Outpatient Cancer Rehabilitation Research Articles

Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States.

Compared to adults without cancer, cancer survivors report poorer health-related quality of life (HRQOL), which is associated with negative treatment outcomes and increased healthcare use. Cancer-specialized physical and occupational therapy (PT/OT) could optimize HRQOL; however, the impact among survivors with non-breast malignancies is unknown. This retrospective (2020-2022), observational, study of medical record data of 12 cancer types, examined pre/post-HRQOL among cancer survivors who completed PT/OT. PROMIS® HRQOL measures: Global Health (physical [GPH] and mental [GMH]), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA) were evaluated using linear mixed effect models by cancer type, then compared to the minimal important change (MIC, 2 points). Survivors were 65.44 ± 12.84 years old (range: 19-91), male (54%), with a median of 12 visits. Improvements in GPH were significant (p < 0.05) for all cancer types and all achieved MIC. Improvements in GMH were significant for 11/12 cancer types and 8/12 achieved MIC. Improvements in PF were significant for all cancer types and all achieved the MIC. Improvements in SRA were significant for all cancer types and all groups achieved the MIC. We observed statistically and clinically significant improvements in HRQOL domains for each of the 12 cancer types evaluated.

The relationship between patient-reported and objective measures of physical function among cancer survivors receiving rehabilitation care: A correlation analysis.

Physical function is associated with cancer-related quality of life and survival. The correlation of patient-reported and objective measures of physical function has not been quantified previously in the cancer rehabilitation medicine setting. To correlate patient-reported physical function with objective measures of physical function. The secondary aim is to correlate fatigue and social participation levels with objective measures of physical function. Retrospective. Tertiary university cancer center. A total of 226 cancer survivors referred to an outpatient cancer rehabilitation medicine clinic. Not applicable. Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile domains with objective physical function measured by the 30-second sit-to-stand and hand grip strength. Pearson correlation analysis revealed a moderate correlation between patient-reported physical function and the 30-second sit-to-stand test (r = 0.57; p <.001), and a weak correlation of patient-reported physical function and handgrip strength (r = 0.27; p <.001). Multivariable regression modeling controlling for age, gender, and receipt of systemic therapy demonstrated a significant association between patient-reported physical function and the 30-second sit-to-stand test (estimated confidence interval 0.76 [0.60, 0.92], p < .01), in addition to patient-reported function and handgrip strength (estimated 0.22 [0.10, 0.34], p < .01). Multiple myeloma but no other cancer type was inversely associated with lower physical function. Patient-reported physical function correlated moderately with the 30-second sit-to-stand test, whereas hand grip strength demonstrated a weak correlation. The 30-second sit-to-stand test is a suitable substitute for patient-reported physical function. Further work evaluating how measures relate to each other across cancer populations is needed before recommending a standardized set of outcome measures.

Role of Rehabilitation in Spine Tumors.

Primary and metastatic spine tumors can lead to devastating complications, but timely and careful management of these patients can improve outcomes. A multidisciplinary and structured approach is the most effective way to evaluate patients with spine disease and mitigate the risk of complications. The neurologic, oncologic, mechanical and systemic disease framework gives comprehensive guidance to providers regarding appropriate management. Physiatrists play a critical role in these patients' initial evaluation and continued management throughout cancer treatment. Patients with spinal cord involvement have extensive needs, requiring an individualized management approach. Even though patients with nontraumatic spinal cord injury benefit from rehabilitation efforts and have improved outcomes, they are not routinely admitted to inpatient rehabilitation units or referred to outpatient cancer rehabilitation. Ongoing efforts are needed to promote rehabilitation medicine involvement in improving functional outcomes and quality of life for patients with spine involvement.

