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A systematic review of rehabilitation and exercise recommendations in oncology guidelines. ​

Literature Information ​

DOI10.3322/caac.21639
PMID33107982
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2021
Times Cited101
Keywordscancer rehabilitation, clinical pathways, consensus, disability, guideline
Literature TypeJournal Article, Systematic Review
ISSN0007-9235
Pages149-175
Issue71(2)
AuthorsNicole L Stout, Daniel Santa Mina, Kathleen D Lyons, Karen Robb, Julie K Silver

TL;DR ​

This study systematically reviewed oncology guidelines from 2009 to 2019 to identify rehabilitation-specific recommendations, highlighting that while 37 out of 69 guidelines endorsed referrals to rehabilitation services, many lacked detailed assessment or intervention strategies. The findings underscore the need for better integration of rehabilitation into cancer care, as existing guidelines are not fully utilized, which could significantly enhance the functional outcomes and quality of life for cancer survivors.

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cancer rehabilitation · clinical pathways · consensus · disability · guideline

Abstract ​

Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.

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Primary Questions Addressed ​

  1. What specific barriers exist that prevent the implementation of rehabilitation recommendations in oncology guidelines?
  2. How do the rehabilitation recommendations vary across different types of cancer and treatment modalities?
  3. What are the long-term outcomes for cancer survivors who adhere to rehabilitation guidelines compared to those who do not?
  4. How can healthcare providers be better educated on the importance of integrating rehabilitation into oncology care?
  5. What role does patient education play in increasing the utilization of rehabilitation services among cancer survivors?

Key Findings ​

Background and Purpose ​

The systematic review aims to characterize rehabilitation-specific recommendations in oncology guidelines to improve the integration of rehabilitation into cancer care. Conducted as part of the WHO Rehabilitation 2030 initiative, the study identifies guidelines for rehabilitation referral and assessment for adults with cancer published between 2009 and 2019.

Main Methods/Materials/Experimental Design ​

The review followed the PRISMA methodology and included guidelines that:

  • Provided recommendations for rehabilitation services.
  • Were published in English.
  • Focused on adults with cancer.
  • Were published between January 1, 2009, and June 30, 2019.

Search Strategy: Three approaches were used to identify relevant guidelines:

  1. Database searches (PubMed, CINAHL, etc.) with specific search terms.
  2. Hand-searching online guideline repositories.
  3. Surveying international cancer rehabilitation providers for additional guidelines.

Review Process:

  • Screening was conducted in three levels: title/abstract, full text, and quality review using the AGREE II tool.
  • Guidelines were categorized into two categories: Category A (specific recommendations) and Category B (endorsements for referral without specific recommendations).
Mermaid diagram

Key Results and Findings ​

  • A total of 69 guidelines with rehabilitation recommendations were identified.
  • 32 guidelines met full inclusion criteria (Category A), with 21 achieving an AGREE II score of ≥ 45.
  • 37 guidelines (Category B) endorsed referrals but lacked specific intervention recommendations.
  • Guidelines addressed various cancer types and treatment-related consequences, indicating rehabilitation is recognized in oncology care.
  • Despite guideline recommendations, low utilization rates of rehabilitation services among cancer survivors were reported.

Main Conclusions/Significance/Innovation ​

The findings underscore the importance of integrating rehabilitation into oncology care to enhance the quality of life and functional outcomes for cancer survivors. The study highlights a significant gap between guideline recommendations and actual clinical practice, suggesting that improved awareness and implementation of these guidelines could benefit patient care.

Limitations and Future Directions ​

  • The review focused only on guidelines published in English, potentially missing international recommendations.
  • The evolving nature of rehabilitation guidelines necessitates ongoing review and adaptation.
  • Future research should explore the integration of rehabilitation services into oncology workflows and the barriers to guideline adherence.

Future Directions:

  • Increased emphasis on guideline concordance in oncology care.
  • Enhanced collaboration between oncology and rehabilitation professionals.
  • Development of comprehensive rehabilitation pathways for cancer care to address the functional needs of survivors.

References ​

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  7. Interventions to address sexual problems in people with cancer. - L Barbera;C Zwaal;D Elterman;K McPherson;W Wolfman;A Katz;A Matthew; - Current oncology (Toronto, Ont.) (2017)
  8. Toward Strengthening Rehabilitation in Health Systems: Methods Used to Develop a WHO Package of Rehabilitation Interventions. - Alexandra Rauch;Stefano Negrini;Alarcos Cieza - Archives of physical medicine and rehabilitation (2019)
  9. Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis. - Josephine Neo;Lucy Fettes;Wei Gao;Irene J Higginson;Matthew Maddocks - Cancer treatment reviews (2017)
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Literatures Citing This Work ​

  1. In This for the Long Haul: Ethics, COVID-19, and Rehabilitation. - Monica Verduzco-Gutierrez;Leslie Rydberg;Melba Nicholson Sullivan;Debjani Mukherjee - PM & R : the journal of injury, function, and rehabilitation (2021)
  2. Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm. - Kelley R Covington;Timothy Marshall;Grace Campbell;Grant R Williams;Jack B Fu;Tiffany D Kendig;Nancy Howe;Catherine M Alfano;Mackenzi Pergolotti - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2021)
  3. Clinician's perspectives of implementing exercise-based rehabilitation in a cancer unit: a qualitative study. - Amy M Dennett;Casey L Peiris;Germaine Tan;Nora Shields - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2021)
  4. Patient activation and patient-reported outcomes of men from a community pharmacy lifestyle intervention after prostate cancer treatment. - Agnieszka Lemanska;Karen Poole;Ralph Manders;John Marshall;Zachariah Nazar;Kevin Noble;John M Saxton;Lauren Turner;Gary Warner;Bruce A Griffin;Sara Faithfull - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
  5. An evaluation of the provision of oncology rehabilitation services via telemedicine using a participatory design approach. - Grainne Brady;Kate Ashforth;Siobhan Cowan-Dickie;Sarah Dewhurst;Natalie Harris;Alline Monteiro;Catherine Sandsund;Justin Roe - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
  6. Telerehabilitation's Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation. - Amy Dennett;Katherine E Harding;Jacoba Reimert;Rebecca Morris;Phillip Parente;Nicholas F Taylor - JMIR cancer (2021)
  7. Randomised controlled trial to investigate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to ameliorate lower urinary tract symptoms in men treated for prostate cancer. - Sara Faithfull;Jane Cockle-Hearne;Agnieszka Lemanska;Sophie Otter;Simon S Skene - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
  8. Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge. - Hartmut Bertz - Cancers (2021)
  9. Clinical Outcome Assessment in Cancer Rehabilitation and the Central Role of Patient-Reported Outcomes. - Jens Lehmann;Maria Rothmund;David Riedl;Gerhard Rumpold;Vincent Grote;Michael J Fischer;Bernhard Holzner - Cancers (2021)
  10. Prehabilitation is the Gateway to Better Functional Outcomes for Individuals with Cancer. - Nicole L Stout;Jack B Fu;Julie K Silver - Journal of cancer rehabilitation (2021)

... (91 more literatures)

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