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Purpose: Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. Materials and methods: Two systematic searches were conducted in five databases mapping peer-reviewed research literature. Results: In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. Conclusion: From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status. IMPLICATIONS FOR REHABILITATION: Healthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer. Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options. Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options. It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation. [ABSTRACT FROM AUTHOR]

Background:By mapping the existing literature on exercise oncology, gaps in knowledge can be identified, and future directions for research can be pointed out. Objectives:This review aimed to map diagnoses and outcome measures targeted in reviews and describe the effects on those outcomes. Further, the aim was to map exercise intervention characteristics being reviewed and the effects depending on these characteristics, and to discuss implications for future research. Methods: A systematic search was performed in PubMed, Cinahl, PSYCHInfo, and Cochrane Library. Reviews including physical activity and exercise intervention trials in adult patients during or after curative oncological treatment were included. Reference lists were scanned in order to find additional relevant papers. Results:Twenty-three reviews were included in the present study. The majority included mixed forms of cancers. Significant improvements were reported on physical fitness, cancer-related fatigue (CRF), health-related quality of life, physical function, psychological outcomes, lymphedema-related symptoms, biological markers, and physical activity level. Four reviews targeted time point for implementation of exercise intervention. There were slightly greater effects on CRF, physical fitness, and walking distance from implementation after completed treatment. Two reviews comparing exercise types reported superior effects from combinations of aerobic exercise and resistance training compared to aerobic or resistance training alone. One review targeted exercise intensity, and the results indicated a greater effect from moderately intense exercise compared to high intense exercise. One review assessed behaviour change techniques in exercise trials and suggested the use of programme goal-setting, self-monitoring, and generalization of behaviour to promote adoption and maintenance of exercise behaviour. Conclusion: Exercise seems to be beneficial during and after curative oncological treatment in several types of cancer. A higher reporting of exercise intervention details is essential in future exercise intervention trials and there is still a need for large, randomized trials, especially in forms of cancer other than breast cancer. [ABSTRACT FROM AUTHOR]

Objectives: Fear of cancer recurrence (FCR) is a common experience among cancer survivors and often persists after the termination of cancer treatments. The purpose of this paper was to evaluate FCR in survivors of Hodgkin's and diffuse large B-cell lymphomas, given a high rate of survivorship in this patient population. Research Approach: The parent study was a multi-site, cluster-randomized trial to assess a communication skills intervention: survivorship planning consultation (versus a time-attention control - wellness rehabilitation intervention) to promote transition to survivorship. Participants & Methodological Approach: 199 patients enrolled in the study and completed a survivorship (or control) consultation one-month after receiving the news of their survivorship status; 141 of those patients (n = 92 experimental arm, n = 49 control arm) completed an interview at their 6-month follow-up consultation. In the interview, participants described frequency of FCR, causes of FCR, coping mechanisms, and specific things oncologists said to reduce FCR. Both qualitative and quantitative methods were utilized for analyzing participant responses. Findings: The majority (88%) of participants reported experiencing FCR, with a higher number of participants in the experimental arm significantly more likely to endorse FCR compared to the control group participants. The main causes of FCR were having medical appointments and concerns about potential relapse and secondary cancers. Participants endorsed utilizing self-sufficient coping mechanisms. As well, participants reported that oncologists most frequently cited specific cure rates of lymphoma to reduce patients' FCR. Interpretation & Implications for Psychosocial Providers: Communication skills training programs should emphasize FCR in survivorship consultations. [ABSTRACT FROM AUTHOR]

