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

文献信息 ​

DOI10.3322/caac.21639
PMID33107982
期刊CA: a cancer journal for clinicians
影响因子232.4
JCR 分区Q1
发表年份2021
被引次数101
关键词癌症康复、临床路径、共识、残疾、指南
文献类型Journal Article, Systematic Review
ISSN0007-9235
页码149-175
期号71(2)
作者Nicole L Stout, Daniel Santa Mina, Kathleen D Lyons, Karen Robb, Julie K Silver

一句话小结 ​

本研究系统回顾了2009年至2019年间发布的成人癌症患者肿瘤护理指南，发现虽然69个指南中有37个支持转诊至康复服务，但具体评估与干预建议不足，这与临床上低康复利用率形成对比。研究指出，改善康复护理的实施符合指南建议，可能显著提升癌症幸存者的功能和生活质量，强调了康复在肿瘤护理中的重要性。

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癌症康复 · 临床路径 · 共识 · 残疾 · 指南

摘要 ​

指南促进高质量的癌症护理。肿瘤学指南中的康复建议尚未被充分描述，可能为改善康复与肿瘤护理的整合提供见解。本报告是世界卫生组织（WHO）“康复2030”倡议的一部分，旨在识别肿瘤护理指南中与康复相关的具体建议。我们进行了指南的系统性回顾。仅纳入2009年至2019年间发布的、针对成人癌症患者的英文指南，这些指南提供关于康复转诊、评估或干预的建议。共识别出13840篇文章。在去重和应用过滤后，筛选出4897篇文章。最终确定了69个具有康复具体建议的指南。在这69个指南中，有37个支持转诊至康复服务，但没有提供关于评估或干预的具体建议。有32个指南符合完整纳入标准，并使用AGREE II工具进行了评估。这32个指南中，有21个获得了≥ 45的AGREE II质量评分，并被完整提取。专门针对药物干预及补充和替代干预的指南被排除在外。研究结果识别出推荐康复服务的指南，覆盖多种癌症类型及癌症治疗的各种后果，表明康复已成为肿瘤护理的一个公认组成部分。然而，这些发现与临床报告中低康复利用率的情况相悖，表明指南建议可能被忽视。考虑到功能性疾病对大多数癌症幸存者产生负面影响，改善符合指南的康复护理可能对癌症幸存者的功能和生活质量产生重大影响。

英文摘要 ​

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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主要研究问题 ​

  1. 在现有的肿瘤学指南中，哪些具体的康复干预措施被推荐用于不同类型的癌症患者？
  2. 针对癌症幸存者的功能性障碍，是否有研究探讨了康复服务的具体效果和应用案例？
  3. 在康复推荐中，如何评估不同干预措施对癌症患者生活质量的影响？
  4. 目前有哪些因素可能导致临床实践中对康复指南的遵循率较低，如何改善这一情况？
  5. 有哪些国家或地区在肿瘤护理中成功整合了康复服务，值得借鉴的经验是什么？

核心洞察 ​

研究背景和目的 ​

癌症治疗常常导致患者在身体和认知功能方面的损害，这些损害对生活质量产生了负面影响。尽管越来越多的证据支持将康复服务纳入癌症护理，但目前在临床实践中，康复服务的利用率仍然较低。本研究旨在系统性地评估近十年内癌症相关的康复指导方针，以识别其中的康复推荐，从而为改善癌症护理中的康复整合提供依据。

主要方法/材料/实验设计 ​

本研究采用系统评价的方法，遵循PRISMA标准。筛选了2009年至2019年间发表的、针对成人癌症患者的康复指导方针。最终纳入69个包含康复推荐的指导方针，依据AGREE II工具进行质量评估。

Mermaid diagram

关键结果和发现 ​

  • 69个指导方针中，37个推荐转介康复服务，但缺乏具体的评估或干预建议。
  • 32个指导方针满足完整纳入标准，经过AGREE II评估后，有21个指导方针的质量得分≥45。
  • 推荐的康复服务覆盖多种癌症类型和治疗后遗症，表明康复在癌症护理中已被认可。
指导方针类型数量AGREE II得分≥45主要推荐内容
总体指导方针6921转介康复服务、评估与干预
类别A3221特定康复评估与干预建议
类别B370仅推荐转介

主要结论/意义/创新性 ​

研究结果显示，尽管癌症相关的康复服务在指导方针中得到广泛认可，但实际临床应用中仍存在显著的利用差距。提高康复服务的利用率对于改善癌症幸存者的功能和生活质量至关重要。本研究为制定更有效的康复整合策略提供了重要依据。

研究局限性和未来方向 ​

  • 仅纳入了英文文献，可能导致遗漏其他语言中的相关指导方针。
  • 由于指导方针的更新速度较快，本研究结果可能在未来的临床实践中需重新评估。
  • 未来研究应关注如何在临床实践中更好地实施这些康复推荐，尤其是在癌症治疗的不同阶段。

总之，本研究为癌症护理中的康复整合提供了系统的证据支持，呼吁临床医生和政策制定者加强对康复服务的重视与利用。

参考文献 ​

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  2. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. - Karen M Mustian;Catherine M Alfano;Charles Heckler;Amber S Kleckner;Ian R Kleckner;Corinne R Leach;David Mohr;Oxana G Palesh;Luke J Peppone;Barbara F Piper;John Scarpato;Tenbroeck Smith;Lisa K Sprod;Suzanne M Miller - JAMA oncology (2017)
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  4. Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. - Jeanne Carter;Christina Lacchetti;Barbara L Andersen;Debra L Barton;Sage Bolte;Shari Damast;Michael A Diefenbach;Katherine DuHamel;Judith Florendo;Patricia A Ganz;Shari Goldfarb;Sigrun Hallmeyer;David M Kushner;Julia H Rowland - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2018)
  5. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. - A Horwich;C Parker;C Bangma;V Kataja; - Annals of oncology : official journal of the European Society for Medical Oncology (2010)
  6. Differential Impact of Symptom Prevalence and Chronic Conditions on Quality of Life in Cancer Survivors and Non-Cancer Individuals: A Population Study. - I-Chan Huang;Melissa M Hudson;Leslie L Robison;Kevin R Krull - Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology (2017)
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  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)
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引用本文的文献 ​

  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 更多 篇文献)

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