Programme + Abstract Book
Nordic Cancer
Rehabilitation Symposium Copenhagen 2010
NCRS
2010
Welcome
General Information Programme
Keynote speakers Abstracts - Oral presentations Abstracts - Poster presentations
Table of contents
p.4 p.6 p.10 p.13 p. 33
It is a great pleasure for the Organizing Committee to welcome researchers, health care professionals and administrators working in the field of cancer rehabilitation to participate in the first Nordic Cancer Rehabili- tation Symposium, 20-21 September 2010, in Copenhagen, Denmark.
We have put together an outstanding program with international top scientists presenting an overview of what is known about the physical, psychosocial and mental problems cancer patients are facing and what kind of interventions that may help the patients to gain a better quality of life. Experiences with the implementa- tion of rehabilitation programs in different countries and health care settings will be presented by researchers and health care professionals. The symposium days will give us a great opportunity to discuss the results of the existing research and how to optimise future research in this area. Across cancer diagnoses, health care sectors, and research traditions many aspects are to be discussed, i.e. screening and identification of needs among cancer patients and relatives, outcome measures, social inequality, communication and cooperation across health care sectors, and obstacles for implementation into future cancer care.
Please accept our warm welcome to this first Nordic Cancer Rehabilitation Symposium. We hope you will enjoy your stay and have many stimulating exchanges with colleagues from around the world. We also hope that you will be able to find time to enjoy the city of Copenhagen.
All the best for a wonderful meeting!
Best regards, The Organizing Committee
Information
Venue
Radisson BLU Falconer Hotel & Conference Center Falkoner Allé 9
2000 Frederiksberg
Telephone number: +45 38 15 65 00
Official website:
www.cancer.dk/ncrs
Practical staff at the symposium
Gro Samsø Bastian
Mobile number: +45 26 81 46 05 Chalotte Poulsen
Mobile number: +45 27 24 76 94 Maria Elisabeth Hartmann Mobile number: +45 61 77 21 97
Language
The official language of the symposium is English
Organization
&
Financial support:
Danish Cancer Society www.cancer.dk
National Research Center of Cancer Rehabilitation, Institute of Public Health, University of Southern Denmark
www.sdu.dk
Acta Oncologica www.informahealthcare.com/onc
Supporters: Eli Lilly, Norwegian Cancer Society,
Novartis & Roche
The Organizing Committee
Bo Andreassen Rix, MD, PhD, Head of the documentation and development section, Patient Support Department, The Danish Cancer Society
Dorte Gilså Hansen, MD, PhD, Head of National Research Center of Cancer Rehabilitation, Institute of Public Health, University of Southern Denmark; Senior researcher at the Research Unit of General Practice, University of Southern Denmark
Pernille Envold Bidstrup, MSc in psychology, PhD, Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society
Susanne Oksbjerg Dalton, MD, PhD, Senior researcher at the Department of Psychosocial Cancer Research, The Institute of Cancer Epidemiology, The Danish Cancer Society
Christoffer Johansen, MD, PhD, DSc (Med), Head at the Department of Psychosocial Cancer Research, The Institute of Cancer Epidemiology, The Danish Cancer Society; Professor at the National Research Center of Cancer Rehabilitation, University of Southern Denmark
Symposium Secretariat
Gro Samsø Bastian
Telephone number: +45 35 25 76 45 Email: ncrs@cancer.dk
Danish Cancer Society Strandboulevarden 49 2100 Copenhagen
Public Transport
To the city center:
Take the Metro from the Frederiksberg Metro station Take Bus 14 or Bus 15 from the Frederiksberg City Hall To the airport:
Take the Metro (M2) from the Frederiksberg Metro station directly to the CPH airport.
ATM
Nordea Smallegade 2 2000 Frederiksberg Danske Bank Falkoner Allé 55 2000 Frederiksberg
Tourist Information
Wonderful Copenhagen
Telephone number +45 70 22 24 42 Open Mon-Fri 10.00 - 16.30 www.visitcopenhagen.com
Sights in Copenhagen
Tivoli, Vesterbrogade 3, 1630 København V, Open daily 11.00-23.00 until 26 September 2010 Copenhagen ZOO, Roskildevej 38, 2000 Frederiksberg, Open daily 10.00-17.00
Taxi
Copenhagen Taxi Telephone number +45 35 35 35 35 Taxamotor Telephone number +45 38 10 10 10
In case of emergency
Telephone number 112
Hospital - Emergency Ward
Frederiksberg Hospital Nordre Fasanvej 57 2000 Frederiksberg
Doctors on call
Weekdays 16:00 - 08:00
Telephone number: +45 70 13 00 41
24-hour chemist
Steno Apotek Vesterbrogade 6C 1620 Copenhagen V
Telephone number: +45 33 14 82 66
Dentist - emergency only
Tandlægevagten
Open daily 20:00 - 21:30, weekends and holidays also 10:00 - noon Oslo Plads 14
2100 København Ø
Jyske Bank Vesterbrogade 9 1780 København V Money Exchange Forex Bank
Falkoner Allé 12 B, st.