The broader impact of specialized outpatient cancer rehabilitation on health and quality of life among breast cancer survivors.

e18881 Background: After diagnosis and treatment, women with cancer often experience significant functional decline from which most do not recover. Functional deficits, especially when persistent, are related to poorer health and quality of life (QOL). Interventions to mitigate declines in function, health and QOL are necessary given their known associations with morbidity and mortality yet are understudied and underutilized. While there is evidence supporting cancer rehabilitation’s (Physical or Occupational therapy, PT/OT) ability to improve physical function and upper extremity disability among breast cancer survivors (BCS), the impact of cancer PT or OT on health and QOL is unknown. To understand this broader impact, we examined the rehabilitation needs and outcomes of BCS who attended specialized, community-based cancer PT/OT. Methods: In this retrospective study, we extracted case characteristics and patient-reported outcomes (PRO) measures of health, function and QOL from a national sample of BCS who attended cancer-specialized outpatient PT or OT. We examined ICD-10 codes to identify rehabilitation needs. PROs collected at baseline and discharge from rehabilitation included: Patient Reported Outcome Measuring System (PROMIS) global physical health, global mental health, physical function, and ability to participate in social roles and activities. To examine change from baseline to discharge we used paired t-tests ( p&lt; .05) and calculated effect size (Cohen’s d). Results: PT/OT patients (N = 2,706; PT, n = 2,245; OT, n = 461) were 99.6% female, 58.33±12.50 years old and attended approximately 10 (IQR: 7.0 – 17.0) sessions. Needs included: muscle atrophy, weakness or ataxia (PT: 44%, OT: 32%); lymphedema (PT: 40%, OT: 56%); upper extremity impairment (PT: 44%, OT: 28%); pain (PT: 44%, OT: 25%); and scar tissue or fibrosis (PT: 15%, OT: 16%). At discharge, all health, function and QOL-related outcomes improved significantly (p &lt; .001) in both PT and OT. Specifically, significant gains in PROMIS global physical health (PT: M∆ = 3.56±7.21, d= 0.49; OT: M∆ = 2.26±7.03, d= 0.32), global mental health (PT: M∆ = 2.01±6.91, d= 0.29; OT: M∆ = 1.34±7.20, d= 0.19), physical function (PT: M∆ = 2.81±7.45, d= .38, M∆ = 1.91±7.39, d= .26), and participation in social roles &amp; activities (PT: M∆ = 3.24±9.09, d= .36; OT: M∆ = 1.91±8.41, d= .23) were observed. Conclusions: BCS presented to community-based outpatient rehabilitation with a variety of needs yet, despite this variety, demonstrated significant improvement in self-perceived health, physical function and QOL. Significant gains were reported for both PT and OT interventions. For providers working with BCS, these results can be used to increase awareness of the role of cancer rehabilitation and support referral to these services. Future research should evaluate the impact of specialized PT/OT on individuals with other cancer types.

Understanding Patient Experience with Outpatient Cancer Rehabilitation Care.

Understanding patient experience is key to optimize access and quality of outpatient cancer rehabilitation (physical or occupational therapy, PT/OT) services. We performed a retrospective mixed-method analysis of rehabilitation medical record data to better understand patient experience and aspects of care that influenced experience. From the medical record, we extracted case characteristics, patient experience data (Net Promoter Survey®, NPS) and patient-reported outcome (PRO) data. We categorized cases as 'promoters' (i.e., highly likely to recommend rehabilitation) or 'detractors', then calculated NPS score (-100 [worst] to 100 [best]). We identified key themes from NPS free-text comments using inductive content analysis, then used Pearson [r] or Spearman [ρ] correlation to explore relationships between NPS, characteristics, and PRO improvement. Patients (n = 383) were 60.51 ± 12.02 years old, predominantly women with breast cancer (69.2%), and attended 14.23 ± 12.37 visits. Most were 'promoters' (92%); NPS score was 91.4. Patients described two experiences (themes) that influenced their likelihood to recommend rehabilitation: (1) feeling comfortable with the process and (2) observable improvement in health/functioning, and described attributes of clinic staff, environment and clinical care that influenced themes. Likelihood to recommend rehabilitation was associated with achieving the minimal clinical important difference on a PRO (ρ = 0.21, p < 0.001) and cancer type (ρ = 0.10, p < 0.001). Patients who received specialized cancer PT/OT were highly likely to recommend rehabilitation. Feeling comfortable with the rehabilitation process and making observable improvements in health and/or functioning influenced likelihood to recommend. Rehabilitation providers should leverage the findings of this study optimize access to and quality of cancer rehab services.

