The issue is... the occupational therapist’s role in addressing the silent sequelae associated with cancer-related cognitive dysfunction among survivors of cancer

The National Comprehensive Cancer Network identified occupational therapy as a first line of intervention for the treatment of cancer-related cognitive dysfunction (CRCD) (National Comprehensive Cancer Network [NCCN], 2016). Thus, occupational therapists have an opportunity to develop interventions that facilitate participation in meaningful occupations for survivors of cancer living with CRCD. In this article, we argue for occupational therapists to create occupation- and evidence-based, client-centered interventions for survivors of cancer with CRCD that address the multidimensional presentation of CRCD. One survivor’s story illustrates the affect of CRCD on occupational performance and the features to consider when developing interventions to meet the unique needs of survivors of cancer with CRCD. We recommend that interventions can be provided through self-paced home programming, community settings, or delivered through modes such as tele-rehabilitation to reach the growing population of survivors of cancer

Assessing the predictive validity of the Salzberg Scale during acute care and inpatient rehabilitation

Pressure ulcers (PrU) are a leading secondary medical complication in the spinal cord injury (SCI) population. With over two hundred known risk factors, PrU prevention is extremely complex but can provide an astounding difference in a patient’s recovery. Multiple risk assessment scales allow us to quantify risk across a broad range of populations, yet the literature provides little evidence that these tools are representative of PrU development in the SCI population. The Pressure Ulcer Assessment Scale for the Spinal Cord Injured (Salzberg Scale) is a risk assessment scale specific to the SCI population, composed of fifteen risk factors that divide PrU development risk into four categories. The objective of this thesis is to assess the predictive validity of the Salzberg Scale during acute care and inpatient rehabilitation following spinal cord injury. Data was extracted from a primary study on PrU outcomes for newly injured traumatic SCI patients in acute care and inpatient rehabilitation. A secondary analysis assigned subjects a raw Salzberg Scale score based on collected medical information and Salzberg Scale component definitions. The Salzberg scores were used to compute sensitivities, specificities, and accuracy of the scale with newly defined risk cut-off scores for acute hospitalization and inpatient rehabilitation. Sensitivity and specificity were calculated for the scale’s ability to predict PrU ranging from two to 22 days after administration of the Salzberg Scale risk assessment tool. The use ofthe scale in the acute care hospitalization to assess risk for PrU within 2-3 days showed the only strong predictive results with an area under the curve (AUC) of 0.8482 at the indicated cutoff score of 15. The sensitivity of 100.0% and a specificity of 75.0%, showed a more accurate prediction balance than the validation study conducted by Salzberg on a broader population sample. Overall, failure of the scale’s predictive ability to predict a pressure ulcer over a longer time period suggests further studies must be completed in order for the scale be recommended for implementation in an inpatient rehabilitation setting

Developing a Stakeholder-Driven Cancer Rehabilitation Intervention for Older Adults with Breast Cancer

The number of older adult breast cancer survivors is rapidly growing. Yet with survival, this population often experiences high, persistent rates of cancer-related disability. This disability manifests in the form of activity limitations or difficulties executing daily activities that older adult breast cancer survivors need or want to do. Despite efforts to improve detection of activity limitations and referral to rehabilitation services, cancer rehabilitation remains underutilized in this population. The focus of this dissertation was threefold. First, we examined the state of the science related to nonpharmacological interventions influencing activity limitations in older breast cancer survivors. We identified that existing interventions 1) are frequently complex in nature; 2) incorporate adaptive skills training, behavioral strategies, and exercise; 3) vary in delivery features; and 4) are associated with a wide range of effect sizes. The best combination of interventions and delivery features remain unclear. Second, we conducted semi-structured interviews with older breast cancer survivors to identify preferences for cancer rehabilitation interventions. We learned that the choice to pursue cancer rehabilitation is influenced by emerging awareness of disability, coping styles, comparisons with others, provider interactions, perceptions of cancer as a lifelong project, social support, and cost of rehabilitation. Participants’ preferences for intervention content varied but included some desire for interventions that provide peer support, healthy behavior training, and symptom management. Participants preferred interventions delivered in outpatient clinics or community-based settings. Third, we compiled findings from the scoping review and stakeholder interviews for expert panel review and consensus. Using a modified Delphi process, panelists rated intervention content and delivery features according to feasibility and prioritization. Our results revealed high consensus for intervention content including physical activity and adaptive skills training as well as interventions delivered in outpatient clinics or post-treatment, through a combination of in-person and virtual visits, lasting no more than 3 months, and occurring biweekly. Overall, these findings provide important evidence-based, stakeholder-informed directions for future intervention research in cancer rehabilitation. These findings can be used to inform the development, testing, and implementation of valued and accessible interventions to address activity limitations among older breast cancer survivors

Identifying Predictors of Cancer Rehabilitation Medicine Referral and Utilization Among Cancer Survivors