2000 Frederiksberg
Programme
8.00 - 10.00 10.00-10-15
10.15-11.15
11.15-11.30 11.30-13.15
13.15-14.15
Registration inclusive coffee
Short Break
Lunch break
Welcome remarks Dorte Gilså Hansen (DK) Frede Olesen (DK)
Site specific cancer rehabilitation needs Chair: Susanne Oksbjerg Dalton (DK),
10.15-10.30 Gunnar Steineck (SE): Prostate cancer [1.1]
10.30-10.45 Marianne Ewertz (DK): Rehabilitation after breast cancer [1.2]
10.45-11.00 Sophie D. Fosså (NO): Specific rehabilitation needs in testicular cancer survi- vors (TCSs) [1.3]
11.00-11.15 Jens Overgaard (DK): Head and neck cancer [1.4]
Nordic and European experiences with rehabilitation programs Chair: Bo Andreassen Rix (DK)
11.30-11.45 Jette Vibe-Petersen (DK): Rehabilitation of cancer patients in Denmark – an upcoming field [2.1]
11.45-12.00 Matti Rautalahti (FIN): Cancer Rehabilitation in Finland [2.2]
12.00-12.15 Corinna Bergelt (GER): Cancer rehabilitation in Germany [2.3]
12.15-12.30 Mia Bergenmar (SE): Cancer rehabilitation programs – examples from Sweden [2.4]
12.30-12.45 Jon Håvard Loge (NO): Cancer rehabilitation in Norway [2.5]
12.45-13.00 Agnes Smaradottir (IS): Past, present and future of cancer rehabilitation in Iceland [2.6]
13.00-13.45 Brigitte Gijsen (NL): The Dutch cancer rehabilitation system; 15 years nationwide experiences and developments to meet patients’ needs and improve cancer care [2.7]
14.15-15.45
15.45-17.15 17.15-18.30
19.30 -
Monday September 20, 2010
Coffee break & Poster session
Symposium dinner & Poster Award Rehabilitation needs and intervention
14.15-14.30 Chair: Eva Grunfeld (CA): The role of clinical practice guidelines and survivor- ship care plans in cancer rehabilitation [3.1]
14.30-14.45 Lene Thorsen (NO): Cancer patients’ need for rehabilitation service [3.2]
14.45-15.00 Gail Dunberger (SE): Contributing factors for fecal leakage among gynecologi- cal cancer survivors [3.3]
15.00-15.15 May Vestar Onsrud & Anne Grev (NO): Project rehabilitation of cancer pa- tients/Building group support for cancer patients [3.4]
15.15-15.30 Stinne Holm Bergholdt (DK): The GP’s role in cancer rehabilitation: A rand- omized, controlled study [3.5]
15.30-15.45 Line Oldervoll (NO): Is intensive inpatient cancer rehabilitation more effective than outpatient cancer rehabilitation? [3.6]
Health behavior – impact on physical and psychological well-being and survival 17.15-17.45 Chair: Wendy Demark-Wahnefried (USA): Home-based Diet-Exercise Inter- ventions to Improve Health Behaviors, Body Weight, and Functional Status in Cancer Survivors:
Results of the RENEW trial[4.1]
17.45-18.00 Andreas Holst Andersen (DK): Do patients with lung cancer benefit from physical exercise? [4.2]
18.00-18.15 Joanna Andersson (NO): Effect of nutritional intervention in patients at-risk of disease-related malnutrition [4.3]
18.15-18.30 Else Ibfelt (DK): No change in health behavior or self-rated health after cancer
rehabilitation: results of a randomized trial [4.4]
Programme
7.30 - 8.00 8.00-9.30
9.30-10.00 10.00-11.00
11.00-11.15
11.15-12.15
Coffee and light breakfast
Coffee Break
Short break
Rehabilitation of depression and anxiety
08.00-08.15 Chair: Robbert Sanderman (NL) Delivering psychosocial services to patients with emotional problems – some experiences from the Netherlands [5.1]
08.15-08.30 Chair: Robert Zachariae (DK): Cancer-related distress among cancer patients and survivors – risk factors and rehabilitation needs [5.2]. 08.30-08.45 Anne Kari Aarstad (NO): Distress, quality of life, neuroticism and psychological coping are related in head and neck cancer patients during follow up[5.3]
08.45-09.00 Hanne Würtzen (DK): Mindfulness based stress reduction – too stressed to participate? Psychosocial characteristics of participants and non-participants in a randomized controlled trial (MICA)[5.4]
09.00-09.15 Marie Höyer (SE): Health-related quality of life among women with breast cancer – a population-based study in central Sweden [5.5]
09.15-09.30 Nis Palm Suppli (DK): Factors associated with the prescription of antidepres- sive medication to breast cancer patients [5.6]
Social inequality in cancer and rehabilitation
10.00-10.15 Chair: Susanne Oksbjerg Dalton (DK): Addressing social inequality in cancer rehabilitation [6.1]
10.15-10.30 Gitte Bjørn Hvilsom (DK): Socioeconomic position and breast reconstruction in Danish women [6.2]
10.30-10.45 Lena-Marie Petersson (SE): Work ability after breast cancer surgery – a prospective cohort study [6.3]
10.45-11.00 Anders Bonde Jensen (DK): Treatment related pain and socio-economic factors 15 months post-surgery in a nationwide cohort of women treated for primary breast cancer [6.4]
Cancer survivors’ perspectives
11.15-11.30 Chair: Helle Ploug Hansen (DK): Rehabilitation and the problem of context [7.1]
11.30-11.45 Karen la Cour (DK): Rehabilitation needs of people with advanced cancer in relation to everyday life [ 7.2]
11.45-12.00 Maria Kristiansen (DK): Ethnicity and cancer – differences and similarities in access to emotional support among Danish-born and migrant cancer patients [7.3]
12.00-12.15 Nina Henriksen (DK): A literary study of the Danish cancer narrative, its sub- genres and ideologies [7.4]
Tuesday September 21, 2010
Coffee Break
Perspectives
Christoffer Johanson (DK) Lunch break
Survivorship
14.00-14.15 Chair: Christian Graugaard (DK): Sexuality and coping with cancer: Some intro- ductory remarks [9.1]
14.15-14.30 Agneta Wennman-Larsen (SE): Return to work after breast cancer surgery?
Impact of encounters with health-care professional and social-insurance officers – a cohort study [9.2]
14.30-14.45 Søren Christensen(DK): Sexual quality of life 15 months post-surgery in a na- tionwide cohort of disease-free women treated for primary breast cancer [9.3]
14.45-15.00 Ulrika Fallbjörk (SE): Is breast reconstruction a part of the rehabilitation proc- ess? Differences between women choosing or abstaining breast reconstruction after mastectomy [9.4]
Screening for psychological distress
15.30-15.45 Chair: Alex Mitchell (UK): Validation of the Distress Thermometer using Activi- ties of Daily Living: What is the relationship between
distress and dysfunction? [10.1]
15.45-16.00 Pernille Envold Bidstrup (DK): Accuracy of the Danish version of the ‘distress thermometer’ [10.2]
16.00-16.15 Annika Thalén-Lindström (SE): Health-related quality of life in an unselected population of oncology patients screened for anxiety and depression [10.3]
16.15-16.30 Sigridur Gunnarsdottir (IS): Using the Icelandic Version of the distress version of the distress thermometer and problem list to screen for distress among
family members [10.4]
Relatives of cancer patients
12.15-12.30 Chair: Ulrika Kreicbergs (SE) Loss of a child to cancer – how to mitigate par- ents’ psychological distress? [8.1]
12.30-12.45 Chair: Mariët Hagedoorn (NL): Distress and support processes in couples coping with cancer [8.2]
12.45-13.00 Nanna Fridriksdóttir (IS): Unmet needs, quality of life and symptoms of anxi- ety and depression among family members of cancer patients [8.3]
12.15-13.00
13.00-14.00 14.00-15.00
15.00-15.30
15.30-16.30
16.30 - 16.45
Keynote speakers
Agnes Smáradóttir (IS), MD
Agnes Smáradóttir works as an attending physi- cian at the Department of Medical Oncology at Landspitali, University Hospital in Reykjavik, Iceland.
She graduated from medical school at University of Iceland in 1995.
In 1999 she moved to Connecticut, USA and re- ceived her clinical training in internal medicine and in hematology/oncology at the University of Connecti- cut. She is board certified from American Board of Internal Medicine, in internal medicine and medical oncology. Her clinical work is mostly in the field of lung cancer and gastrointestinal cancers. One of her main interests is rehabilitation during and after che- motherapy. Research interests include lung cancer, esophageal cancer.