Impact and Acceptability of Outpatient Cancer Rehabilitation For Breast Cancer Survivors With Upper Extremity Disability

<h3>Research Objectives</h3> Quantify the impact and acceptability of outpatient physical and occupational therapy (PT/OT) for breast cancer survivors (BCS) with low-, medium-, or high-severity upper extremity disability (UED). <h3>Design</h3> Retrospective, pre-post observational study. <h3>Setting</h3> Community-based outpatient rehabilitation clinics. <h3>Participants</h3> BCS (identified by ICD-10) who presented for PT/OT and reported UED at baseline via the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) patient reported outcome measure. <h3>Interventions</h3> Standard of care provided by cancer-specialized PT/OT. <h3>Main Outcome Measures</h3> QuickDASH and patient-rated acceptability (1-item): "How likely are you to recommend [this rehabilitation facility] to family/friends", 0 (not likely) – 10 (highly likely)?". <h3>Results</h3> Patients (N=417) were 59.89 ± 12.06 years old and mostly female (99%). They participated in PT (87%) or OT (13%) and attended a median of 10 sessions (IQR: 6.0 – 16.0). At baseline, 62% had high severity UED (QuickDASH >31.5), 25% had moderate severity UED (QuickDASH=18.5-31.5), and 13% had low severity UED (QuickDASH = 13-18.5). From baseline to discharge, significant medium or large effect size (Cohen's d) was observed for each group: high severity UED (M∆=25.13±20.33, d=1.24, p=.00), moderate severity UED (M∆=11.36±11.9, d=0.95, p=.00), and low severity UED (M∆=4.84±9.15, d=0.53, p=.00). Sixty-eight percent of BCS with high severity UED achieved the minimum clinically important difference (MCID), whereas 44% and 4% achieved the MCID in the moderate and low severity UED groups, respectively. Median acceptability across all groups was 10 (n=167, IQR = 10 – 10). <h3>Conclusions</h3> Outpatient cancer PT/OT was associated with significant improvements in patient-reported breast cancer-related UED measured by the QuickDASH, particularly for those with high-severity UED, and was acceptable for all groups. Subsequent studies are warranted to explore UED prevalence and severity by cancer treatment modality, as related to optimizing functional improvement with PT/OT. <h3>Author(s) Disclosures</h3> Drs. Wood, Kendig and Pergolotti receive a salary from ReVital Cancer Rehabilitation, Select Medical.

Responsiveness and interpretation of the PROMIS Cancer Function Brief 3D Profile.

BackgroundMeasuring function with valid and responsive tools in patients with cancer is essential for driving clinical decision‐making and for the end points of clinical trials. Current patient‐reported outcome measurements of function fall short for many reasons. This study evaluates the responsiveness of the Patient‐Reported Outcomes Measurement Information System (PROMIS) Cancer Function Brief 3D Profile, a novel measure of function across multiple domains.MethodsTwo hundred nine participants across five geographically distinct tertiary care centers completed the assessment and pain rating at two outpatient cancer rehabilitation clinic visits. Patients and providers completed a global rating of change measure at the second visit to indicate whether the patient was improving or worsening in function. Multiple response indices and linear models measured whether the measure was responsive to self‐reported and clinician‐rated changes over time. Correlations between changes in function and changes in anchors (pain rating and performance status) were also calculated.ResultsFunction as measured by the PROMIS Cancer Function Brief 3D Profile changed appropriately as both patients and clinicians rated change. Small to moderate effect sizes supported the tool's responsiveness. Function was moderately correlated with pain and more strongly correlated with performance status, and changes in function corresponded with changes in anchor variables. No floor/ceiling effect was found.ConclusionsThe PROMIS Cancer Function Brief 3D Profile is sensitive to changes over time in patients with cancer. The measure may be useful in clinical practice and as an end point in clinical trials.Lay summary We gave patients a questionnaire by which they told their physicians how well they were functioning, including how fatigued they were.This study tested that questionnaire to see whether the scores would change if patients got better or worse.

Community-based outpatient cancer rehabilitation services for women with gynecologic cancer: acceptability and impact on patient-reported outcomes.

