How Receptive Are Patients With Late Stage Cancer to Rehabilitation Services and What Are the Sources of Their Resistance?

Abstract

Objective To describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, as well as the rationale for their level of interest. Setting A comprehensive cancer center in a Northcentral US quaternary medical center Design A prospective mixed methods study Participants 311 adults with Stage IIIC or IV non-small cell or extensive stage small cell lung cancer. Interventions Not applicable Main Outcome Measures Telephone acquired responses to the administration of: 1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); 2) Numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; 3) a query regarding receptivity to receipt of rehabilitation services, and 4) a query about rationale for non-receptivity. Results Overall 99 (31.8%) of the study’s 311 participants expressed interest in receiving rehabilitation services; 38 at the time of enrollment and an additional 61 during at least one subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs. 9.91%, p = 0.04) and a musculoskeletal comorbidity (42.4% vs. 31.6%, p = 0.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns. Conclusions One-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.

Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis

“…We observed variation in the selection of BCTs according to the type of intervention, exercise and symptom self‐management, and consequently, the domains of the COM‐B model targeted. Use of BCTs to overcome known barriers and to maximise changes associated with successful participation varied. Exercise studies aimed to enable physical capability and motivation through instruction, practice, action planning, and feedback BCTs, supported by the provision of equipment and social support.…”

“…The format of rehabilitation services can act as an enabler or a barrier to participation . We identified intervention characteristics addressing barriers related to travel to clinical settings, number of contacts with providers, and supervision.…”

“…The acceptability of rehabilitation interventions to patients with thoracic cancer is influenced by many factors including, the stage of disease, symptoms, comorbidities, cancer treatment intensity and overall health status. These factors interact with the patient, carer and clinician's recognition of rehabilitation need and perceptions about the possible benefits, harms, and demands of proposed rehabilitation intervention(s) . Where benefit is perceived as being important and achievable, the acceptability of an intervention increases …”

A health services research agenda to fully integrate cancer rehabilitation into oncology care

“…Barriers to the timely receipt of cancer rehabilitation services exist at the level of the patient, provider, system, payer, and policy . Patients have low uptake of these services due to a lack of awareness of their benefits, lack of prioritization or interest, out‐of‐pocket costs, or travel and logistical demands . Among oncology providers, barriers include a lack of knowledge of rehabilitation services, how to refer, and who to refer; a lack of awareness of the benefits; a lack of clinical pathways or standards pointing to cancer rehabilitation services as best practices; a lack of the availability of (or knowledge of) services in oncology‐based institutions or in nearby communities; a lack of infrastructure supporting an easier referral process; and an underrecognition of potential cost savings and reduced complications with the use of early rehabilitation programs.…”

“…10 Patients have low uptake of these services due to a lack of awareness of their benefits, lack of prioritization or interest, out-of-pocket costs, or travel and logistical demands. 18,20 Among oncology providers, barriers include a lack of knowledge of rehabilitation services, how to refer, and who to refer 19 ; a lack of awareness of the benefits 21 ; a lack of Cancer November 15, 2019 clinical pathways or standards pointing to cancer rehabilitation services as best practices 9 ; a lack of the availability of (or knowledge of) services in oncology-based institutions or in nearby communities 22 ; a lack of infrastructure supporting an easier referral process; and an underrecognition of potential cost savings and reduced complications with the use of early rehabilitation programs. Payer-level, system-level, and policy-level barriers include an unwieldy system for navigating rehabilitation insurance benefits, financial caps on rehabilitation therapy sessions, low reimbursement rates for rehabilitation, 23 high costs of cancer care for patients and society, 24,25 and a drive to avoid the overuse of health care to control costs.…”