Alex Mitchell (UK), MRCPsych
Alex Mitchell is consultant in psycho-oncology at Leicestershire Partnership Trust; Honorary Senior Lecturer at the University of Leicester and maintains the website www.psycho-oncology.info
In 2009 he was co-editor of the book “Screening for Depression: An Evidence based Approach” from Ox- ford University Press. His research interests includes the scientific approach to clinical diagnosis and im- proving quality of care. In 2009 he was awarded the Hiroomi Kawano New Investigator Award for best international researcher psycho-oncology.
Christian Graugaard (DK), MD, PhD
For nearly two decades Christian Graugaard has been working solely within the field of sexology, both scientifically, clinically, and politically.
He is currently senior researcher at The University Library of Copenhagen, lecturer at the Department of Psychology (University of Copenhagen), and chairman of The Danish Family Planning Association,
“Sex & Samfund”.
Further, he is editor-in-chief of the world’s oldest medical journal, “Bibliotek for Læger”, and has pub- lished extensively on sexuality related issues.
His primary research interests are: sexuality and disease, adolescent sexuality, and the history and sociology of body, gender, and sex.
Christoffer Johansen (DK), MD, PhD, DSc (Med)
Since 2001 Dr. Johansen has been the Head of the Department of Psychosocial Cancer Research at the Danish Institute of Cancer Epidemiology. The depart- ment conducts research using epidemiological meth- ods, clinical trials and anthropological investigations.
Dr. Johansen has been a member for 5 years in the National Strategic Research Council in Denmark.
Currently he is a member of the Swedish Cancer- fonden and serves as co-editor of the Scandinavian cancer journal, Acta Oncologica. He is furthermore on the Editorial Board of European Journal of Can- cer and PsychoOncology.
Christoffer Johansen is the first professor in cancer rehabilitation research inaugurated in 2010. The research conducted by Dr. Johansen includes the hy- pothesis of an association between mind and cancer both as a risk factor and as a prognostic factor as well as various issues within psychosocial interven- tion and cancer rehabilitation.
Corinna Bergelt (GER), MSc in psychol- ogy, PhD
Corinna Bergelt holds a PhD in psychology from the University of Hamburg, Germany. Her PhD thesis focused on individual goals in cancer rehabilitation.
She is currently a part of the psychooncological research group at the Institute of Medical Psychol- ogy at the Hamburg University Medical Centre. In addition to her research activities she is also involved in the education of medical students and teaches medical psychology and rehabilitation.
Her research covers various aspects of psychooncol- ogy, including psychosocial aspects of predictive genetic testing, cancer and the family, psychological risk factors for cancer, the evaluation of different cancer rehabilitation programs and occupational cancer rehabilitation.
Dorte Gilså Hansen (DK), MD, PhD
Since 2009 Dorte Gilså Hansen has been Head of the National Research Center of Cancer Rehabilita- tion Research, University of Southern Denmark.
Furthermore she is a Senior Researcher at the Research Unit for General Practice, University of Southern Denmark.
Among her main research topics are cancer rehabili- tation, diagnostic pathways, organization and interdis- ciplinary collaboration, socioeconomic inequality and epidemiology.
Over the years Dorte Gilså Hansen has been greatly involved in establishing and implementing various medical and multidisciplinary quality improvement projects in general practice in Denmark and in the European countries.
Eva Grunfeld (CA), MD, DPhil, FCFP Dr. Eva Grunfeld is a physician scientist with the On- tario Institute of Cancer Research, Health Services Research Program and Director of the Knowledge Translation Research Network.
At the same time she is the Giblon Professor and Director of Family Medicine Research at the Depart- ment of Family and Community Medicine, University of Toronto.
Her research focuses on evaluation and knowledge translation of cancer health services, covering the entire spectrum of cancer control activities. Among her many ongoing research projects, she is currently PI on a multicentre RCT evaluating survivorship care plans.
Frede Olesen (DK), MD, PhD, DSc (Med)
Frede Olsen is Director of the Research Unit for General Practice and Professor at the University of Aarhus, Denmark.
He was the founding President of the European Society of General Practice/Family Medicine, Vice- President of the World Organization of General Practitioners/Family Physicians (WONCA) and a member of the European working party on quality in family practice. In 2009 he received the Danish Medical Association’s most prestigious award. Since 2006 Frede Olesen has been Chairman of the Dan- ish Cancer Society.
Gunnar Steineck (SE) MD
Gunnar Steineck is professor at The Institute of Karo- linska at Göteborg University
Helle Ploug Hansen (DK), RN, Extended MA, PhD
Helle Ploug Hansen is professor in the research unit Man, Health & Society, Institute of Public Health and the National Research Center of Cancer Rehabilita- tion at the University of Southern Denmark. She is furthermore head of the Milieu for Humanistic Cancer research and maintains the website www.
mifohuk.dk.
Her research interests include an anthropological ap- proach to patients’ experiences, needs and perspec- tives on cancer. Her present research is on cancer rehabilitation using different kinds of theory based qualitative research strategies. Her publications cover various aspects of psycho-social and cultural aspects of cancer focusing on themes such as stigmatiza- tion and normalization, body image, narratives and govermentality.
Jette Vibe-Petersen (DK), MD Jette Vibe-Petersen is Director of Health Care Cen- tre for Cancer Survivors. She is a specialist in Internal Medicine and worked as a hospital doctor until 2006, when she decided to change her field of work to cancer rehabilitation. She is now the Director of the only centre for cancer rehabilitation in Denmark, a centre which she and her dedicated staff has built entirely from scratch over the past three years.
The centre functions as a close collaboration be- tween the municipality of Copenhagen and The Danish Cancer Society. The centre has extensive experience in cancer rehabilitation, and an external evaluation report in March 2010 has shown that the total joint rehabilitation activities in the centre are very beneficial for cancer patients and their relatives.
Jens Overgaard (DK) MD, DSc (Med)
Jens Overgaard is professor at Århus University
Jon Håvard Loge (NO), MD, PhD Jon Håvard Loge holds a position as senior re- searcher at the National Resource Centre for late Effects after Cancer Treatment at the Oslo University Hospital.
He is furthermore Professor II at the Department of Behavioural Sciences in Medicine at the University of Oslo.
His main interests of research are (1) methodologi- cal aspects of patient-reported outcomes (2) clinical studies in palliative medicine, cancer survivorship and cancer rehabilitation and (3) psycho-oncology.
Marianne Ewertz (DK), MD, DSc (Med)
Marianne Ewertz is professor in clinical oncology with special focus on breast cancer at Odense University Hospital and the University of Southern Denmark.
She has combined a clinical career with research in cancer epidemiology with her most recent research focusing on side effects to breast cancer treatment such as cognitive function in relation to chemo- therapy and risk of heart disease subsequent to radiotherapy for breast cancer
.She is chairman of the Scandinavian Breast Group, member of the Executive Committee and Steering Committee of the Early Breast Cancer Trialists´ Col- laborative Group, and of the Danish Breast Cancer Collaborative Group.