Women with gynecologic cancers often experience functional impairments impacting quality of life. Physical and occupational therapy (PT/OT) treat functional impairment; however, the acceptability and impact of these services for women with gynecologic cancer are unknown. We reviewed rehabilitation charts of women with gynecologic cancer who received PT/OT (i.e., patients) in 2019 and completed patient-reported outcome measures (PROMs) selected by their therapist at intake (pre) and discharge (post). We calculated descriptive statistics for patient, rehabilitation, and acceptability (0-10) data. For PROM data, we used paired samples t-tests to evaluate pre-post change, and then calculated effect size (Hedge's g) and the proportion who achieved a minimal detectable change (MDC). PT/OT patients (N = 84) were 64.63 ± 11.04years old with predominant diagnoses of ovarian (41.7%) or endometrial (32.1%) cancer. They attended a median of 13 sessions (IQR = 8.0-19.0). Sessions were predominantly PT (86%) vs. OT (14%). Median acceptability was 10 (IQR = 9.8-10.0). Pre-post improvement was observed for each of the 17 PROMs used by therapists. Significant improvement (p < .05) was observed for four PROMs: the Patient-Specific Functional Scale (M∆ = 2.93 ± 2.31, g = 1.47, 71% achieved MDC), the Lower Extremity Functional Scale (M∆ = 12.88 ± 12.31, g = 0.61, 60% achieved MDC), the Lymphedema Life Impact Scale (M∆ = 20.50 ± 20.61, g = 1.18, 58% achieved MDC), and the Modified Fatigue Impact Scale (M∆ = 6.55 ± 9.69, g = 0.33, 7% achieved MDC). PT/OT was acceptable and improved patient-reported outcomes for women with gynecologic cancers. Future research is needed to establish gynecologic-specific guidelines for referral and PT/OT practice.

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

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.

The Effect of Cancer Rehabilitation on Functional Outcomes in a Patient With Stage IV Melanoma With Subsequent Brain Metastases: A Case Report

Background and Purpose: Malignant melanoma has a high propensity to metastasize, specifically to the brain. Research has shown that incorporating oncology rehabilitation as part of the interdisciplinary care team promotes independence in functional mobility that leads to an improvement in a patient's quality of life. Case Description: A 70-year-old man presented with recurrent melanoma to the brain 10 years after initial diagnosis. Multiple brain metastases led to left hemiparesis of the arm and leg. Left-sided weakness affected his ability to perform activities of daily living and exercise regularly. The confounding impairments in balance resulted in multiple falls at home. Interventions: Interventions included balance training on various surfaces, core and proximal lower extremity strengthening, aerobic conditioning, and implementation of a home exercise program. Outcomes: The patient attended outpatient cancer rehabilitation for 19 weeks and discharged from physical therapy with a reported 47.7% improvement in global physical health and 26.7% improvement in global mental health on the PROMIS tool. At discharge, performance on the Five Times Sit to Stand Test, Timed Up and Go Test, and Dynamic Gait Index was below cutoff scores, indicating the patient was no longer a high risk for falls at home. Discussion: Physical therapy specifically tailored for the oncology patient allows for a customized rehabilitation approach that incorporates oncologic medical history and treatment into the episode of care, with the ultimate goal of improving quality of life and function throughout the patient's cancer journey.

Cancer Rehabilitation Provided by Designated Cancer Hospitals in Japan: The Current State of Outpatient Setting and Coordination after Discharge.

ABSTRACTObjectives:The aim of the present study was to clarify the current state of outpatient cancer rehabilitation and coordination systems provided by designated cancer hospitals in Japan.Methods:A questionnaire was sent to 427 designated cancer hospitals in Japan to investigate the status of outpatient cancer rehabilitation and whether it was sufficiently conducted. The status of regional coordination with post-discharge rehabilitation facilities was surveyed.Results:Responses were received from 235/427 facilities (55.0%). Outpatient cancer rehabilitation was implemented in 92 (39.1% of responding facilities), and of these facilities, 83.7% answered that the provision of rehabilitation was insufficient. The reasons were ineligibility for reimbursement of medical fees, a lack of human resources, a lack of awareness of the need, and a lack of education. Regional coordination was conducted by 39.1% of responding facilities, yet a regional alliance path had been established in only 9.8% of centers. The absence of coordination was associated with large facility size, the absence of physiatrists, and few rehabilitation professionals who had completed the training program; an insufficient framework for regional coordination was also given as a reason.Conclusions:To provide adequate outpatient cancer rehabilitation, sufficient human resources, the reimbursement of medical fees in the outpatient setting, and education and a framework to promote regional coordination are necessary.

