Outpatient cancer rehabilitation services for gynecologic cancer survivors: Who participates, and do they benefit?

Abstract

e18793 Background: Women with gynecologic cancers are likely to experience acute, late, or lasting functional impairments that impact ability to complete activities of daily living and quality of life. While cancer rehabilitation interventions (physical or occupational therapy, PT/OT) treat functional impairment, the use, impact, and acceptability of these services in community-based settings is unknown. We describe outpatient PT/OT services used by gynecologic cancer survivors and evaluate the impact and acceptability of these services using patient-reported outcome measures (PROM). Methods: This retrospective study included women with history of gynecologic cancer (via ICD-10 code) who: (1) received community-based outpatient cancer PT/OT services provided by a single institution in 5 geographic regions of the United States in 2019, and (2) completed a PROM at evaluation and discharge. Data was extracted from PT/OT medical charts. We calculated descriptive statistics for all available patient and rehabilitation characteristics (including age, cancer type, complexity-level of rehabilitation, interventions provided and number of visits). To evaluate pre-post rehabilitation change for each PROM, we used paired samples t-tests, then calculated pre-post effect size (Hedge’s g) and the proportion who achieved the minimal detectable change (MDC). We calculated median Net Promotor Score (NPS, 0-10) to determine acceptability. Results: Women who received rehabilitation (N = 84) were 64.63 ± 11.04 (range = 40.82 – 90.82) years old with predominant diagnoses of ovarian (n = 35, 41.7%) or endometrial (n = 27, 32.1%) cancer. Most attended PT (vs. OT) and completed 13 sessions ( IQR= 8.0 – 19.0). Seventeen different PROM were used. From pre- to post- rehabilitation, a significant improvement was seen in four PROM: Lower Extremity Functional Scale (LEFS; n= 20, M∆ = 12.88 ± 12.31, t(19) = 4.68, p = .00), Modified Fatigue Impact Scale (MFIS; n= 14, M∆ = 6.55 ± 9.69, t(13) = 2.53, p = .03), Patient-Specific Functional Scale (PSFS; n= 14, M∆ = 2.93 ± 2.31, t(13) = 4.72, p = .00), and Lymphedema Life Impact Scale (LLIS; n= 12, M∆ = 20.50 ± 20.61, t(11) = 3.45, p = .01). A large pre-post effect size (g ≥ 0.80) was observed for three PROM (17.6%), including: The PSFS ( n= 14, g = 1.47), LLIS, ( n= 12, g = 1.18), and Activities-specific Balance Confidence (ABC6; n= 3, g = 1.77). Overall, 54.8% (n = 46) patients achieved the PROM MDC. Median acceptability was 10.0 out of 10.0 ( n= 64, IQR = 9.75 – 10.0). Conclusions: For women with gynecologic cancers and functional impairment, cancer rehabilitation improved patient-reported function and was highly acceptable. Future research is needed to understand diagnosis-specific considerations and to optimize timing of rehabilitation.