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Background. The increasing incidence of cancer combined with prolonged survival times seen throughout the western world increases the need for rehabilitation. Diagnosis and treatment for cancer may have substantial effects on the patients' physical, psychological, social and existential well-being. The aim of this paper is to describe the current situation in cancer rehabilitation in the Nordic countries, the Netherlands and Germany. Material and methods. Description of the current situation in cancer rehabilitation in the Nordic countries and literature review. Results. Rehabilitation as defined by multiple organizations covers a multidimensional view on chronic disease and its effect on the patient's life. The rehabilitation systems in Denmark, Finland, Sweden, Germany and the Netherlands differ depending on the differing social security and health-care systems, but rehabilitation provided is largely based on a similar, multidimensional and multidisciplinary understanding of cancer rehabilitation. Research on rehabilitation efforts in European countries indicates that there is substantial evidence with regard to single interventions which can be part of cancer rehabilitation. Discussion. In order to assure patients and families continuing quality of life, rehabilitation should be an integral and continuous part of all cancer care. [ABSTRACT FROM AUTHOR]

Dance therapy and dance theatre are innovative interventions for patients with a chronic disease such as cancer. In this pilot study we investigate both how dance theatre as a supportive intervention may influence the mental health and quality of life of male cancer survivors and how participants experience this type of intervention. We used a pre-post design with two points of measurement based on a mixed-methods approach including quantitative and qualitative data. The sample (N = 16) included male cancer survivors and men indirectly affected by cancer. The results show that the level of distress and depressive symptoms slightly improved during the project. Anxiety symptoms showed a significant reduction. The results of the interviews revealed positive effects of the dance project in terms of coping with late effects, physical strengthening, emotional disclosure and developing personal empowerment and increased self-esteem. The results are preliminary and encourage validation in future studies. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. Methods: We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values. Additionally, ANOVAs were calculated to test for group differences. Results: Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier‐dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small‐ to medium‐sized effects. Conclusion: Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient‐oriented publications. Suggestions for improving patients' health services accessibility are made. [ABSTRACT FROM AUTHOR]

Background: We aimed to analyze preferred and perceived levels of patients' involvement in treatment decision-making in a representative sample of cancer patients. Material and Methods: We conducted a multicenter, epidemiological cross-sectional study with a stratified random sample based on the incidence of cancer diagnoses in Germany. Data were collected between January 2008 and December 2010. Analyses were undertaken between 2017 and 2019. We included 5889 adult cancer patients across all cancer entities and disease stages from 30 acute care hospitals, outpatient facilities, and cancer rehabilitation clinics in five regions in Germany. We used the Control Preferences Scale to assess the preferred level of involvement and the nine-item Shared Decision-Making Questionnaire to assess the perceived level of involvement. Results: About 4020 patients (mean age of 58 years, 51% female) completed the survey. Response rate was 68.3%. About a third each preferred patient-led, shared, or physician-led decision-making. About 50.7% perceived high levels, about a quarter each reported moderate (26.0%) or low (24.3%) levels of shared decision-making. Sex, age, relationship status, education, health care setting, and tumor entity were linked to preferred and/or perceived decision-making. Of those patients who preferred active involvement, about 50% perceived high levels of shared decision-making. Conclusion: The majority of patients with cancer wanted to be involved in medical decisions. Many patients perceived a high level of shared decision-making. However, many patients' level of involvement did not fit their preference. This study provides a solid basis for efforts to improve shared decision-making in German cancer care. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) is impaired in many cancer patients. The aim of this study was to test whether detriments in QoL were less pronounced in global assessments of QoL compared to more specific components. A total of 2059 cancer patients with mixed diagnoses were examined 6 months after discharge from a cancer rehabilitation clinic. QoL was measured with the EORTC QLQ-C30, which contains a global QoL scale, and 14 functioning and symptom scales and symptom items. A sample of the general population ( n = 4476) served as controls. Regression analyses were performed to calculate expected mean scores for the patients, based on their age and gender distribution. Global QoL in the cancer sample (M = 69.3) was nearly equal to that of the general population, while the mean scores of all functioning scales, symptom scales and symptom items showed markedly worse QoL. This general relationship between global and specific QoL was found for seven of eight cancer types. The results indicate that global QoL is not the sum of its parts. This should be considered when treatment effects on QoL are examined. One alternative is to use higher order summarising functioning and symptom scales. [ABSTRACT FROM AUTHOR]

Background. The purpose of the study was to explore the association between work-related factors and not returning to work in cancer patients. The identification of any special issues contributes to the development of occupation-related rehabilitation programmes. This study focused on aspects that may be influenced by patients with the help of counselling (e.g., handling occupational stress). Material and methods. At the beginning and one year after the end of rehabilitation, we asked patients to answer occupation-related questionnaires. We used t-tests and χ2-tests as well as logistic regression analyses to address our research questions. Results. Of 333 patients, 21% had not returned to work one year after the end of rehabilitation. In comparison with working patients, patients who were not working reported poorer mental health and more occupational problems at the beginning of rehabilitation. Unemployment at the beginning of rehabilitation, an elevated risk of early retirement and limited self-assessed work ability increased the probability of not returning to work. Conclusion. Patients who did not return to work represent a subgroup within rehabilitation. These patients need special support and should receive counselling beyond the time of rehabilitation. This is particularly true for unemployed patients who need intensive help to return to the workforce. Furthermore, patients' estimations of their work ability and their plans for returning to work play a crucial role and should be discussed during rehabilitation. [ABSTRACT FROM AUTHOR]

Background. Fear of cancer recurrence (FCR) or cancer progression is one of the most frequent distressing psychological symptoms in cancer patients. In contrast to anxiety disorders according to the ICD-10 or DSM-IV, FCR describes an emotional response to the real threat of a life-threatening illness. Elevated levels of FCR can become dysfunctional, causing considerable disruption in social functioning, and affect well-being and quality of life (QoL). We examined the prevalence and course of FCR in cancer patients during and after a rehabilitation program, and investigated associations between demographic, medical and psychosocial factors. We further aimed to identify predictors of FCR one year after cancer rehabilitation. Methods. A total of eligible N = 1281 patients (77.5% participation rate) were consecutively recruited on average 11 months post-diagnosis and assessed at the beginning (t1) (1148), at the end (t2) (1060) and 12 months after rehabilitation (t3) (n = 883). Participants completed validated measures assessing FCR, anxiety, depression, QoL, social support, and a range of cancer- and treatment-related characteristics. Results. At t1, 18.1% of our sample was classified as having high levels of FCR and 66.6% showed moderate levels of FCR. Fear of recurrence decreased over time (p < 0.001) (η² = .095), however, at follow-up 17.2% of our sample showed high levels of FCR and 67.6% had moderate levels of FCR. Linear regression analysis (stepwise backward) including demographic, medical and psychosocial factors, revealed that lower social class, having skin cancer, colon cancer or hematological cancer, palliative treatment intention, pain and a higher number of physical symptoms, depression, lower social support and adverse social interactions predicted FCR one year after rehabilitation (R² adjusted = 0.34) (p < 0.001). Conclusion. Our data provide evidence that elevated levels of FCR represent a continuing problem in cancer patients. The need to enhance cancer rehabilitation and survivorship programs including interventions tailored to specific problems such as FCR is emphasized. [ABSTRACT FROM AUTHOR]