Experience of Recurrent/Advanced Cancer Patients Receiving Outpatient Cancer Rehabilitation

Experience of Recurrent/Advanced Cancer Patients Receiving Outpatient Cancer Rehabilitation

Prevalence of function-limiting late effects in Hodgkin lymphoma survivors.

Hodgkin lymphoma (HL) is highly curable, but survivors often develop function-limiting impairments. Screening guidelines for neuromuscular and musculoskeletal late effects are not as well recognized across medical disciplines. Early identification and management of functional late effects are instrumental in improving the longitudinal care of HL survivors. To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life (QOL) in HL survivors. A retrospective cohort analysis. Outpatient cancer rehabilitation clinic. One hundred HL survivors. Not applicable. Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects contributing to functional impairment and disability in HL survivors. Among the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemo-radiation for their initial cancer treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculoplexopathy (93%), mononeuropathy (95%), and localized myopathy (93%). Musculoskeletal sequelae included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function-limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology, and/or lymphedema therapy. Neuromuscular, musculoskeletal, visceral, oncologic, and other late effects are extremely common in HL survivors seeking physiatric evaluation. Multiple function-limiting disorders can coexist in HL survivors with the potential to severely compromise function and QOL. Safe and effective rehabilitation may depend on the physiatrist's ability to identify, evaluate, and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.

Outpatient multidisciplinary cancer rehabilitation in Switzerland: a status assessment

AimThis study aimed to assess the situation of outpatient multidisciplinary cancer rehabilitation in Switzerland as of March 2018.Subject and methodsSeventeen programmes providing outpatient cancer rehabilitation were identified; 12 in the German-speaking, 4 in the French-speaking and 1 in the Italian-speaking part of Switzerland. Structure, organisation, type of programme and details on therapies offered were assessed. Difference by language regions and the status of the programme (running vs in development) were examined in a descriptive analysis.ResultsCentres in the German- and Italian-speaking parts had mostly individual modular programmes with a longer duration (median: 12 weeks) and low intensity (median: 2.5–3 h per week). The French-speaking part had standard programmes with a shorter duration (median: 9 weeks) but higher intensity (median: 5.5 h per week) and a higher number of obligatory modules a patient must attend (median: 2 instead of 1). The language regions also showed differences in duration of therapies, communication, indications and screening instruments.ConclusionOutpatient cancer rehabilitation in Switzerland is characterized by a wide range of programmes. These differences between language regions, as well as between the individual programmes, highlight important variables that may influence the efficiency and the quality of the different programmes; understanding these variables could lead to improvements in cancer rehabilitation in Switzerland.

Psychometric Characteristics and Validity of the PROMIS Cancer Function Brief 3D Profile

ObjectiveTo develop an item response theory (IRT)–calibrated, patient-reported outcome measure (the PROMIS Cancer Function Brief 3D Profile) of physical function, including associations with fatigue and social participation, in cancer rehabilitation patients. DesignLarge-scale field testing, graded response model IRT analyses, and multivariate regression analysis. SettingSix cancer rehabilitation clinics associated with cancer centers across the United States. ParticipantsAdults (N=616) treated in outpatient cancer rehabilitation medicine clinics. InterventionNot applicable.Main Outcome Measures: The PROMIS(r) Cancer Function 3D Profile (including existing items from PROMIS(r) item banks). ResultsA total of 616 patients completed 21 items in the initial item pool. Nine items were removed because of comparatively lower information that they provide according to the IRT item calibrations, low item-total correlations, or bimodal distributions. The remaining items generated a 12-item short form. Regression analyses determined that the items were responsive to and representative of the patient population across trait ranges and multiple domains and subdomains of function. ConclusionsThis psychometric investigation supports the use of the PROMIS Cancer Function Brief 3D Profile for evaluating function in outpatient cancer rehabilitation patients.

