Short-term effectiveness of inpatient cancer rehabilitation: A longitudinal controlled cohort study

Maria Ture; Felix Angst; André Aeschlimann; Christoph Renner; Ulrich Schnyder; Nic Zerkiebel; Josef Perseus; Jürgen Barth; Marius Bredell; Chantal Martin Soelch; Heinrich Walt; Josef Jenewein

doi:10.7150/jca.19564

Short-term effectiveness of inpatient cancer rehabilitation: A longitudinal controlled cohort study

J Cancer. 2017 Jul 1;8(10):1717-1725. doi: 10.7150/jca.19564. eCollection 2017.

Authors

Affiliations

¹ Department of Cranio-, Maxillo-Facial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² RehaClinic Bad Zurzach, Zurzach, Switzerland.
³ Oncology Centre Hirslanden Zurich, Switzerland.
⁴ Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland.
⁵ Susenberg Klinik Zurich, Switzerland.
⁶ Zürcher RehaZentrum Davos, Switzerland.
⁷ Institute of Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Switzerland.
⁸ Department of Psychology, Unit of Clinical and Health Psychology, University of Fribourg, Switzerland.

Abstract

Background: Inpatient rehabilitation for cancer patients has been demonstrated to improve patients' health related quality of life (HRQoL) effectively. The purpose of this study was to compare changes in general health and HRQoL of cancer patients who were referred to inpatient rehabilitation (IR) with those in two control groups who underwent outpatient management either with advice for inpatient rehabilitation (A⁺) or without (A^-). Methods: In this naturalistic, longitudinal, controlled cohort study, changes in general health and HRQoL were assessed at either discharge of acute hospital or start of rehabilitation (baseline) and at the follow-up 3 weeks later or end of rehabilitation. Outcome variables included general health and HRQoL assessed by the Short Form 36 (SF-36) and the Functional Assessment of Cancer Therapy (FACT), and fatigue (FACT-F), depression and anxiety by the Hospital Anxiety and Depression Scale (HADS). Changes on the scores were compared with bivariate and multivariate analyses using standardized mean differences (SMD). Results: IR patients (n=133) were on average older, reported lower HRQoL and health, and suffered more frequently from carcinoma than patients of the A⁺ (n=30) and the A^- (n=82) groups. In the IR patients, pain, physical functioning, mental health, vitality, and fatigue improved significantly compared to the A⁺ controls. Compared to the A^- group, the bivariate effects were lower but still statistically significant on many scales. Conclusions: IR showed moderate, statistically significant superior effects over outpatient management of cancer patients after acute treatment. Findings indicate that inpatient cancer rehabilitation can be recommended as an effective management after acute treatment. As today, referrals to inpatient rehabilitation for cancer patients are still not based on structured standardized procedures, the implementation of such screening is needed to address patients' needs and to render the potential for rehabilitation more reliable.

Keywords: Anxiety; Cancer; Depression.; Effectiveness; Fatigue; Health; Inpatient rehabilitation; Quality of Life; Rehabilitation.