Effect of Collaborative Telerehabilitation on Functional Impairment and Pain Among Patients With Advanced-Stage Cancer

Abstract

IMPORTANCE Most patients with advanced-stage cancer develop impairment and pain-driven functional losses that jeopardize their independence. OBJECTIVE To determine whether collaborative telerehabilitation and pharmacological pain management improve function, lessen pain, and reduce requirements for inpatient care. DESIGN, SETTING, AND PATIENTS The Collaborative Care to Preserve Performance in Cancer (COPE) study was a 3-arm randomized clinical trial conducted at 3 academic medical centers within 1 health care system. Patient recruitment began in March 2013 and follow-up concluded in October 2016. Participants (N = 516) were low-level community or household ambulators with stage IIIC or IV solid or hematologic cancer. INTERVENTIONS Participants were randomly assigned to the (1) control arm, (2) telerehabilitation arm, or (3) telerehabilitation with pharmacological pain management arm. All patients underwent automated function and pain monitoring with data reporting to their care teams. Participants in arms 2 and 3 received 6 months of centralized telerehabilitation provided by a physical therapist-physician team. Those in arm 3 also received nurse-coordinated pharmacological pain management. MAIN OUTCOMES AND MEASURES Blinded assessment of function using the Activity Measure for Postacute Care computer adaptive test, pain interference and average intensity using the Brief Pain Inventory, and quality of life using the EQ-5D-3L was performed at baseline and months 3 and 6. Hospitalizations and discharges to postacute care facilities were recorded. RESULTS The study included 516 participants (257 women and 259 men; mean [SD] age, 65.6 [11.1] years), with 172 randomized to 1 of 3 arms. Compared with the control group, the telerehabilitation arm 2 had improved function (difference, 1.3; 95% CI, 0.08-2.35; P = .03) and quality of life (difference, 0.04; 95% CI, 0.004-0.071; P = .01), while both telerehabilitation arms 2 and 3 had reduced pain interference (arm 2, −0.

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

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“…87 Several studies noted reductions in unplanned hospitalizations, lengths of stay, and emergency room visits among patients who participated in exercise programming. 88,89 Although it is often assumed that multidimensional programs offer larger benefits, they are also inherently more expensive. It is as yet unclear whether such programs are more cost-effective compared with monodimensional programs.…”

A health services research agenda to fully integrate cancer rehabilitation into oncology care

“…There are a few examples in which the use of technology can support virtual cancer exercise and cancer rehabilitation systems, but they need further testing for feasibility, usability, acceptability, and implementation for a variety of populations . Telehealth care is one type of delivery that needs further testing but recently was found to improve function, decrease pain, and decrease health care service use, aiding community clinicians and increasing the reach of cancer rehabilitation in rural and/or low‐resource settings . The use of technology also can revolutionize the evaluation of value metric reporting, and by adding real‐time assessment of outcomes and quality.…”

Cost‐effectiveness of the Collaborative Care to Preserve Performance in Cancer (COPE) trial tele‐rehabilitation interventions for patients with advanced cancers

“…The randomized clinical COPE trial assigned 516 patients who were experiencing functional limitations to: (a) a control group (arm A), (b) tele‐rehabilitation (arm B), and (c) tele‐rehabilitation plus pharmacological pain management (arm C). Clinical outcomes of this trial have been reported elsewhere . All arms underwent automated home‐based monitoring of physical functioning and pain via telephone and/or internet, with reporting of these data to their care teams.…”

“…These assumptions have been challenged by reports of reduced hospital and emergency department service utilization among patients randomized to quality of life‐ and symptom‐directed interventions that improve pain and/or function . The recently reported Collaborative Care to Preserve Performance in Cancer (COPE) was notable among these efforts as the first to significantly reduce hospital lengths of stay and requirements for post‐acute care by targeting pain and function . Moreover, the COPE trial enrolled patients with advanced stage cancers, a population whose hospitalizations account for up to two‐thirds of their health‐care costs.…”