Multidisciplinary rehabilitation should become part of the total care plan for patients with cancer.

Background: Many physical and psychosocial interventions or combined interventions have been developed for cancer survivors. We implemented a 12- week comprehensive rehabilitation program, combining physical exercise, psycho-education and individual counselling. We hypothesized that the rehabilitation program would lead to improvements in quality of life, fatigue, kinesiophobia, distress, anxiety, depression, physical functioning and physical condition.Patients and methods: A longitudinal cohort study design was applied in 74 cancer survivors. The participants filled out a questionnaire and underwent a physical test at baseline and at the end of the program. Different measurement instruments were used: EORTC QLQ-C30, FACT-F, HADS, RAND-36, TAMPA, Distress Barometer and Tecumseh Step Test. Statistical analysis was carried out using SPSS 17.0.Results: Thirty six patients (48,6%) participated. Drop out was due to following reasons: difficulty to combine the program with job and family, lack of motivation, self sufficiency or alternative method. Eighty five percent of the participants were female and the most prevalent cancer was breast cancer.The overall quality of life improved significantly after the rehabilitation program compared with the baseline assessment (p=0,000). There was significant improvement also in specific aspects such as physical condition (p=0,007), fatigue (p=0,010) and depression (p=0,012). In contrast kinesiophobia (p=0,229), distress (p=0,344) and anxiety (p=0,101) did not change significantly.Discussion and Conclusion: We have initialized and evaluated the short term impact of a comprehensive rehabilitation program as a post treatment effort in cancer patients treated with curative intent. This comprehensive rehabilitation program is the first to include individual counselling and distress measurement. A general and significant improvement in all aspects affecting quality of life and rehabilitation was observed, but less so for aspects that might be influenced by prognostic concerns. The relative contribution of the program versus spontaneous recovery and long term impact need to be further determined in a prospective randomized study. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1065.

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82 Background: A common physical sequel after adjuvant therapy is a decrease in shoulder movement of the upper-limb of the affected side and the development of LE. Resistance exercise is known to be safe and does not increase the risk of LE. The objective of this study is to evaluate the effect of a VEP on shoulder range of motion and upper-limb LE after adjuvant therapy in BCs. Methods: 22 BCs treated with surgery and adjuvant therapy were randomly assigned to the VEP (n=12) or the control (n=10). The VEP aimed at improving aerobic endurance, joint mobility and muscle strength. The frequency of the VEP was 2 times a week, during 3 months, with a total of 30 sessions. Primary endpoints included the range shoulder motion and arm volumes of both arms. The secondary outcome was quality of life (QoL) as measured by the EORTC QLQ-C30. All outcome measures were assessed at baseline and after 3 months. Results: After ending the VEP, in the exercise group, the movements such as abduction (p=0.04), external rotation (p=0.02), extension (p=0.03) and flexion (p=0.01) of the affected arm increased significantly but there was no change for internal rotation (0.27). No significant changes in arm volume (p=0.06) were found after 3 months compared to baseline, whereas the quality of life did improve significantly (p=0.01). After 3 months the range of motion of the shoulder of the affected arm (sum of abduction, external rotation, extension and flexion) in the exercise group tended to be better although this was not significant (p=0.50). The arm volume difference between the two groups was not significant (p=0.10) but it was for the QoL (p=0.02). Conclusions: A VEP lead to significant specific improvements in arm mobility compared to baseline. These BCs also compared favourably to the control cohort, but this was not significant. The study confirms that exercising the ipsilateral arm and shoulder has no detrimental effect on LE and has a positive impact on the QoL. Standard guidelines concerning physical therapy to ameliorate shoulder function and LE are not available. Additional patients will be enrolled to develop standard recommendations for physical therapy to improve shoulder and limb function in BCs.