Association of Outpatient Cancer Rehabilitation With Patient-Reported Outcomes and Performance-Based Measures of Function

Background and Purpose/Objective: Evidence supporting the effect of community-based cancer-specific physical and occupational therapy (PT/OT) services on cancer-related disability is limited. We examined the effect of community-based outpatient cancer-specific PT/OT for performance-based and patient-reported outcomes (PROs) for adults with cancer. Methods: This retrospective, pre/posttreatment study included 185 adults seen for cancer rehabilitation (PT/OT). Demographic and clinical data were patient-reported. Patient-Reported Outcomes Measurement Information System (PROMIS) measures included global physical health (GPH) and global mental health (GMH) scale (10 item); physical function (PF; 4-item), and ability to participate in social roles and activities (SRA; 4-item). Performance-based measures included hand grip strength (HGS) and the Timed Up and Go (TUG) test. We used descriptive statistics to evaluate patient characteristics, paired-samples t test to compare scores pre- and post-PT/OT, and independent-samples t test to compare the mean change for all outcomes between patients in the active and posttreatment groups. Results: Patients were predominantly female (n = 137; 75%), were 41 to 65 years old (n = 99; 57%). The majority had been diagnosed with breast (n = 98; 53%) cancer. Most (n = 115; 62.2%) patients completed at least one follow-up evaluation over 6 ± 4.5 weeks. A significant effect (P &lt; .05; Cohen d = 0.21-0.35) was observed for GPH, SRA, HGS, and TUG test. There was no difference in average effect between the active and posttreatment groups. Conclusions: Community-based cancer-specific PT/OT has a significant effect on the functioning and participation of adults with cancer. Implications for Cancer Survivors: Community-based cancer rehabilitation services may benefit cancer survivors' functioning and health-related quality of life across the cancer continuum.

Increasing Referrals of Patients With Gastrointestinal Cancer to a Cancer Rehabilitation Program: A Quality Improvement Initiative

People with cancer are at risk for initial, late, and long-term effects of cancer and its treatments. Cancer rehabilitation (CR) focuses on prevention/treatment of these sequelae and optimization of physical, social, and vocational functioning. Our center has a multidisciplinary impairment-driven outpatient CR program, but referrals of patients with GI cancer were low. We aimed (for 2019, relative to 2018) (1) to increase CR referrals of patients with GI cancer by 50% and (2) to increase the proportion of referrals coming from oncologists. Balancing measures included inappropriate referrals and cancellations. A rapid cycle improvement approach was used to optimize GI referrals to the CR program. Barriers to CR referral were identified through a literature review and informal interviews of GI clinicians. Barriers included (a) knowledge of CR program existence, (b) awareness of the referral process, (c) time, and (d) lack of CR program exposure. The team used Plan-Do-Study-Act (PDSA) cycles every 2 months from January to December 2019 to address barriers. A p-chart was used to analyze the results. PDSA cycles included CR program advertisement, a presentation to GI staff, nurse-led patient identification, patient-facing posters, and clinician thank-you emails. The p-chart showed a 100% relative increase in referral numbers and an improvement in the percentage of patients referred by oncologists from 51% to 75%. There was no significant change in inappropriate referrals or cancellations. Through PDSA cycles, we improved the total number of patients with GI cancer and percentage referred by an oncologist to a CR program. Future work will assess sustainability.

Prevalence and Risk Factors of Adhesive Capsulitis in Asian Breast Cancer Patients Undergoing an Outpatient Community Cancer Rehabilitation Program

ObjectivesTo investigate the prevalence and risk factors for adhesive capsulitis in postoperative breast cancer patients up to 5 years after surgery who were attending an outpatient community cancer rehabilitation program, and to determine whether any significant relationship exists between arm lymphedema and adhesive capsulitis. DesignCross-sectional observational study. SettingNational cancer rehabilitation center. ParticipantsAsian women (N=135) who underwent breast surgery and were referred for an outpatient community cancer rehabilitation program. InterventionsNot applicable. Main Outcome MeasuresPresence of adhesive capsulitis, lymphedema. ResultsThe prevalence of adhesive capsulitis and lymphedema in this population was 22.2% and 33.3%, respectively. A history of mastectomy (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.23-12.63; P=.021), mastectomy with reconstruction (OR, 2.72; 95% CI, 1.27-30.54; P=.024), and lymphedema (OR, 7.92; 95% CI, 2.73-22.95; P<.001) were found to be significantly associated with adhesive capsulitis on multivariate analysis. ConclusionsAdhesive capsulitis and lymphedema are common in breast cancer survivors. The design of cancer rehabilitation programs for breast cancer survivors should include surveillance and management of adhesive capsulitis, especially in the presence of lymphedema.