To develop and explore underlying dimensions of the Self-Regulation Assessment (SeRA) and psychometric features of potential components. Further, to identify associations between the SeRA and disability-management self-efficacy, type of diagnosis, and type of rehabilitation. Based on a previously developed model of self-regulation, expert and patient opinions, and cognitive interviews, a list of 22 items on self-regulation (the SeRA) was constructed. The SeRA was included in a cross-sectional survey among a multi-diagnostic group of 563 former rehabilitation patients. Exploratory analyses were conducted. Respondents had a mean age of 56.5 (SD 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. Four components were found within the SeRA, labelled as "insight into own health condition," "insight into own capabilities," "apply self-regulation," and "organization of help." Cronbach's alpha was high (total scale: 0.93, subscales: range 0.85–0.89). Only scores on the first subscale showed a ceiling effect. Subscale three showed the highest correlation with a self-efficacy measure. Small differences in SeRA total scores (range 71.6–78.1) were found between different diagnostic groups. The SeRA is a new self-regulation measure with four subscales. Further research is needed to establish the validity and reliability of the SeRA. The Self-Regulation Assessment (SeRA) was developed to provide a comprehensive measurement of self-regulation among rehabilitation populations. The SeRA could potentially be used to identify persons with self-regulation problems at the start of rehabilitation treatment and measure outcomes of rehabilitation for self-regulation. The SeRA could potentially be used to help analyse outcomes of rehabilitation practice as well as evaluate interventions on self-regulation. [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]

As individuals with cancer actively undergo medical treatment, they often experience profound impairments and side-effects that impact their physical and psychosocial functioning and well-being. As occupational therapy practitioners working in acute care, challenges when working with those with oncological diseases may include high acuity, impact on multiple body systems, and fluctuating symptom presentation and levels of function. Thus, it is critical for occupational therapy practitioners to be skilled in identifying and addressing the distinct needs of cancer survivors in the acute care setting. This manuscript presents a descriptive case study to highlight occupational therapy's role in cancer rehabilitation in the acute care setting. [ABSTRACT FROM AUTHOR]

Purpose: To build consensus around an optimal patient-reported outcome measure of cancer symptoms and patient needs to facilitate patient-provider communication and trigger referrals to supportive services. Methods and materials: The Grid-Enabled Measures platform was used to crowdsource and facilitate collaboration to achieve consensus. Respondents were invited to nominate and independently rate the usefulness of measures that: (1) have been actively used at a healthcare institution, (2) have a multiple choice or yes/no type format, (3) are applicable to adults with cancer, (4) are patient-reported, and 5) have psychometric data if possible. Discussion boards within the GEM workspace allowed respondents to identify barriers to implementing patient assessment and referral systems. Results: 166 individuals from various disciplines from 25 organizations participated. Six instruments were nominated, and 553 rating surveys were submitted. The three most highly-rated overall instruments were the Distress Thermometer, the James Supportive Case Screening, and the Functional Assessment of Cancer Therapy-General. Participants noted that wide-scale implementation of this process requires both identifying problems and providing clinicians with algorithms to facilitate appropriate referrals. Conclusions: Consensus reported three most highly-related measures as optimal for comprehensive screening and identification for referral by assessing multiple domains of functioning and quality of life. Gaining consensus on the best patient reported outcome measures is an important step towards improving access to cancer rehabilitation services. A consensus agreed on several measures to use for cancer rehabilitation screening. Functional Assessment of Cancer Therapy-General, National Comprehensive Cancer. Network Distress Thermometer and the James Instrument. The selected measures do not put undue burden on clinicians and patients. [ABSTRACT FROM AUTHOR]

