. Curr Opin Obstet Gynecol, 2009 May et al, Supportive Care in Cancer, 2009 Grunfeld, Earle. J Natl Cancer Inst Monogr, 2010 May et al, Archives of Physical Medicine and Rehabilitation, 2010 Weert et al, Physical Therapy, July 22, epub ahead of print, 2010 Velthuis et al, BMC Cancer, 2010 Maria Hellbom et al. Acta Oncologica, 2011
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