Mariët Hagedoorn (NL), PhD (Med)
Mariët Hagedoorn is appointed as a professor of Health Psychology at the University Medical Center Groningen, Department of Health Sciences, Section Health Psychology. Her main focus of research is adaptation to cancer and other somatic illnesses (e.g.
diabetes and renal dissease) within intimate relation- ships.
Specific research interests include (1) gender differ- ences in psychological distress in both patients and their partners (2) the role of supportive communi- cation in couples’ adjustment and (3) the interplay of intra- and interpersonal factors in adaptation to disease
Matti Rautalahti (FIN), MD, PhD
Since 1998 Matti Rautalahti has been the Chief Medical Officer of the Cancer Society of Finland.
One of his primary tasks is to coordinate and de- velop the cancer rehabilitation services the regional cancer societies offer and arrange. This includes small scale studies of the efficacy of rehabilitation. Besides this Matti Rautalahti is involved in various preventive programs, projects and campaigns. His professional work and publications are mostly from the area of cancer epidemiology.
Mia Bergenmar (SE), RN, PhD
Mia Bergenmar holds a position at the Unit for Out- come and Quality Assessment at the Department of Oncology, Karolinska University Hospital.
She is a member of the European Organisation for Research and Treatment of Cancer (EORTC) Qual- ity of Life Group. Currently she is a part of a psy- chooncological research group at the Department of Oncology-Pathology, Karolinska Institutet. Her main focus of research is patient information, patient satisfaction and quality of life.
Robbert Sanderman (NL), MSc in Psy- chology, PhD
Robbert Sanderman is a trained clinical psycholo- gist. Since 1999 he has been professor in Health Psychology at the Faculty of Medicine and Faculty of interventions aimed at restoring quality of life among such groups of patients. He is furthermore scientific director of the Graduate School for Health Research Psychology at the University of Groningen.
Robbert Sanderman is among others Chair of the Board of the Research Institute Psychology and Health; and Honory Fellow of the European Health Psychology Society and member of the Scientific committee of the Consumer Quality-Index in the Netherlands (SHARE), a research school and re- search institute of the University Medical Center Groningen.
Robbert Sanderman’s research is focused on psy- chological and social adaptive processes in patients with chronic somatic diseases and he is involved in studies testing the efficacy of psychosocial interven- tions aimed at restoring quaity of life among such patients.
Keynote speakers
14
Sophie D. Fosså (NO), MD, PhD
For 40 years Sophie D. Fosså has been working at the Norwegian Radium Hospital as a Medical on- cologist and radiotherapist. The last 15 years she has been chairperson of the National Resource Centre for longterm studies after cancer. Sophie D. Fosså has published widely in the international literature and have ca 500 publications on PubMed. She is espe- cially interested in urological oncology and has done thorough research on testicular cancer.
Susanne Oksbjerg Dalton (DK), MD, PhD
Susanne O. Dalton is working as a senior researcher at the Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society.
Her main focus of research is social inequality in cancer outcomes and she has conducted a number of population-based studies on social position and risk for and prognosis after cancer. Other areas of research include depression both as a risk factor for and late effect of cancer, as well as other aspects of cancer rehabilitation including returning to work.
Ulrika Kreicbergs (SE), RN, PhD
Dr. Kreicbergs (Associate Professor in 2009) holds a position as a senior researcher at the Karolinska Institutet, Dept. of Women and Children’s Health, Stockholm, Sweden as well as at the Sophiahem- met University College, Stockholm, Sweden. Prior to embarking on doctoral education, she had 8 years of clinical experience as a registered nurse in medical oncology, orthopedic and pediatrics.
Dr. Kreicbergs research is focused on children with advanced illness. A common denominator of the research is the “holistic” psycho-social perspective which considers not only the sick child, but also the family and the caregivers.
The overall aim is to minimize the child’s suffering and reduce the psycho-social morbidity in family members and caregivers by identifying harmful, yet avoidable or modifiable health-care related factors.
Wendy Demark-Wahnefried (USA), RD, PhD Wendy Demark-Wahnefried, is the Webb Chair and Professor of Nutrition Sciences at the University at Alabama at Birmingham (UAB) and also the Associate Director of the UAB Comprehensive Cancer Center.
She is a nutrition scientist whose research spans ba- sic science studies focused on determining the role of food-related components on cancer progression, to clinical research that involves nutrition-related concerns of cancer patients, as well as determin- ing effective lifestyle interventions that improve the overall health of cancer survivors and their families.
Her laboratory has conducted some of the largest studies exploring metabolic and body composition changes in response to cancer treatment.
Site specific cancer rehabilitation needs
Presentation number: 1.1• Gunnar Steineck, Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Hospital, Sweden
NO ABSTRACT
Presentation number: 1.2
Rehabilitation after breast cancer
• Marianne Ewertz, Department of Oncology, Odense University Hospital, Insti- tute of Clinical Research, University of Southern Denmark, Denmark
Breast cancer is the most frequent malignant disease among women world wide. Combinations of loco-regional and systemic treatments have increased the survival resulting in an increasing number of breast cancer survivors. While cure remains the most important goal for treatment, we can no longer ignore how cure is achieved. At the same time, it must be recognised that breast cancer keeps recurring for up to 20 years, especially if the tu- mour was oestrogen receptor positive.
Therefore, the process of rehabilitation includes dealing with not only effects of completed treatments, but also management of side effects to ongoing treatments, such as endocrine therapy.
Local therapies, such as surgery and radiotherapy, may cause pain and impaired movement of the arm and shoulder in 20-50% of patients depending on time since treatment. Lymphedema arises through damage to the lymphatic vasculature by lymph node dissection and radiotherapy in around 15-15% of the patients.
The state-of-the-art therapeutic approach of lymphedema relies on physiotherapeutic techniques to reduce limp volume and to maintain the health of the skin and supporting structures.
Chemotherapy is associated with a number of toxicities of which some may persist after completion. These include effects of early menopause, such as decreased fertility and increased risks of cardiovascular disease, vasomotor symptoms, vaginal dryness, dyspareunia, weight gain, and osteoporosis.
In addition, being diagnosed with cancer can lead to many psy- cho-social problems, such as depression, fear of recurrence, sleep disturbances, cognitive problems, and fatigue.
There is a need to rethink our strategy with respect to follow-up after treatment in relation to rehabilitation. Specific goals for re- habilitation should be formulated and implemented into national guidelines for follow-up. High priority should be directed towards research programs aiming at developing and testing new inter- ventions for alleviating symptoms and side effects experienced by breast cancer survivors.
