A systematic review of rehabilitation and exercise recommendations in oncology guidelines

Abstract

Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirtyseven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors. CA Cancer

Development of the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) Algorithm

“…has the potential to optimize patient care via improved decision making about the safest and most e cacious exercise referral to improve patients' long-term health, function, and quality of life across the cancer continuum. American College of Sports Medicine guidelines for exercise testing and prescription [19] Acvtiv Onco Model [20] Chronic [21] American College of Sports Medicine guidelines for exercise testing and prescription [19] Cancer-speci c exercise risk screening tool [22] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 (National Comprehensive Cancer Network, 2020) [23] Macmillan Cancer Rehabilitation pathways [24] Yes or No: New, worsening or di culty managing any of the following conditions: lymphedema, ostomy, signi cant weight uctuations, infection, ataxia, malnourishment, severe fatigue, bone/back/neck pain and unusual weakness Acvtiv Onco Model [20] Macmillan Cancer Rehabilitation pathways [24] High risk signs/symptoms [21] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Macmillan Cancer Rehabilitation pathways [24] Cancer-speci c exercise risk screening tool [22] Acvtiv Onco Model [20] [24] National Comprehension Cancer Network (NCCN): Survivorship Clinical Practice Guidelines V1.2020 [23] Focused review of safety considerations in cancer rehab [17] The [25] Exercise in Medicine in Oncology: ACSM 2019 Roundtable [2] Macmillan Cancer Rehabilitation pathways [24] Acvtiv Onco Model [20] Cancer-speci c exercise risk screening tool [22] Association of Clinical Oncology (ASCO) Management of Older Adults Guideline [26] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] International Society of Geriatric Oncology (SIOG) recommendations for management of cancer-related cognitive decline [27] Level 2 side effects Yes or No, presence of ≥1 of the following factors:…”

“…Macmillan Cancer Rehabilitation pathways [24] Acvtiv Onco Model [20] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] Dyspnea Level functional factors Yes or No, presence of ≥1 of the following factors:…”

“…Fall in previous six months Other mobility issues, including: Decreased balance, Decreased gait speed, Mild bodily pain when moving, di culty with ADL/IADL Macmillan Cancer Rehabilitation pathways [24] Association of Clinical Oncology (ASCO) Management of Older Adults Guideline [26] Cancer and Aging Research Group Fall Risk Model [28] Exercise in Medicine in Oncology: ACSM 2019 Roundtable [2] The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise [6] Level 1 side effects Yes or No, presence of ≥1 of the following factors:…”

“…High levels of research evidence demonstrate the role of exercise in cancer prevention and survival [3,4], exercise prescription guidelines for common cancer-related effects (fatigue, anxiety, depression, lymphedema, etc.) have been developed [5], and 46 international professional oncology societies or organizations recommend rehabilitation or exercise services [6]; including the American Cancer Society, American Society for Clinical Oncology (ASCO) and seven different clinical practice guidelines from the National Comprehensive Cancer Network (NCCN). Leading researchers and clinical organizations agree survivors should 'avoid inactivity', and oncology clinicians should screen and refer survivors to exercise or rehabilitations programs for specialized care based on their individual needs.…”

An Evaluation of the Provision of Oncology Rehabilitation Services via Telemedicine Using a Participatory Design Approach

“…The majority of patients living with and beyond cancer will experience physical, cognitive and emotional impacts as a result of their cancer diagnosis and/or treatments received [1]. Functional impairments during and following a cancer diagnosis and treatment can impact an individual's social and vocational roles and can result in poorer survival outcomes [2]. Rehabilitation services provide vital interventions for people aiming to reduce the potential impact of cancer and cancer treatments on physical, social, emotional and cognitive functioning [2].…”