Associations of Age and Sex with the Efficacy of Inpatient Cancer Rehabilitation: Results from a Longitudinal Observational Study Using Electronic Patient-Reported Outcomes

Abstract

Cancer rehabilitation is thought to increase the quality of life (QOL) and functioning of cancer survivors. It remains, however, uncertain whether subgroups benefit equally from rehabilitation. We wished to investigate the outcomes of multimodal rehabilitation according to age, sex and functioning. Patients of an Austrian rehabilitation center routinely completed the EORTC QLQ-C30 and the hospital anxiety and depression scale (HADS) questionnaires prior to (T1), and after rehabilitation (T2). To compare the outcomes between age groups (i.e., <40, 41–69, and ≥70 years), sex, and the Norton scale risk status, repeated measures of analyses of variance were calculated. A total of 5567 patients with an average age of 60.7 years were included, of which 62.7% were female. With T1 indicating the cancer survivors’ needs, older and high-risk patients reported lower functioning (all p < 0.001) and a higher symptom burden for most scales (all p < 0.05) before rehabilitation. Regardless of age, sex or risk status, the patients showed at a least small to medium improvement during rehabilitation for anxiety, depression, and most functioning and symptom scales. Some between-group differences were observed, none of which being of a relevant effect size as determined with the Cohen’s d. In conclusion, QOL is improved by rehabilitation in all patients groups, independently from age, sex, or the risk status.

The Role of Rehabilitation in the Treatment of Constipation in Oncological Patients

“…Of these studies, 15 were clinical trials comparing rehabilitation, osteopathy intervention, or acupuncture with (a) the constipation medication alone [19,29,33], (b) no other treatment (control or sham group) [21,24,[26][27][28][30][31][32]34], (c) different therapeutic programs (traditional versus pre-and postoperative rehabilitation program [22], different abdominal massage/manipulation [23,24] and acupuncture versus electroacupuncture [26]). Only one article reported a longitudinal observational study that compared different types of patients by age and sex, while also describing cancer localization [25]. Given its highly focused theme, the large sample size (6.757 patients), and the presence of control groups, it was included (Table 2) [25].…”

“…Only one article reported a longitudinal observational study that compared different types of patients by age and sex, while also describing cancer localization [25]. Given its highly focused theme, the large sample size (6.757 patients), and the presence of control groups, it was included (Table 2) [25].…”

“…Although physical exercise, abdominal massage, TENS and acupuncture have been suggested for managing constipation in oncological patients, no existing studies have proposed a specific protocol for managing cancer-related constipation. A physiotherapy pro-gram consisting of massages and aerobic and resistance training was shown to improve constipation symptoms in women, regardless of age, sex and frailty status [25]. The combination of abdominal massage, abdominal muscle stretching and education on proper defecation posture helped to alleviate constipation severity and related depression [20].…”

“…For specific rehabilitation strategies, the progression from 3 h of mobilization and walking on the first day after surgery to 8 h on the fourth postoperative day was proposed [22]. Additionally, a 21-day program of physiotherapy featuring massages and aerobic and resistance training consisting of 2-3 h of therapeutic units per working day [25] was suggested for its anti-constipation effect. Moreover, the current literature proposes TENS on both ankle joints (10 Hz) for 5 days [27], or once daily for 14 consecutive days, 30 min time each, at acupuncture points (Tianshu' and 'Zusanli') [19] 1.5 cm away from the midline of the T8 to T12 vertebrae (belonging to acupoints of B3, BL18, BL19, BL20 and BL21 in the traditional Chinese meridian theory system), RN12, and the pain point on the abdomen for 30 min [21].…”

“…The Cleveland Clinic constipation score [26] was also used. Quality of life was examined through the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) [19,26,28,29,[31][32][33][34], the European Organisation for Research and Treatment of Cancer EORTC Quality of life Core Questionnaire (EORTC QLQ-C) [22,23,25,27], the health-related quality of life score (HRQoL) [22] and the McGill Quality of Life Questionnaire (MQOL) [24]. Moreover, mood was studied with generic scales such as the Hospital Anxiety and Depression Scale (HADS) Questionnaires [25], the self-rating anxiety scale, and the self-rating depression scale [26].…”