Presentation number: 1.3
Specific rehabilitation needs in testicular cancer sur- vivors (TCSs)
• Sophie D. Fosså, Oslo University Hospital, Radiumhospitalet, Dep. of Oncology, National Resource Centre, Long term studies after cancer, Norway
Rehabilitation of a TCS aims to restore the patient’s physical and psychosocial function at a maximal degree, taking into account that cancer treatment may have left him with unavoidable Ad- verse Effects ( AEs),in spite of risk- adapted treatment strategies.
Rehabilitation starts with pre-treatment information about the type and incidence of expected adverse effects (AEs), and treat- ment possibilities of physical and psycho-social AEs, thus initiat- ing the necessary coping process. Post-treatment rehabilitation includes therapeutic tasks, if available ,and help to live with persistent AEs ,typically observed in TCSs. No evidence- based therapy is known for oto-neurotoxicity. Some affected patients may need help to change their occupational activity, avoiding cold environments. Assisted fertilisation may reduce infertility prob- lems .In case of symptoms related to biochemical hypogonadism testosterone substitution should be considered. Regular checkups by the family doctor are recommended for cardiovascular dis- eases (blood pressure, serum lipids, weight, life style adjustment if necessary [smoking, physical activity], hormones). In high-risk patients testicular self- examinations and regular ultrasonography contribute to early detection of a contralateral TC.
Probably due to response skift overall quality of life in TCSs is comparable to that of the age- matched male general population without clear association to prior treatment. However, about 25% of the patients after chemotherapy report AEs compared to 15% after the surveillance strategy.
Fatigue and being without work represent the strongest risk fac- tors for poor quality of life.
Conclusion: In TCSs the rehabilitation needs as to physical long term effects, are relatively easily recognised and can often, though not always, be met .Psychosocial needs frequently require extensive evaluation of the affected TCS’ social environment, his personality and vulnerability and are often not met without resource - demanding multimodal therapeutic management.
Presentation number: 1.4
• Jens Overgaard, Aarhus University Hospital, Denmark
NO ABSTRACT
Abstracts
Robert Zachariae (DK), Professor, MSc, MDSci
Robert Zachariae is head of the Psychooncology Re- search Unit at the Department of Oncology, Aarhus University Hospital, and Department of Psychology, Aarhus University. His current research activities include sociodemographic, clinical, and psychosocial predictors of Quality-of-Life and prognosis in a large national cohort of women treated for breast cancer, effects of Emotional Disclosure Intervention in cancer patients, cognitive impairment related to cancer and cancer treatments, and information and communication needs of cancer patients.
Abstracts Oral Presentations
Nordic and European experiences with rehabilitation programs
Presentation number: 2.1
Rehabilitation of cancer patients in Denmark – an upcoming field
• Jette Vibe-Petersen, Director of Health Care Centre for Cancer Survivors in Copenhagen, Denmark
In Denmark rehabilitation is defined as a targeted and temporary process of collaboration between individuals, their relatives and the professionals, with the aim to promote independence and a meaningful life.
Rehabilitation is by The Health Act managed partly by municipali- ties and partly by hospitals, but a clear definition concerning divi- sion of responsibility is needed before a coherent trans-sectional rehabilitation program can be established.
The Health Care Centre for Cancer Survivors in the City of Copenhagen was established in 2007 by the Health and Care Administration in collaboration with the private organisation The Danish Cancer Society, and is so far the only centre of this kind in Denmark. The municipal part of the centre offers individually planned cancer rehabilitation to a population of 530.000 citizens of which about 3.000 new patients yearly are diagnosed with cancer. In Copenhagen more than 20.000 persons are living with or after a cancer disease, and a part of these will experience relapse thereby increasing the number of patients who need aid in getting back on track, physically, emotionally and socially.
The centre is offering a primary contact person, patient educa- tion, physiotherapeutic intervention, dietary guidance and psy- chological counselling. An evaluation from 2009 shows, that 80%
of the patients referred are women, the average age is 55 years, one third of the patients have no post-secondary education and half of the patients are employed (of these 77% on sick-leave).
Following a visitation dialogue 44 % of the patients wish a re- habilitation program containing strength and indurance training twice weekly making physical activity the most used team based activity. Of the individual offers physiotherapeutic services are mostly used.
The evaluation also shows that out of 51 lung cancer patients 24% had moderate- and 33% severe co-morbidity. The corre- sponding numbers for 178 breast cancer patients were 17 and 12%.
Presentation number: 2.2
Cancer Rehabilitation in Finland
• Matti Rautalahti, Chief Medical Officer, Cancer Society of Finland
The development of rehabilitative activities among cancer pa- tients in Finland started in the early 1970’s by the cancer societ- ies. During the following decades cancer rehabilitation became
to mean 5-7-day multidisciplinary courses arranged by one of the regional cancer societies or national patient organizations in rehabilitation centers across the country. In 2000 the Cancer Society of Finland widened this view into rehabilitative services to include all activities aiming to improve the psycho-social well- being and quality of life of cancer patients and their families. The perspective was changed from pre-defined means into processes and goals. The rehabilitative services include a wide variety of activities arranged both by the public health care and NGO’s.
The Finnish model for cancer rehabilitation is based on the fol- lowing principles:
• the services cover the whole period from symptoms to post- treatment follow-up
• different needs are met with specific services
• all patients do not need all the services
• patients have individual needs for common problems
• effective rehabilitation is multidisciplinary teamwork
• rehabilitation is an integral part of treatment and recovery
• need for rehabilitation should be considered for all cancer pa- tients
The more intensive and targeted out-patient rehabilitation and psycho-social courses are financed mainly by the National Social Insurance Institute (for those under 65 years of age) or through grants from the National Slot Machine Association (65+ years).
Currently about 10% of the 27000 new annual patients partici- pate on one of the longer courses (over 100 annually) and many more take advantage of the shorter or less intensive courses or services.
The national cancer plans have included some aspects of reha- bilitation since the 1950’s, but more emphasis will be given to this area in the current development of the latest plan scheduled to be ready in 2011. Some of the clinical guidelines for different cancers include a section of rehabilitation (e.g. breast), but it is still not the rule.
Presentation number: 2.3
Cancer rehabilitation in Germany
• Corinna Bergelt, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
Based on the historical background of the German social security system, the German rehabilitation system evolved as a specific and independent sector within the health care system.
In Germany, rehabilitation is mainly financed by the statutory pension insurance agencies. Cancer rehabilitation measures (about 150.000 are carried out per year) are mainly conducted as inpatient programs in specialized rehabilitation clinics, which are staffed with multidisciplinary rehabilitation teams. Cancer re- habilitation measures normally last 3 weeks. If medically indicated,
a prolongation can be applied for by the rehabilitation physician.
During rehabilitation patients receive a combined multidisci- plinary treatment program consisting of physical therapy, patient education, relaxation training, functional training, psychooncologi- cal treatment, group sessions, nutrition counseling, occupational counseling etc., depending on the patient’s functioning and needs as assessed at the beginning of the rehabilitation measure.
