Community-based Multidimensional Cancer Rehabilitation in Norway – a Feasibility Study

Under embargo until: 2023-07-28Background: Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. Objective: The aim was to assess feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. Methods: A feasibility study with a mixed methods explanatory sequential design. The intervention was a 12-week group-based rehabilitation program comprising five components: goal setting, physical exercise, psychoeducation, individual follow-up consultations and peer support. Feasibility was assessed through recruitment, retention and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive and qualitative data were transcribed and analyzed using framework analyses. Results: Sixty participants started and 55 completed the 12-week rehabilitation program. The majority were female (80%) and mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as was adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. Conclusions: High retention, strong adherence and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. Implications for practice: The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway “Home”.acceptedVersio

Integrated Short-term Palliative Rehabilitation to improve quality of life and equitable care access in incurable cancer (INSPIRE): a multinational European research project

Background: Disability related to incurable cancer affects over a million Europeans each year and people with cancer rank loss of function among the most common unmet supportive care needs. Objectives: To test the clinical and cost-effectiveness of an integrated short-term palliative rehabilitation intervention, to optimise function and quality of life in people affected by incurable cancer. Design: This is a multinational, parallel group, randomised, controlled, assessor blind, superiority trial. Methods: The INSPIRE consortium brings together leaders in palliative care, oncology and rehabilitation from partner organisations across Europe, with complementary expertise in health service research, trials of complex interventions, mixed-method evaluations, statistics and economics. Partnership with leading European civil society organisations ensures citizen engagement and dissemination at the highest level. We will conduct a multinational randomised controlled trial across five European countries, recruiting participants to assess the effectiveness of palliative rehabilitation for people with incurable cancer on the primary outcome – quality of life – and secondary outcomes including disability, symptom burden and goal attainment. To support trial conduct and enhance analysis of trial data, we will also conduct: comparative analysis of current integration of rehabilitation across oncology and palliative care services; mixed-method evaluations of equity and inclusivity, processes and implementation for the intervention, at patient, health service and health system levels. Finally, we will conduct an evidence synthesis, incorporating INSPIRE findings, and a Delphi consensus to develop an international framework for palliative rehabilitation practice and policy, incorporating indicators, core interventions, outcomes and integration methods. Scientific contribution: If positive, the trial could produce a scalable and equitable intervention to improve function and quality of life in people with incurable cancer and reduce the burden of care for their families. It could also upskill the practitioners involved and motivate future research questions. The intervention could be adapted and integrated into different health systems using existing staff and services, with little or no additional cost