Rehabilitation services and patient needs

Transcription

1 Rehabilitation services and patient needs

2 National Research Center of Cancer Rehabilitation Research Unit of General Practice Institute of Public Health Dorte Gilså Hansen, MD, PhD Head of Center Research in cancer rehabilitation is important for the implementation of evidence-based rehabilitation in clinical cancer care -How can we identify cancer patients in need of rehabilitation? -What kind of interventions work and what is the effect? -How should we organise targeting the most susceptible?

3 Rehabilitation services and patient needs

4 Association between unmet needs and quality of life of cancer patients: a population-based study DG Hansen, PV Larsen, LV Holm, N Rottmann, SH Bergholdt, J Søndergaard Submitted for ACTA Oncologica

5 Background Two conceptually different morbidity measures Unmet needs of rehabilitation Quality of life Used to Identify patients in need of rehabilitation Evaluate rehabilitation interventions The association between the two outcomes are scarcely known

6 Study aim To analyse the hypothesis that patient perceived unmet needs of rehabilitation during the cancer trajectory are asssociated with decreased quality of life

7 Material and methods Large-scaled survey Patient questionnaire at 14 months following diagnosis Response rate 70% 3,947 adult, incident, mixed-site cancer patients Diagnosed Two of five Danish Regions (2.4 mill.) Identification by use of the hospitals Patient Administrative Systems and the National Patient Registry L Holm et al. Support Care Cancer 2012

8 From the patient questionnaire Unmet needs of rehabilitation six areas Physical Emotional Family-oriented Sexual Work-related Financial Quality of life Health-related quality of life (EORTC) Psychological distress (POMS)

9 Unmet needs of rehabilitation Until now, to what extent have you had your needs fulfilled in terms of help with physical problems? Not at all To a small extent To some extent To a great extent Not relevant

10 Unmet needs of rehabilitation Until now, to what extent have you had your needs fulfilled in terms of help with physical problems? Not at all To a small extent To some extent To a great extent Not relevant Unmet needs versus No unmet needs - each area Unmet needs or No unmet needs - overall Number of unmet needs

11 Quality of life Health-related quality of life EORTC QLQ C-30 The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 Psychological distress POMS-SF The Profile of Mood States- Short Form 30-items on 2 pages Refer to last month 15 aspects Global health status Five functional scales Three symptom scales Six single symptom items List of 37 adjectives on 2 pages Refer to last week Total mood disturbance and Six subscales Depression/dejection Anger/hostility Tension/anxiety Vigour/activity Fatigue/inertia Confusion/bewilderment

12 All n (%) All 3439 Sex Men 1466 (42.6) Women 1973 (57.4) Age (years) (7.9) (44.9) (47.3) Cancer diagnoses Breast 976 (28.4) Prostate 501 (14.6) Colorectal 522 (15.2) Gynecological 230 (6.7) Malignant melanoma 233 (6.8) Lung 188 (5.5) Lymphoma 104 (3.0) Head and neck 125 (3.6) Other 560 (16.3) Study population Unmet needs At least one area 2066 (60.1) 1 area 618 (18.0) 2 areas 356 (10.4) 3 areas 284 (8.3) 4 areas 307 (8.9) 5 areas 208 (6.1) All 6 areas 293 (8.5) Physical 1275 (40.0) Emotional 1205 (37.5) Sexual 1058 (33.4) Family-oriented 1013 (31.6) Financial 849 (26.7) Work-related 808 (25.3)

13 Association between unmet needs and quality of life Table 1 Health-related quality of life EORTC Table II Psychological distress - POMS

14 EORTC QLQ C-30 N Mean (95% CI) Adjusted mean difference* (95% CI) p value Global health status Unmet needs (66.2, 68.0) (-13.7, -10.8) <0.001 No unmet needs (78.5, 80.6) Functional subscales Physical functioning Unmet needs (76.9, 78.8) (-11.4, -8.6) <0.001 No unmet needs (86.2, 88.3) Role functioning Unmet needs (70.3, 73.1) (-17.0, -12.9) <0.001 No unmet needs (84.9, 87.7) Emotional functioning Unmet needs (75.3, 77.4) (-15.5, -12.6) <0.001 No unmet needs (90.1, 91.7) Cognitive functioning Unmet needs (77.6, 79.7) (-13.0, -10.0) <0.001 No unmet needs (89.5, 91.3) Social functioning Unmet needs (83.4, 85.4) (-11.5, -8.7) <0.001 No unmet needs (94.1, 95.7) *Adjusted for sex, age (three age groups), and cancer diagnosis (breast, prostate, colorectal, and others) A difference of 5-8 in the functional subscales is considered clinically relevant. Statistically significant differences were observed for all 15 EORTC scores, and all POMS scores.