Evaluation studies from the last two decades indicate that cancer rehabilitation leads to improved quality of life, physical functioning and general well-being in the cancer patient. Many of these stud- ies, however, applied naturalistic pre-post designs. Studies includ- ing a comparison group of rehabilitation non-participants find that non-participants indicate lower functional and psychosocial symptom levels at baseline, which indicates a well-functioning self-selection process with regard to the patients’ self-assessment and their inclination to apply for and participate in cancer reha- bilitation.
The presentation describes and discusses the main characteristics of cancer rehabilitation and rehabilitation research in Germany.
Presentation number: 2.4
Cancer rehabilitation programs – examples from Sweden
• Mia Bergenmar, Unit for Outcome and Quality Assessment at the Department of Oncology, Karolinska University Hospital, Sweden
There are differences in Sweden with respect to accessibility of resources for cancer rehabilitation, how cancer rehabilitation units are organised, what services they offer and how the ser- vices are adapted to different patient groups.
In the southern part of Sweden, there is one larger multi- professional team focusing on rehabilitation of cancer patients, the Department of Rehabilitation and Support, Department of Oncology, University Hospital of Skåne. Smaller cancer rehabilita- tions teams are located in Gothenburg (Sahlgrenska University Hospital) and in Kristianstad. In Halmstad, a rehabilitation team is currently established. In the middle of Sweden there is one larger multi-professional team, the Department of Psychosocial On- cology and Rehabilitation, Department of Oncology, Karolinska University Hospital, Stockholm. In Uppsala, cancer rehabilitation is organised as a network of different profession.
This is also the case at the University Hospital of Umeå, in the northern part of Sweden.
The two larger units consist of physicians, nurses, physiothera- pists, dieticians, psychologists, and social counsellors. Both teams offer structured multimodal rehabilitation programs and accept referrals for families with under-aged children where one of the parents has a cancer diagnosis.
There are several rehabilitation units run by private entrepre- neurs. They offer a variety of rehabilitation courses, most often on weekly basis. Patients’ can get referral to rehabilitation units certified by a County Council.
Currently, the focus on cancer rehabilitation in Sweden has taken a new direction. In early 2010 the Swedish government initiated a rehabilitation counsel where cancer rehabilitation is included.
The purpose is to define evidence-based rehabilitation interven- tion facilitating return-to-work. Cost-effectiveness evaluation has also become more important, in addition to outcomes in terms of quality of life.
Presentation number: 2.5
Cancer rehabilitation in Norway
• Jon Håvard Loge, National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital and Department of Behavioural Sciences in Medicine, University of Oslo, Norway
During the last 5-10 years, Norwegian politicians and health au- thorities have strongly advocated the need for rehabilitation and a national strategy was launched in 2007. This points to cancer rehabilitation as an important area for development of new ser- vices.
The Norwegian Cancer Society has for several years had a strong focus on service development within cancer rehabilita- tion. It has supported the establishment of several in- and out- patient services.
The exact number of rehabilitation services, their contents and how many cancer patients that utilize them and for what reasons are not available. For in-patient services this is partly related to the many services that are offered by private institutions con- tracted by the regional health authorities. Registry data indicate that the number of cancer patients admitted during the last 5 years has been reduced.
Out-patient rehabilitation services are offered at oncological departments and at local hospitals. Some of these are designed for specific groups of cancer patients. The oncological depart- ments also offer supportive cancer care with somewhat different content. There might also be services within the greater munici- pals with content of relevance for cancer rehabilitation but data on content, number and usage of these services cannot be col- lected. Since 1990, one national centre, the Montebello-centre, has run courses of 5-10 days duration for cancer patients and their relatives. The main goal of the courses is to improve the patients’coping.
Research on cancer rehabilitation is at its beginning. Some studies on single interventions such as physical training have been pub- lished while complex interventions have not been studied.
Conclusions: Several in- and out-patient services are available for Norwegian cancer patients. The present main challenge is to get an exact overview of the services and evaluate their con- tents and effects. Research on cancer rehabilitation are therefore strongly needed.
Abstracts
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Oral Presentations
Presentation number: 2.6
Past, present and future of cancer rehabilitation in Iceland
• Agnes Smáradóttir, Department of Medical Oncology at Landspitali, University Hospital in Reykjavik, Iceland
Rehabilitation for cancer patients in Iceland has mainly been or- ganised within Landspitali, University hospital. Inpatients have had access to physical therapy, occupational therapy as well as psy- chologists and social workers Few years ago a multidisciplinary team was formed to establish an outpatient rehabilitation center which was located away from the hospital grounds. Patient who needed inpatient rehabilitation were referred to a general inpa- tient rehabilitation ward.
Despite good intention the outpatient rehabilitation center ran into problems with housing and staff and it was difficult to admit a cancer patient to the inpatient rehabilitation ward. This year the cancer rehabilitation team was dissolved because of changes within the hospital structure.
Despite the set back another multidisciplinary team was estab- lished to re-organize rehabilitation for cancer patients within the hospital. Presently a cancer patient can be referred to outpatient physical therapy sessions. Individual relaxation training sessions have been available for several years. Most patient have an in- terview with social worker regarding insurance issues as well as support for families and many patient and/ or their family mem- bers are referred for an interview with a psychologist. There are also rehabilitation centers that offer inpatient rehabilitation for 2-4 weeks. In addition a privately run organization offers different programs for people with cancer.
The problem that cancer rehabilitation has faced in Iceland is e.g. there is no official policy and it’s not considered priority. It has been a trend to cut down rehabilitation services when in- stitutions have budget problems, as acute services need to have priority.
Despite these obstacles there is genuine interest in improving rehabilitation for cancer patient in Iceland. With the change in the treatment of the disease and people living longer with incurable disease focused rehabilitation is essential to the wellbeing of the cancer patient and their families.
Presentation number: 2.7 T
he Dutch cancer rehabilitation system; 15 years nationwide experiences and developments to meet patients’ needs and improve cancer care
• Brigitte Gijsen, Association of Comprehensive Cancer Centres, The Nether- lands
• Hellendoorn-van Vreeswijk Jeanette AH, Association of Comprehensive Cancer Centres, The Netherlands
• Ria AG Koppejan-Rensnebrink, Association of Comprehensive Cancer Centres, The Netherlands
• Jan-Paul Van den Berg, Meander Medical Centre, The Netherlands
• Saskia Lunter, Association of Comprehensive Cancer Centres, The Netherlands
Purpose: To meet cancer patients’ needs for rehabilitation, the Comprehensive Cancer Centres in The Netherlands recognized a deficiency in cancer care and developed a health-oriented rehabilitation programme Herstel & Balans (Recovery & Stabil- ity). Implementation strategies are combined with a nationwide network to make high standard cancer rehabilitation available to all patients.
Methods: The Comprehensive Cancer Centres developed and implemented a multidimensional rehabilitation programme by working together with rehabilitation centres, hospitals, health professionals, patients and insurance companies. In multicentre settings effects of the rehabilitation are evaluated. The strate- gies for nationwide implementation and quality control combine professional education, protocols, licences, and a multifunctional website including a quality monitor. A nationwide network is developed for the dissemination of cancer rehabilitation innova- tions, knowledge, professional guidelines and protocols.
Results: A multidimensional cancer rehabilitation programme is developed. Multicentre evaluations of the rehabilitation showed a significant increase of patients’ quality of life and a decrease of fatigue. The implementation strategies were successful in making cancer rehabilitation nationwide available to all patients (www.
herstelenbalans.nl). Oncologists in Belgium have also adopted the programme. The quality system is useful to control the pro- gramme’s quality and outcomes at more than 65 locations. The initial financial problems have been minimized. The nationwide network for cancer rehabilitation supports the dissemination of cancer rehabilitation improvements, knowledge and educa- tion, guidelines and protocols. The professional expertise in this relatively new working field increased immensely. The initial single concept has developed into modular cancer rehabilitation which meets the different needs of cancer patients during and after curative and palliative treatment.
Conclusion: The development, implementation strategies and quality system for the rehabilitation programme Herstel & Balans in the Netherlands were successful. The rehabilitation proved to be an important innovation in cancer care. The nationwide cancer rehabilitation network enables the dissemination of inno- vations, knowledge and guidelines. More research and innovation are necessary.
Rehabiliation needs and intervention
Presentation number: 3.1
The role of clinical practice guidelines and survivor- ship care plans in cancer rehabilitation
• Prof. Eva Grunfeld, Director, Knowledge Translation Research, Health Services Research Program, Ontario Institute for Cancer Research Giblon Professor and Director of Research, Dept. of Family and Community Medicine, University of Toronto, Canada
The prevalence of individuals with a history of cancer is increas- ing. There are estimated to be over 22 million cancer survivors worldwide. For the purposes of this presentation cancer sur- vivorship is defined as the period following primary treatment until cancer recurrence or end-of-life.
This period is now recognized as a unique phase in the cancer control continuum with specific clinical, rehabilitation, and health system needs. Clinical practice guidelines (CPG) and survivorship care plans (SCP) are potentially two tools to improve the quality of care provided to cancer survivors. The objectives of this pre- sentation are to:
1) describe both CPGs and SCRs;
2) review their potential benefits for cancer rehabilitation;
3) summarize what CPGs and SCRs are available internationally;
and
4) present a framework for cancer survivorship/rehabilitation research
Presentation number: 3.2
Cancer patients’ need for rehabilitation services
• Lene Thorsen, National Resource Center for Late Effects, Department of Oncology, Oslo university Hospital; Norway
• Cecilie E. Kiserud, National Resource Center for Late Effects, Department of Oncology, Oslo university Hospital, Norway
• Sophie D. Fosså, National Resource Center for Late Effects, Department of Oncology, Oslo university Hospital, Norway
• Gunhild M. Gjerset, National Resource Center for Late Effects, Department of Oncology, Oslo university Hospital, Norway
• Eva Skovlund, School of Pharmacy, University of Oslo, Norway
• et al.
Purpose: To examine needs for rehabilitation services and identify patient- and disease-related factors associated with such needs.
A secondary aim was to assess unmet needs for rehabilitation services.
Material and Methods: A cross-sectional questionnaire-based postal survey to cancer patients aged 25-60 years, diagnosed in 2005/2006 with the ten most frequent diagnoses in Norway.
Eligible patients from four hospitals were identified at the Nor- wegian Cancer Registry in 2008. Outcome measures were two questions addressing a) need for rehabilitation services (yes/no) and b) rehabilitation services offered (yes/no). Each question listed 7 rehabilitation services. Unmet needs were defined as
reporting more needs than services offered. Analyses were per- formed by logistic regression analyses.
Results: Among the 1325 participants, the mean age was 52 years and 70% were women. Need for physical therapy was reported most frequently (43%), followed by physical training (34%), psychological counseling (27%), recreation stay (24%), supportive group sessions (24%), consultation with social worker (19 %) and occupational therapy (6 %). Changes in employment status, presence of comorbidities and chemotherapy were as- sociated with need for rehabilitation. Almost 40 % of the patients stated a need for more than one rehabilitation service and 36
% reported no need for rehabilitation services. Thirty percent reported unmet needs. Unmet need was more frequent among patients with lymphoma than among patients with breast cancer.
Conclusions: A majority of the patients reported a need for at least one rehabilitation service. However, more than one third reported need for more than one rehabilitation service. In ad- dition, almost one third had an unmet need for rehabilitation.
Prospective studies should be conducted in order to investigate need of rehabilitation in more details
Presentation number: 3.3
Contributing Factors for Fecal Leakage among Gy- necological Cancer Survivors
• Gail Dunberger, Karolinska Institutet, Clinical Cancer Epidemiology, Sweden
• Helena Lind, Karolinska Institutet, Clinical Cancer Epidemiology, Sweden
• Gunnar Steineck, Karolinska Institutet, Clinical Cancer Epidemiology and Sahlg- renska Academy, Sweden
• Erik Onelöv, Karolinska Institutet, Clinical Cancer Epidemiology, Sweden
• Elisabeth Åvall-Lundqvist, Gynecological Oncology, Radiumhemmet, Karolinska Hospital, Sweden
Purpose: To investigate if loose stools and defecation urgency are contributing to fecal leakage among gynecological cancer survi- vors treated with pelvic radiotherapy.
Methods: A population-based study of 869 women, treated with pelvic radiotherapy for a gynecological cancer during 1991 to 2003 at two departments of gynecological oncology in Sweden, took place in 2006. A control group of 480 women from the Swedish Population Registry, matched for age and regional resi- dence, was also included. In preparation, we made in-depth inter- views with 26 women with gynecological cancer. Based on their narratives, we constructed a study-specific questionnaire includ- ing 351 questions and validated it face-to-face. The questionnaire covered questions of physical symptoms originating in the pelvis, demographics, psychological and quality of life factors. In relation to bowel symptoms, 60 questions were asked concerning fecal leakage, daily life and interrelated symptoms.
Results: In total 616 cancer survivors (78%) and 344 (72%) con- trol women participated. Mean follow-up since radiotherapy was 7.8 years. Forty-nine percent among cancer survivors reported fecal leakage, at least occasionally, and among them 23% report- ed fecal leakage without forewarning. Loose stools, at least once a week, was reported in 58% of the survivors with fecal leakage
Abstracts Oral Presentations
compared to 20% in survivors without fecal leakage. Defecation urgency, at least once a week, among survivors with compared to survivors without fecal leakage showed a prevalence of 48%
and 11% respectively. The need to have immediate toilet access to avoid fecal leakage, with the cut-off level at least once a week, was reported by 26% of survivors with fecal leakage compared to 3% among survivors without fecal leakage, with a relative risk of 10.0 (95% CI; 4.8-19.9).
