Background and Objective: Intervention research has shown that exercise-based rehabilitation is safe and effective for reducing disease burden across the cancer continuum. However, the translation of this research to programs implemented in health care settings remains a challenge. This study describes the implementation of a physical therapy–based exercise program for patients who have been diagnosed with cancer and its effectiveness for reducing fatigue and improving aerobic capacity. Methods: Retrospective analysis of a single-group, pre/postprogram assessment for adult patients who have been diagnosed with cancer (N = 546). Six-Minute Walk Test (6MWT) measured aerobic capacity. Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue) and Piper Fatigue Scale (PFS) measured fatigue. Paired-samples t tests examined changes in outcomes from pre- to postprogram assessments. Linear regression explored predictors of postprogram outcomes. Results: Participants were 63.7 ± 12.2 years old, diagnosed with breast (27.1%), hematological (15.4%), head and neck (12.6%), lung (12.3%), prostate (11%), colorectal (7.3%), or other (14.3%) cancers. For those who completed the postprogram measures (N = 169), FACIT-Fatigue scores improved (MΔ = +8.42 ± 9.2, t 79 = −8.21, P = .000), PFS scores improved (MΔ = −2.1 ± 2.0, t 81 = 9.5, P = .000), and 6MWT distance improved (MΔ = +42.9 ± 53.8 m, t 160 = −10.1, P = .000). Age (P = .034) and time since completing chemotherapy (P = .000) or radiation therapy (P = .014) was inversely associated with the 6MWT. Greater exercise session attendance was associated with higher PFS scores (P = .020). Limitations: Only 31% of participants completed postprogram assessments, and limited information was available regarding reasons for dropout/withdrawal. Conclusions: This study provides a real-world example of a cancer rehabilitation program implemented in a health care setting, which was successful in reducing fatigue and improving aerobic capacity.
A 3-tier histopathologic scoring system, the chemotherapy response score (CRS), was previously devised for reporting the histologic response to neoadjuvant chemotherapy in interval debulking surgery specimens of stage IIIc/IV tuboovarian high-grade serous carcinoma. This has been shown to predict the outcome and offer additional information to other methods of assessing the treatment response. In the present study, the reproducibility of this scoring system was assessed by determining the interobserver agreement among reporting pathologists. A total of 5 groups each comprising 3 pathologists with different levels of expertise were selected. The participants underwent an online tutorial on how to apply the CRS system. 40 cases (38 cases in 2 appraiser groups) were scored individually by each of the 15 pathologists. The interobserver reproducibility was calculated using Fleiss' κ, Kendall's coefficient of concordance, and the absolute agreement between (a) individual pathologists within 1 group, (b) with the majority score agreement between all groups, and (c) with all individual scores. The CRS system was found to be highly reproducible among all the pathologists' groups (κ=0.761). The agreement in identifying the group of patients with the best response to chemotherapy was exceptionally high (κ=0.926). We conclude that CRS has a high interobserver reproducibility, especially in identifying the subgroup of patients with the best chemotherapy response, justifying its inclusion in clinical trials and reporting practice.
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