Abstract
BackgroundAccess to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis. Models to integrate rehabilitation within oncology services as cancer treatment commences are required, but must be informed by those they are intended to support. We aimed to identify views of patients, carers and clinicians to develop and refine a rehabilitation model to be tested in a feasibility trial for people newly diagnosed with lung cancer or mesothelioma.MethodsWe conducted a focus group study with people affected by lung cancer or mesothelioma, their carers and clinicians providing their care to identify priorities for rehabilitation in this period. We sought views on core intervention components, processes and outcomes and integration with oncology services. Data were analysed using thematic analysis.ResultsFifteen clinicians (oncologists, nurse specialists, physiotherapists and occupational therapists), nine patients and five carers participated. A proposed outline rehabilitation model was perceived as highly relevant for this population. Participants recommended prompt and brief rehabilitation input, delivered whilst people attend for hospital appointments or at home to maximise accessibility and acceptability. Participants recognised variation in need and all prioritised tailored support for symptom self-management, daily activities and the involvement of carers. Clinicians also prioritised achieving fitness for oncology treatment. Patients and carers prioritised a sensitive manner of approach, positivity and giving hope for the future. Participant’s recommendations for outcome measurement related to confidence in usual daily activities, symptom control and oncology treatment completion rates over objective measures of cardiorespiratory fitness.ConclusionThe importance of providing tailored rehabilitation around the time of diagnosis for people with lung cancer or mesothelioma was affirmed by all participants. The refined model of rehabilitation recommended for testing in a feasibility trial is flexible, tailored and short-term. It aims to support people to self-manage symptoms, tolerate cancer treatments and to remain active and independent in daily life. It is delivered alongside scheduled hospital appointments or at home by an expert practitioner sensitive to the psycho-social sequelae that follow a diagnosis of thoracic cancer.
Highlights
Access to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis
Rehabilitation services are not always integrated into cancer services, and there is a lack of data on the feasibility and acceptability of rehabilitation models, in advanced cancer [2]
To support identification of environmental and personal factors which may act as barriers to participation in rehabilitation [9, 12, 13], determinants or mechanisms of effect [14], the outline model was underpinned by the World Health Organisation International Classification of Function Disability and Health, [15] plus theories of rehabilitation [16] and behaviour change [17,18,19]
Summary
Access to rehabilitation to prevent disability and optimise function is recommended for patients with cancer, including following cancer diagnosis. New models are needed as despite compelling evidence of need relating to the physical, psychological, social and functional consequences of diagnosis and treatment [3,4,5,6], people with thoracic cancer may not be willing to access services [7,8,9,10] Rehabilitation trials in this population are predominantly exercise or symptom self-management based and have not directly addressed participation in daily life activities in the period following diagnosis when people are at risk of deconditioning [11]. To begin to address this, based on the literature, we developed outline parameters for a comprehensive model of rehabilitation These included integration with oncology services, delivery soon after diagnosis and tailored components to support people maintain participation in daily activities and minimise the onset of impairments as they commence cancer treatment (see Fig. 1). To support identification of environmental and personal factors which may act as barriers to participation in rehabilitation [9, 12, 13], determinants or mechanisms of effect [14], the outline model was underpinned by the World Health Organisation International Classification of Function Disability and Health, [15] plus theories of rehabilitation [16] and behaviour change (see Fig. 1) [17,18,19]
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