Conclusions: Interrelated bowel symptoms, as loose stools and defecation urgency, are common among gynecological cancer survivors and are contributing factors for fecal leakage.
Presentation number: 3.4
Project Rehabilitation of cancer patients / Building group support for cancer patients
• May Vestar Onsrud & Anne Grev, Gjøvik kommune, Norway
• Aud-Inger Ystgaard, Gjøvik kommune, Norway
• Anne Grev, Gjøvik kommune, Norway
The municipality of Gjøvik with 28.700 inhabitants, county of Oppland, Norway - gives priority to rehabilitation of cancer pa- tients. This is done in collaboration with the corresponding Hos- pital and the Cancer Society. The municipality has in 2009 - 2010 a rehabilitation project founded by the Cancer Society and the organization of Health and Rehabilitation. The project target can- cer patients in curative and palliative phase. This is in accordance with the municipality’s Cancer Plan 2007 – 2011. The municipality has a professional network of cancer contacts led by a cancer coordinator.
The main focus is to give cancer patients back empowerment of their own lives and to ensure patients and their families the best follow-up through targeted interdisciplinary services.
Areas in the project were the following:
• Systematic introduction of the use of “Individual Plan” for pallia- tive patients
• Systematic introduction of the use of the ESAS (Symptom identification tools)
• Competence elevation
• Diet /nutrition
• Support education
• Building group support for cancer patients Results:
• Several methods have been developed in the above areas, which should contribute to improved quality of life for cancer patients. The methods will be saved in the municipality’s internal computer system.
• A weekly offer for 2 different groups of cancer patients has started. The program includes physical activity, information on key
topics, opportunity for conversation and fellowship. The groups are divided according to functional level, and about 40 receive a weekly offer.
• The neighboring municipalities want their patients in the offer, but the capacity limits this.
• Recent information topics include: The importance of physical activity for cancer patients, energy conservation, diet /nutrition, recipes and taste samples, coping strategies, social rights, psycho- logical reactions, dental care and wellness.
• 22 employees in the municipality have attended courses and are practicing in current issues in cancer care.
Evaluation: The feedback on questionnaires to participants has been very positive. It shows that this was a huge, long-awaited offering that participants did not hesitate to sign up on. Already the day after newspaper reports, most participants registered. It has been a very stable attendance at the group offers.
Presentation number: 3.5
The GP’s role in cancer rehabilitation: A randomised, controlled study
• Stinne Holm Bergholdt, Research Unit of General Practice, University of South- ern Denmark
• Jakob Kragstrup, Research Unit of General Practice, University of Southern Denmark
• Jens Søndergaard, Research Unit of General Practice, University of Southern Denmark
• Dorte Gilså Hansen, National Research Center of Cancer Rehabilitation, Re- search Unit of General Practice, University of Southern Danmark
Background: Attention to cancer patients needs for individually designed rehabilitation is increasing, taking physical, psychologi- cal, social, economical and work-related consequences of the cancer disease into consideration. Patients’ shifts between differ- ent sectors require ongoing adjustments of the organisation and procurement of rehabilitation offers to optimize the continuity of care. It is often stated that general practice is in a unique posi- tion to undertake the overall responsibility for the rehabilitation course of cancer patients. This study focus on the role the gen- eral practitioner can play in improving cancer patients’ quality of life by being involved in the rehabilitation process.
Purpose: We aim to test the hypothesis that a targeted effort to motivate the general practitioner (GP) to act proactively with regard to the patients’ rehabilitation can, as the primary objective
• improve cancer patients’ health related quality of life and as secondary outcomes
• improve the patient satisfaction with the GP’s contribution to the rehabilitation
• reduce the number of sick days
• facilitate a proactive conduct among the GP’s
Methods: This randomized, controlled study was designed to as- sess the effect of a new practice aiming to facilitate rehabilitation among newly diagnosed cancer patients compared to standard routines. In this new practice, the concept of rehabilitation was introduced to the patients by hospital nurses early after diagnose.
The different needs for physical, psychological, social, work and economy related rehabilitation were identified and communicat- ed to the GP along with more general information about cancer patient’s rehabilitation needs and an encouragement to the GP to be proactive according to individual patients’ rehabilitation course.
In total 1028 cancer patients receiving treatment at Vejle Sygehus were included, across departments and type of cancer. The data will be obtained from public health registers and questionnaires to patients at 6 resp. 14 months after diagnosis (measuring Health-Related Quality of Life, satisfaction with and use of re- habilitation activities and satisfaction with their GP) and to the patients GPs 14 months after diagnosis (measuring satisfaction with the information from the hospital and activities to meet the patients’ rehabilitation needs).
Results: Collection of data is completed April 2010. Preliminary results concerning the GP questionnaire data will expectedly be ready for presentation at the symposium.
Presentation number: 3.6
Is intensive inpatient cancer rehabilitation more ef- fective than outpatient cancer rehabilitation?
• Line Oldervoll, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
• Jon Håvard Loge, National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital and University of Oslo, Norway
• Anne Hokstad, Røros Rehabilitation Centre, Røros, Norway
• Roy Nystad, Division of rehabilitation, Oslo University Hospital, Norway
• Gro Bertheussen, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
• et al.
Purpose: To study the effects of and compare the effects be- tween intensive inpatient- (IPR) and outpatient-rehabilitation (OPR) programs for cancer patients on physical fatigue (FAT), physical (PF) and emotional functioning (EF).
Method: Breast and gynecological cancer patients aged18-67 years who had completed primary treatment were included.
Patients in the IPR program attended a 4 week stay; 3 weeks primary- and a one-week follow-up stay. The OPR-patients at- tended once a week for 7 weeks. Both programs were adminis- tered to groups of 10-15 participants and consisted of physical exercise, education and group discussions concerning “living with cancer”. FAT was measured by the Fatigue Questionnaire. EF and PF were assessed by two scales in the European Organization for Research and Treatment Core Quality of Life Questionnaire.
Assessments were performed at start (T1) in both programs, at arrival of the follow-up stay approximately eight weeks after the primary stay (IPR-program) and by end of OPR-program (T2).
Paired sample t-tests were used to analyze for changes in FAT, EF and PF within each program. Linear regression analysis adjusted for baseline differences was used to detect differences in out- comes between the programs.
Results: Fifty eight participants in the IPR and 53 in the OPR completed assessments at T1 and T2. Mean age was 52 and 50 years. FAT was reduced (p ≤ 0.05) and PF and EF improved (p<
0.05) in both programs. The reduction of FAT in the IPR-program was statistically significantly better than in the OPR-program. No differences between the programs on improvement in PF and EF were found.
