Municipal cancer rehabilitation
Cancer survival rates are steadily increasing; however, many survivors struggle with late effects. Though the need for rehabilitation is evident, evidence-based cancer rehabilitation services in primary care are lacking.
Main content
Background:
Thanks to early diagnosis and advanced, multi-modal, often long-lasting treatments, the five-year survival rate for cancer in Norway is high at around 76% for all cancer types combined. This often comes at a price with late effects that may be short-term, protracted or even life-long, and issues such as fatigue, neuropathy, lymphoedema, impaired memory and concentration, increased anxiety and depression and sexual implications may adversely affect cancer survivors with subsequent social, economic and work-related challenges. Research has established that multidimensional rehabilitation can mitigate the impact of some impairments by improving physical function and aspects of quality of life. Cancer rehabilitation in Norway has traditionally been offered through in-patient specialist services, however, the responsibility of cancer rehabilitation was declared a municipal responsibility in 2012. There is still a paucity of evidence-based multidimensional cancer rehabilitation services at primary care level, and the demand for such services are sought addressed through this research project.
Aims and research questions:
The aim of this study was to pilot and evaluate a newly developed model for community-based multidimensional rehabilitation for cancer survivors through:
- Investigating the feasibility and acceptability of intervention recruitment, retention, implementation and adherence by answering the following research questions:
- What is the attrition rate in the study?
- What are the adherence rates for scheduled rehabilitation sessions?
- What are participants’ experiences and perceived benefits of the intervention?
- Assessing the feasibility and acceptability of clinical outcome measures employed in the pilot testing, to determine their suitability for a future effectiveness trial. More specifically, we aimed to answer the following research questions:
- What are the completion rates for the outcome measures employed in the study? (Patient reported outcome measures (PROMs) and objective measure) (feasibility and acceptability)
- What are the completion rates for using a pedometer and returning a log on physical exercise? (feasibility and acceptability)
- What is the distribution of the outcome scores over time and what are the potential changes in outcome variables pre- and post-intervention? (responsiveness and limited-efficacy testing)
- How do participants experience research participation and how can this help explain findings from the quantitative data? (acceptability)
Research design and methods:
This is an intervention feasibility study with a mixed methods sequential explanatory design. The piloted community-based multidimensional cancer rehabilitation intervention (the rehabilitation program) span over 12 weeks and comprised five components: 1) group-based physical exercise, 2) group-based psychoeducation, 3) individual goal setting, 4) individual consultations with rehabilitation practitioners and 5) peer support). Quantitative data were collected through intervention and assessment completion rates, self-reported questionnaires on clinical outcomes, physical activity logs, 6-minute walk test, and qualitative data were collected through eight focus group interviews with all participants who completed the rehabilitation intervention.
Summary of findings:
The intervention was found to be feasible to implement in a Healthy Life Centre using the municipality’s existing resources. It was also found to be acceptable to study participants with some minor changes to the intervention’s content and structure. Assessment procedures and instruments were found to be feasible and acceptable, with the exception of wearing a pedometer and completing weekly physical exercise logs. Positive changes in outcome variables pre-post intervention showed promise of the intervention and justified progression to a larger effectiveness trial.
Time frame:
2016 – 2019: Piloting the intervention
2021 – 2024 Feasibility and acceptability analysis and publication of results
Publications to date:
- Løken, O. & Hauken, M. (2022). A Qualitative Study of Cancer Survivors’ Experienced Outcomes of a Multidimensional Rehabilitation Program in Primary Healthcare. Cancer Nursing, 45 (3), E646-E654. doi: 10.1097/NCC.0000000000000989
- Ahmedzai, Hilde Hjelmeland PhD, RN; Oldervoll, Line M. PhD; Sweetmore, Anne-Marte Hess BSc; Hauken, May Aasebø PhD, RN. Community-Based Multidimensional Cancer Rehabilitation in Norway: A Feasibility Study. Cancer Nursing ():10.1097/NCC.0000000000001161, December 1, 2022. | DOI: 10.1097/NCC.0000000000001161
Related persons:
Hilde Hjelmeland Ahmedzai
May Aasebø Hauken
Line Merethe Oldervoll
In collaboration with Askøy Municipality, represented by Anne-Kjersti Drange and Anne-Marte Hess Sweetmore
Funding:
Funded by Dam Foundation and Askøy Municipality