Cancer Patients' Perception of Usefulness of Wearable Exercise Trackers.

To determine the feasibility and perception of usefulness of wearable trackers in inpatient and outpatient cancer rehabilitation patients. Prospective study. Acute inpatient rehabilitation and outpatient clinic at a tertiary cancer center. Adult cancer patients (N = 100). Participants were provided with wearable trackers for the duration of the study. Survey regarding feasibility (as defined as equal or more than two-thirds of participants reporting use of the wearable tracker) and usefulness of the wearable tracker and Edmonton Symptom Assessment Scale (ESAS-FS) in both inpatient and outpatient populations. Activity minutes, number of steps, heart rate, and sleep data were collected from the wearable tracker. Patients reported the use of a wearable tracker is feasible, with 48/50 (96%) outpatients and 47/50 (94%) inpatients reported wearing the wearable tracker daily and 37/49 (76%) outpatients and 29/50 (58%) inpatients reported that they would continue to wear the wearable tracker after this study. The majority of cancer patients (41/49 [84%] of outpatient and 33/50 [66%] of inpatient patients) reported that the wearable tracker was useful and 41/49 (84%) outpatients and 27/50 (54%) inpatients perceived the wearable tracker as helping to increase physical activity. The use of wearable trackers in cancer patients is feasible and patients perceive wearable trackers as useful in both the inpatient and outpatient rehabilitation setting. Physical activity in these patients was better in the outpatient population, as expected because of less medical acuity.

Evaluation of outpatient cancer rehabilitation for upper extremity functioning for individuals with breast cancer.

287 Background: Specialized cancer rehabilitation is recommended for individuals with breast cancer from diagnosis throughout survivorship to mitigate the negative acute, late and lasting effects of cancer and cancer treatment on upper extremity functioning. However, evidence supporting the impact of community-based outpatient rehabilitation services is lacking, especially for older adults. Methods: Individuals with breast cancer attended cancer-specialized outpatient physical or occupational therapy provided by a single institution with multiple locations across the US in 2019, and completed the Quick DASH (Disabilities of the Arm, Shoulder and Hand). From de-identified rehabilitation records, we abstracted patient and therapy characteristics, Quick DASH scores and therapy satisfaction scores (0-10 point scale) for individuals with a history of breast cancer (identified by ICD code). We used descriptive statistics to summarize characteristics, paired samples t-tests to evaluate Quick DASH scores from initial evaluation (pre) and discharge (post) therapy, and independent samples t-test to compare mean pre-post difference for individuals younger than 65 ( &lt; 65) versus 65 and older (≥ 65). Results: Patients ( N= 556) were 60.56 ± 12.24 (range = 31.52-89.95) years old and predominantly female ( n= 551, 99.1%). They attended cancer rehabilitation (Physical: n= 477, 85.8%, Occupational: n = 79 (14.2%)) for a median of 8 ( IQR= 5.0 – 13.0) sessions over 8.97 ± 7.57 (range = 0.71-47.7) weeks. Average pre-post change in Quick DASH score (-13.51) was significant (p &lt; .01) and exceeded the validated minimal clinically important difference (-11.20). There was no significant difference between average pre-post change for Quick Dash scores between &lt; 65 (n = 334, 60.1%) and ≥ 65 (n = 222, 39.9%) groups (-15.84 vs. -10.01, p = .07). Therapy satisfaction was rated high (median = 10.0, IQR = 10.0-10.0). Conclusions: Specialized rehabilitation for individuals with breast cancer was associated with statistically and clinically significant improvement in upper extremity function and high rates of satisfaction. Older adults demonstrated benefits similar to younger adults. These findings add to the growing evidence for specialized outpatient cancer rehabilitation.