&nbsp;Cancer rehabilitation medicine has the potential to improve individuals&#39; functioning, engagement in physical activity, and optimize long-term quality of life. However, use of these services remains limited. An electronic health record (EHR)- integrated symptom monitoring program, known as the My Wellness Check program, was implemented in an NCI-Designated Cancer Center to assess needs of patients in ambulatory oncology to improve to triage of patients to supportive care services, inclusive of cancer rehabilitation medicine. Since the implementation,&nbsp;examination of access and utilization has not been formally reviewed.&nbsp;This was a secondary analysis of the My Wellness Check program for participants that had complete data on the physical activity survey between April 2021 and January 2022. Univariable and multivariable logistic regression models were used to model determinants of qualification for referral to, completion of referral, and utilization of cancer rehabilitation medicine services. Explanatory variables included demographic, clinical characteristics, and patient-reported outcomes. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated. There were 1,174 individuals who completed the physical activity survey, of which 46% (n=540) qualified for referral to cancer rehabilitation medicine services. Two factors were associated with qualification for a referral: moderate-to-severe physical function (aOR: 1.815; 95%CI: 1.177, 2.798), and Hispanic or Latino Ethnicity (0.744; 0.574, 0.963) after controlling for group differences.&nbsp;Only 31% (n=168) received a completed physician referral to cancer rehabilitation medicine. Following referral, only 7% (n=11) utilized cancer rehabilitation medicine services.&nbsp;Findings from this analysis can help inform refinement of the My Wellness Check program to ensure that patients at risk of poor physical activity or functional decline are provided access to cancer rehabilitation medicine services.</p

Predictors of Cancer Rehabilitation Medicine Referral and Utilization among Cancer Survivors

To examine patient-level predictors of referral to cancer rehabilitation medicine services following a physical activity screening assessment among cancer survivors. Secondary analysis of individuals that completed My Wellness Check Program (MWC), an electronic health record-integrated symptom screening and referral system for cancer survivors, between April 2021 and January 2022. Multivariable logistic regression models were fit to calculate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Ambulatory oncology clinics in an urban academic medical center. 1,174 cancer survivors who completed the Moving Through Cancer physical activity assessment and at least one MWC assessment battery. Not applicable. Positive screening for physical inactivity (yes/no). Completed referral to cancer rehabilitation medicine services following a positive screen (yes/no). Forty-six percent of survivors screened positive as being physically inactive. Individuals with moderate-severe physical dysfunction compared to none-to-mild (aOR: 1.750; 95%CI: 1.137 - 2.693; p=0.0109) had higher odds and self-reporting Hispanic/Latino ethnicity compared to non-Hispanic/Latino ethnicity (0.720; 0.556, 0.932; p=0.0126) had lower odds of positive screening for physical inactivity. Only 31% of survivors with physical inactivity received a completed referral to cancer rehabilitation medicine services. There were no significant predictors associated with referral completion. Self-reported physical function and ethnicity may help clinicians identify cancer survivors at risk for physical inactivity. Additional research on provider- and organizational-level variables are needed to determine the relationship between referral completion to cancer rehabilitation medicine services following physical activity assessments. This study was funded in part by grant P30CA240139 (Nimer, S: PI; Penedo, F: Cancer Control Co-Leader). P.I.M. was supported by a National Cancer Institute career development award (K01CA258955). We acknowledge the Miami Clinical & Translational Science Institute for their help with data collection on the primary study (UL1TR002736). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health

Health system and patient-level factors associated with multidisciplinary care and patient education among hospitalized, older cancer survivors

Objective: The purpose of this study was to examine system- and patient-level factors associated with the number of healthcare disciplines involved in delivery of patient education among hospitalized older cancer survivors. Methods: We used electronic health record (EHR) data from a single institution documenting patient education among hospitalized older patients (≥65 years) with a history of cancer between 9/1/2018 and 10/1/2019. We used parametric ordinal logistic regression to assess the number of healthcare disciplines involved in documented education activities. Results: The sample (n = 446) was predominantly male, White, and on average 74 years old. Adjusting for patient and system-level variables, men and larger department units had higher odds of receiving education from fewer healthcare disciplines. Patients with a history of breast or prostate cancer and longer lenths of stay had lower odds of receiving patient education from fewer healthcare disciplines. Conclusion: Hospital size, severity of illness, and cancer type are associated with delivery of multidisciplinary education in this sample. Innovation: EHR provides an opportunity to identify patterns in patient education among cancer survivors. Future research should investigate provider perspectives of the findings to inform provider- and system-level strategies to improve patient education

Predictors of cancer rehabilitation medicine referral and utilization based on the Moving Through Cancer physical activity screening assessment

Cancer survivors experience high rates of physical inactivity that often go unaddressed. The My Wellness Check program (MWC) is an EHR-integrated screening and referral system that includes surveillance of physical activity and triage to cancer rehabilitation medicine services. This study examined assessment of physical activity and subsequent referrals to cancer rehabilitation medicine. A secondary analysis was performed for survivors who completed the MWC between April 2021 and January 2022. Univariable and multivariable logistic regression modeled determinants of qualification for a physical activity referral and provider completion of referral to cancer rehabilitation medicine. Referral was based on responses to the Moving Through Cancer questionnaire. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95% CI) were calculated. There were 1,174 survivors who completed the assessment, of which 46% (n = 540) reported physical inactivity. After controlling for group differences, individuals with moderate-severe physical dysfunction (aOR: 1.750; 95% CI: 1.137, 2.693) had higher odds, and self-reporting Hispanic or Latino ethnicity (aOR: 0.720; CI: 0.556, 0.932) had lower odds of physical inactivity. Only 31% (n = 168) received a completed physician referral to cancer rehabilitation medicine following identification of physical inactivity. No patient-level factors were associated with receiving a physician referral. Following referral, 8% (n = 13) utilized cancer rehabilitation medicine services. Patient-level and clinical factors may predict qualification for physical activity referrals; however, they don't appear to predict referral completion to cancer rehabilitation medicine. Future research should focus on potential provider- and organization-level factors that interact and influence access to cancer rehabilitation medicine services

A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability

Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.Immediate accessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review

Purpose: To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. Methods: A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service’s Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. Results: Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. Conclusions: The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. Implications for Cancer Survivors: Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review

PURPOSE: To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS: A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service\u27s Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS: Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS: The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS: Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum