Abstract
PurposeTo tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center.MethodsWe investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2).ResultsNine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47–2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31–2.45), referral to PCRPs (OR 1.81, 95% CI 1.18–2.78), participation in PCRPs (OR 2.04, 95% CI 1.43–2.91), and PAU (OR 1.69, 95% CI 1.25–2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators.ConclusionsThe implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care.Implications for Cancer SurvivorsImplementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
Highlights
It is well known that the physical activity (PA) levels of patients affected by cancer generally decline [1], and only a small proportion of the patients with cancer get sufficient PA during treatment [2, 3]
Screening with the Distress Thermometer (DT) was significantly associated with information provision concerning PA and physical cancer rehabilitation programs (PCRPs), advice to take part in PA and PCRPs, referral to PCRPs, participation in PCRPs, and PA uptake (PAU)
We found determinants at the patient level associated with guideline-based physical cancer rehabilitation (PCR) care
Summary
It is well known that the physical activity (PA) levels of patients affected by cancer generally decline [1], and only a small proportion of the patients with cancer get sufficient PA during treatment [2, 3]. Evidence-based guidelines recommend the implementation of physical cancer rehabilitation programs (PCRPs) or other initiatives to improve the uptake of PA during and after cancer treatment [16, 35,36,37,38,39,40,41,42,43]. It appears that adherence to current guidelines on physical cancer rehabilitation (PCR) is low [49,50,51,52,53], and material on approaches to implementing PCR guidelines is scarce [54,55,56,57,58]. Using the DT for screening appears to be a good starting point for accomplishing adherence to current PCR guidelines, but evidence supporting this hypothesis is missing
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