Purpose: To summarize evidence on the effects of multidisciplinary psychosocial rehabilitation interventions for adult cancer patients on fatigue, quality of life, participation, coping, and self-efficacy. Materials and methods: We searched MEDLINE, Embase, PyscINFO, PEDro, OT Seeker, Sociological Abstracts, CINAHL, and Cochrane CENTRAL for randomized controlled trials. Two reviewers selected articles independently. Results: Thirty-one articles were included and four meta-analyses were conducted. The results of one meta-analysis was statistically significant when comparing multidisciplinary psychosocial interventions to standard care on fatigue among breast cancer patients (standardized mean differences [SMD] 0.30 (95% confidence interval [CI] 0.04, 0.56)) at 2–6 months follow-up. However, no significant results were revealed on health-related quality of life among breast cancer (SMD 0.38 (95% CI −0.40, 1.16)), prostate cancer (SMD 0.06 (95% CI −0.18, 0.29)), and patients with different cancer diagnoses (SMD 0.06 (95% CI −0.14, 0.25)) at follow-up. One study reported on effects of interventions on participation, and four studied the outcomes of coping and self-efficacy. Conclusions: Multidisciplinary psychosocial interventions may decrease fatigue among breast cancer patients. There is an urgent need for rigorous designed trials in cancer rehabilitation, preferably on fatigue, participation, and coping or self-efficacy. The interventions need to be thoroughly described. Multidisciplinary psychosocial interventions may reduce fatigue among breast cancer patients. The effects of multidisciplinary psychosocial interventions among cancer patients on health-related quality of life, participation, and coping are unclear. Urgent need for a systemic approach to the development and conduction of multidisciplinary psychosocial interventions, ideally based on guidelines for complex interventions. Need of larger and more rigorously conducted randomized controlled trials investigating the effects of these rehabilitation interventions on fatigue, participation and coping. [ABSTRACT FROM AUTHOR]

Background: Purpose of this systematic review update was analyzing resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status. Articles published until 31 September 2017 were included. Methods: A systematic literature search was conducted utilizing PubMed, MEDLINE, and EMBASE databases. Included articles were analyzed regarding their level of evidence and their methodological quality using the Cochrane risk of bias tool. Results: Altogether, 23 articles could be included of which 16 were independent RE intervention studies and seven additional articles. Lymphedema assessment was so heterogeneous that conduction of a thorough meta-analysis regarding lymphedema status was still impossible. In all but one study, which reported a small but methodologically weak increase in arm volume, no negative effects of RE on BCRL was recorded. Conclusions: RE seems to be a safe exercise intervention for BCS and not to be harmful concerning the risk of lymphedema. Lymphedema assessment methods that allow for a qualitative analysis of arm tissue composition should be favored. Breast cancer-related lymphedema affects a considerable proportion of breast cancer patients and is debilitating on the physical, functional, social, and psychological domain. At the current time breast cancer related lymphedema is incurable but well manageable by a number of physical therapy modalities, especially complete decongestive therapy (CDT). One of the encouraging treatment methods is resistance exercise. [ABSTRACT FROM AUTHOR]

Background: There has recently been an emphasis on improving cancer care globally, including access to lifesaving treatment and earlier identification of disease. This will lead to more survivors stricken by impairments related to the early and late effects of cancer treatment. An unintended consequence of the noble plan to improve oncology care worldwide is demand on health care systems that may be unable to accommodate increased patient care needs for myriad reasons. As a result, those with disabilities may suffer. Methods: Literature search and input from experts in the field were used to evaluate the growing need for cancer rehabilitation and survivorship care to reduce morbidity associated with cancer treatment. Results: Many governmental and non-governmental organizations have started initiatives to improve cancer care across the continuum, and reduce the symptom burden of those living with cancer. While the start is promising, many barriers must be overcome to ensure high-quality care that would reduce cost and improve patient access, including a lack of trained rehabilitation specialists, poor coordination of efforts, and funding restrictions. Furthermore, global efforts to improve rehabilitation care often do not emphasize cancer rehabilitation, potentially leaving a gap and increasing physical and economic costs of disability. Finally, low-resource countries face unique challenges in improving cancer rehabilitation care. Conclusion: Cancer rehabilitation and survivorship care are needed to improve health care quality, as there is an expected influx of cancer patients with new global efforts to improve oncology care. To accomplish this, rehabilitation initiatives must emphasize cancer rehabilitation as a component of any program, and oncology endeavors should include a plan for the rehabilitation of cancer survivors to reduce morbidity and health care cost. Cancer rehabilitation has the potential to reduce morbidity and health care costs associated with cancer and disability worldwide Advocacy from international organizations regarding cancer rehabilitation is increasing, but has been disjointed and incomplete Low-resource countries in particular face several barriers to providing cancer rehabilitation and survivorship care [ABSTRACT FROM AUTHOR]