Is intensive inpatient cancer rehabilitation more effective than outpatient cancer rehabilitation?

Transcription

1 Is intensive inpatient cancer rehabilitation more effective than outpatient cancer rehabilitation? Line Oldervoll, Anne Hokstad, Roy Nystad, Gro Bertheussen, Jon Arne Sandmæl, Liv Stenvågnes, Gro Haugen, Stein Kaasa, Jon H Loge, Sophie Fosså, Alv Dahl, Lene Thorsen 1

2 Collaboration Et samarbeidsprosjekt 2

3 Background Cancer incidence increase Treatment strategies improves More patients live longer with their disease Reduced health due to the disease and treatment Fatigue Increase risk of (coronary) heart disease Neuropatic pain Anxiety and depression Weight problems Reduced physical functioning 3

4 Aims of the study 1. Study the effect of An inpatient cancer rehabilitation program (IPR) An outpatient cancer rehabilitation program (OPR) Physical fatigue Physical functioning Emotional functioning 2. Compare the effects between the inpatient versus the outpatient rehabilitation program on the same outcomes 4

5 Inclusion criteria Gynecological- and breast cancer Age between years In process of finishing or have completed primary treatment Karnofsky performance status above 70 Employed and in risk of being sick or reported sick (on sick leave) 5

6 Flow chart and time of assessments (IPR) 3 weeks primary stay (physical exercise testing and questionnaires at arrival (T1) 9-12 weeks at home 1 week follow-up stay (physical exercise testing and questionnaires at arrival) (T2) 6-7 months at home Postal questionnaire (T3) 6

7 Flow chart and time of assessments (OPR) Physical exercise testing and questionnaires at arrival of the course (T1) Once a week for 8 weeks (5 hours) Physical exercise testing and questionnaires at the end of the eight week period (T2) 6-7 months at home Postal questionnaire (T3) 7

8 The rehabilitation program (both IPR and OPR) Multidisciplinary teams Physiotherapist Nurse Psychiatric nurse or doctor Medical doctor Nutritionist Social worker Sport instructor Cognitive approach patients in each group 8

9 The IPR program Indoor and out door physical exercise every day Education and conversations individually and in groups Goals with their stay Psychosocial reactions (anxiety and depression), Coping living with cancer, Usual side effects and symptoms, Social security benefits, Physical exercise and training Nourishment education (practically and theoretically) Family and relatives 9

10 OPR program Met once a week 8 weeks course 5 hours each time Lectures followed by group conversation with experts responsible for the lecture Conversations individually if needed Physical exercise Power walking Yoga Strength exercises Exercise in water Relaxation 10

11 Assessments European Organization for Research and Treatment Core Quality of Life (EORTC QLQ-C30) (0-100) Physical functioning (5 items) Emotional functioning (4 items) Fatigue questionnaire (FQ) Physical fatigue (0-21) 11

12 Statistical methods Paired sample t-tests Analysis of covariance (ANCOVA) 12

13 Preliminary results 13

14 Patient demographics IPR (n = 57) OPR (n = 53) Diagnoses N (%) Breast cancer Gynecological cancer 51 (89) 6 (11) 25 (49) 27 (51) Age (range) 52.5 (34-66) 49.6 (32-67) Education (n (%)) College or university education 4 years 35 (61) 24 (45) Marital status Married/cohabitant 37 (65) 36 (68) Children living at home 26 (46) 30 (57) BMI (range) 26 (19-43) 25 (18-43) 14

15 Results Physical fatigue 20 Overall statistical significant effect in favor of the inpatient group (p = 0.02) P P pre post 5 0 Inpatient Outpatient 15

16 Results Physical functioning 100 No overall effect: (p = 0.64) P = P = pre post 20 0 Inpatient Outpatient 16

17 Results Emotional functioning No overall effect: (p = 0.10) P P = pre post 20 0 Inpatient Outpatient 17

18 Summary and conclusions Both groups reduced fatigue and improved physical- and emotional functioning after a rehabilitation program Physical fatigue was statistically more improved in the inpatient than in the outpatient group We need more research about the natural course for these patients Large randomized clinical trials are warranted 18

19 Summary and conclusions Cost-benefit analysis in the two programs Sub-groups analysis will be performed in order to get more detailed information about these two populations National and international collaboration is needed 19

20 Thanks to co-workers The team at Røros rehabilitation centre and St Olavs Hospital/NTNU Anne Hokstad Jon Arne Sandmæl Line Evenås Ingvild Arnesen Gro Bertheussen Stein Kaasa The team at the Norwegian Radium Hospital Roy Nystad Liv Steinvågnes Gro Haugen Sophie Fosså Lene Thorsen Jon Håvard Loge Alv Dahl 20

21 Thanks for the financial support from the Norwegian cancer society Thanks for your attention 21