Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review

Amy M Dennett; Mitchell Sarkies; Nora Shields; Casey L Peiris; Cylie Williams; Nicholas F Taylor

doi:10.1016/j.jphys.2020.12.008

Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review

J Physiother. 2021 Jan;67(1):12-26. doi: 10.1016/j.jphys.2020.12.008. Epub 2020 Dec 24.

Authors

Amy M Dennett¹, Mitchell Sarkies², Nora Shields³, Casey L Peiris³, Cylie Williams⁴, Nicholas F Taylor⁵

Affiliations

¹ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia. Electronic address: amy.dennett@easternhealth.org.au.
² School of Public Health, Curtin University, Perth, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
³ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
⁴ School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Allied Health, Peninsula Health, Melbourne, Australia.
⁵ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia.

PMID: 33358544
DOI: 10.1016/j.jphys.2020.12.008

Abstract

Question: What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function?

Design: Systematic review with meta-analysis of randomised controlled trials.

Participants: Adults diagnosed with cancer.

Intervention: Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors.

Outcome measures: Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach.

Results: Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported.

Conclusion: Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care.

Trial registration: PROSPERO CRD42019130593.

Keywords: Cancer; Exercise; Multidisciplinary; Physical therapy; Rehabilitation.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Delivery of Health Care
Exercise Therapy*
Health Services
Humans
Quality of Life*
Uncertainty