Digest Commentator: Georden Jones, Ph.D. Student in Clinical Psychology, University of Ottawa, supervised by Dr. Sophie Lebel

Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

Background:
Cancer survivors are faced with multiple physical and psychological symptoms which significantly impact their quality of life. Rehabilitation programs including physical and psychological components have demonstrated effectiveness to improve patients’ function and return to normal lives, however little is known about optimal duration of rehabilitation programs and factors associated with clinically relevant change. This study aimed to assess outcomes (health-related quality of life (HRQOL), fatigue, and level of physical activity) following a one-week Inpatient Educational Program (IEP) and investigate factors associated with clinically relevant change. 

Methods: 
Breast, prostate and gastrointestinal patients who were diagnosed within the past ten years and referred to the IEP at The Norwegian Resource Center for Coping with Cancer (Montebello-Center) were invited to participate in the study. A Norwegian general population sample (NORMS) was used as a comparison group. The IEP was offered over 6 days for a total of 30 hours and aimed to improve participants’ level of coping with cancer-specific health problems and to motivate the participants to adopt a healthy lifestyle. The IEP was facilitated by a multidisciplinary healthcare team and was comprised of lectures (50-55%), guided group physical activity (20-25%), and group sessions (25%). Topics included: cancer and its treatment, risk of adverse effects, work, social resources and support, sexuality, psychological reactions, and lifestyle.

Participants completed questionnaires prior to the IEP (T0) and three months post-IEP (T1). The questionnaire package included sociodemographic and medical questions, the Fatigue Questionnaire, the Medical Outcomes Study Short Form 36 (SF-36), and the Nord-Trondelag Health Study Physical Activity Questionnaire (HUNT 1 PA-Q).

Results:
Of the 482 patients who were invited to participate, 332 (69%) agreed. At T1 235/482 (49%) participants completed pre and post measures. The median age of participants was 59.4 y, 63% of participants were female, 57% were diagnosed with breast cancer, 32% prostate cancer, and 11% gastrointestinal cancer. At both time points, participants had higher levels of fatigue and lower levels of HRQOL than the NORMS. Females showed significant changes in physical and total fatigue and in general health and vitality. Males showed improvement in role limitations due to physical problems. No changes were found in level of physical activity. Clinically relevant improvements on significant outcomes ranged from 30-36% and higher education and relapse or progression before T0 were associated with higher improvement in total fatigue scores for females. Study limitations include the lack of a control group, low participation rates at T1 (49%), and the sample may be more representative of females diagnosed with breast cancer.

Why I liked this article:
This study demonstrated that short-term rehabilitation programs may be effective in improving psychosocial outcomes for cancer survivors and that tailoring content and activities by gender may be needed to target specific outcomes.

Health rehabilitation programs are available in Canada for diverse chronic illnesses such as cardiac illnesses, stroke, and acquired brain injuries whereas such programs are less common in oncology. However, oncology rehabilitation programs are more commonly offered in other Western countries such as Norway. This raises questions for me 1) Does the Canadian healthcare system perceive cancer more as an acute illness compared to other countries? 2) Could moving towards a rehabilitation model of cancer survivorship care improve survivors’ transition from tertiary to primary care in the Canadian healthcare system?

Citation of original article: Gjerset, G. M., Kiserud, C. E., Loge, J. H., Fosså, S. D., Wisløff, T., Gudbergsson, S. B., ... & Thorsen, L. (2019). Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors. Acta Oncologica, 1-8.

Journal website: https://www.tandfonline.com/toc/ionc20/current