15 POMS N Mean range Mean Total mood disturbance (95% CI) Adjusted difference * (95% CI) p value Unmet needs (9.6, 11.7) 12.6 (11.2, 14.1) <0.001 No unmet needs (-3.1, -1.4) Anger/hostility 0-28 Unmet needs (2.4, 2.8) 1.4 (1.2, 1.7) <0.001 No unmet needs (1.0, 1.3) Confusion/bewilderment 0-20 Unmet needs (3.0, 3.3) 1.6 (1.4, 1.8) <0.001 No unmet needs (1.33, 1.6) Depression/dejection 0-32 Unmet needs (4.4, 4.9) 2.9 (2.5, 3.2) <0.001 No unmet needs (1.5, 1.9) Fatigue/inertia 0-20 Unmet needs (5.3, 5.7) 2.5 (2.2, 2.9) <0.001 No unmet needs (2.7, 3.1) Tension/anxiety 0-24 Unmet needs (4.2, 4.6) 2.4 (2.1, 2.7) <0.001 No unmet needs (1.8, 2.1) Vigour/activity 0-24 Unmet needs (9.2, 9.6) -2.0 (-2.4, -1.6) <0.001 No unmet needs (10.8, 11.5) *Adjusted for sex, age (three age groups), and cancer diagnosis (breast, prostate, colorectal, and others)

16 Table III. Global health status and total mood disturbance vs. number of areas with unmet needs Global Health Status (EORTC) Total mood disturbance (POMS) n(%) Mean (95% CI) Adjusted difference* (95% CI) Mean (95% CI) Adjusted difference* (95% CI) No unmet needs 1373 (39.0) 79.5 (78.5, 80.6) (-3.1, -1.4) - Unmet needs in 1 area 618 (18.0) 72.6 (71.0, 74.1) -7.0 (-8.9, -5.1) 3.8 (2.3, 5.3) 6.0 (4.1, 8.0) Unmet needs in 2 areas 356 (10.4) 67.7 (65.5, 69.9) (-13.9, -9.2) 10.9 (8.4, 13.4) 12.8 (10.4, 15.2) Unmet needs in 3 areas 284 (8.3) 66.9 (64.5, 69.2) (-15.1, -10.0) 11.8 (8.9, 14.6) 13.6 (11.0, 16.2) Unmet needs in 4 areas 307 (8.9) 62.7 (60.5, 64.9) (-19.3, -14.4) 15.4 (12.7, 18.0) 17.3 (14.7, 19.9) Unmet needs in 5 areas 208 (6.1) 60.4 (57.5, 63.3) (-21.6, -15.8) 17.5 (14.1, 20.9) 19.2 (16.2, 22.1) Unmet needs in 6 areas 293 (8.5) 64.5 (61.9, 67.1) (-17.4, -12.3) 13.8 (10.8, 16.8) 16.1 (13.5, 18.7) All p-values < *Adjusted for sex, age (three age groups), and cancer diagnosis (breast, prostate, colorectal, and others)

17 Main results High prevalence of unmet needs Often unmet needs in several areas Confirmation of study hypothesis Patient-perceived unmet needs are associated with decreased quality of life Unmet needs associated with all aspects of health-related quality of life and psychological distress Clinically relevant differences between patients reporting unmet needs vs. patients with no unmet needs Increasing number of unmet needs has a negative effect on quality of life

18 Conclusion and perspectives Needs assessment can be used to identify patients with critical quality of life scores who require attention from clinicians Have you, so far, received the support you needed? Reducing patient-perceived unmet needs may be a promising strategy for enhancing quality of life of cancer patients Interventions should target both the multidimensional impact of cancer on daily living and the multiplicity of unmet needs Interventions may disappoint with regard to quality of life outcomes since patients still perceive unmet needs in areas not targeted by an otherwise effective intervention

19 Rehabilitation services and patient needs