A new model of early, integrated palliative care: palliative rehabilitation for newly diagnosed patients with non-resectable cancer

  • Lise NottelmannEmail author
  • Lars Henrik Jensen
  • Tove Bahn Vejlgaard
  • Mogens Groenvold
Original Article



The aim of this paper is to describe a model of palliative rehabilitation for newly diagnosed advanced cancer patients and present data on how it was utilised during a randomised controlled trial (RCT).


We designed a highly flexible, multidisciplinary model of palliative rehabilitation consisting of a “basic offer” and tailored elements. The model was evaluated in the setting on an RCT investigating the effect of systematic referral to a palliative rehabilitation clinic concurrently with standard oncology treatment or standard treatment alone. The basic offer of palliative rehabilitation was two consultations and a 12-week possibility of contacting a palliative rehabilitation team, if needed. In addition, patients and family caregivers could be offered participation in a 12-week patient/caregiver school combined with individually tailored physical exercise in groups, individual consultations, or both. Contacts with the palliative rehabilitation team and participant evaluation were registered prospectively.


Between December 2014 and December 2017, 132 adults with newly diagnosed advanced cancer were seen in the palliative rehabilitation outpatient clinic. Twenty percent of the participants received the basic offer only (n = 26), 45% additionally participated in the group program (n = 59), and 35% received supplementary individual consultations without participating in the group program (n = 47). The intervention was primarily led by nurses, and the main themes of the individual consultations were coping, pain, and nutrition. When asked if they would recommend the intervention to others in the same situation, 93% of the respondents agreed, 7% partly agreed, and no one disagreed.


The new model of palliative rehabilitation presented here had a flexibility to meet the needs of the participants and led to a very high degree of patient satisfaction. It could serve as an inspiration to other cancer centres wanting to integrate palliative care into standard oncology services.


Palliative care Rehabilitation Quality of life Neoplasms Models of care Patient satisfaction 



The authors first and foremost wish to thank the patients and family caregivers participating in the study and the Patient and Relatives Council of Vejle Hospital for important input and inspiring discussions. We thank the Danish Cancer Society for conducting by invitation-only workshops during the trial period with valuable exchange of knowledge with other researchers working with patient and caregiver involvement. We thank the employees in the palliative rehabilitation team, especially facilitating nurses Birgitte Skov Zellweger and Grethe Misser Hansen for their important contribution to the study. We thank Karin Larsen for linguistic editing of the manuscript.

Funding information

This study is financially supported by the Danish Cancer Society, the Research Council of Lillebaelt Hospital, the Andreas and Grethe Gullev Hansen Foundation and the Hede Nielsen Family Foundation.

Compliance with ethical standards

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

The study protocol, including all written material intended for study participants, was approved by The Regional Committees on Health Research Ethics for Southern Denmark on April 2, 2014 (Project ID S-20140038).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, von Roenn JH (2012) American Society of Clinical Oncology Provisional Clinical Opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30:880–887CrossRefGoogle Scholar
  2. 2.
    Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302:741–749CrossRefGoogle Scholar
  3. 3.
    Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ (2004) The comprehensive care team. Arch Intern Med 164:83CrossRefGoogle Scholar
  4. 4.
    Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742CrossRefGoogle Scholar
  5. 5.
    Cherny N, Catane R, Schrijvers D, Kloke M, Strasser F (2010) European Society for Medical Oncology (ESMO) Program for the Integration of Oncology and Palliative Care: a 5-year review of the designated centers’ incentive program. Ann Oncol 21:362–369CrossRefGoogle Scholar
  6. 6.
    Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 35:96–112CrossRefGoogle Scholar
  7. 7.
    WHO | WHO Definition of Palliative Care [Internet]. WHO. World Health Organization; 2012 [cited 2018 Nov 12]. Available from:
  8. 8.
    Hawley P (2017) Barriers to access to palliative care. Palliat Care 10:1178224216688887PubMedPubMedCentralGoogle Scholar
  9. 9.
    Cheville AL, Kornblith AB, Basford JR (2011) An examination of the causes for the underutilization of rehabilitation services among people with advanced cancer. Am J Phys Med Rehabil 90:S27–S37CrossRefGoogle Scholar
  10. 10.
    Cheville AL, Morrow M, Smith SR, Basford JR (2017) Integrating function-directed treatments into palliative care. PM R 9:S335–S346CrossRefGoogle Scholar
  11. 11.
    Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M et al (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337:a1655CrossRefGoogle Scholar
  12. 12.
    Schmidt K, Vogt L, Thiel C, Jäger E, Banzer W (2013) Validity of the six-minute walk test in cancer patients. Int J Sports Med 34:631–636CrossRefGoogle Scholar
  13. 13.
    Norman K, Stobäus N, Smoliner C, Zocher D, Scheufele R, Valentini L, Lochs H, Pirlich M (2010) Determinants of hand grip strength, knee extension strength and functional status in cancer patients. Clin Nutr 29:586–591CrossRefGoogle Scholar
  14. 14.
    Jones CJ, Rikli RE, Beam WC (1999) A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 70:113–119CrossRefGoogle Scholar
  15. 15.
    Nottelmann L, Groenvold M, Vejlgaard TB, Petersen MA, Jensen LH (2017) A parallel-group randomized clinical trial of individually tailored, multidisciplinary, palliative rehabilitation for patients with newly diagnosed advanced cancer: the Pal-Rehab study protocol. BMC Cancer 17:560CrossRefGoogle Scholar
  16. 16.
    Groenvold M, Klee MC, Sprangers MA, Aaronson NK (1997) Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 50:441–450CrossRefGoogle Scholar
  17. 17.
    Davies E, Higginson IJ (2005) Systematic review of specialist palliative day-care for adults with cancer. Support Care Cancer 13:607–627CrossRefGoogle Scholar
  18. 18.
    Farber SJ, Egnew TR, Herman-Bertsch JL (2002) Defining effective clinician roles in end-of-life care. J Fam Pract 51:153–158PubMedGoogle Scholar
  19. 19.
    Hudson P, Remedios C, Zordan R, Thomas K, Clifton D, Crewdson M et al (2012) Guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. J Palliat Med Mary Ann Liebert Inc 15:696–702Google Scholar
  20. 20.
    Adsersen M, Hansen MB, Groenvold M. DMCG-PAL [Internet]. Danish Palliat. Database Annu. Rep. 2016 [cited 2018 May 28]. Available from:
  21. 21.
    Starks H, Diehr P, Curtis JR (2009) The challenge of selection bias and confounding in palliative care research. J Palliat Med Mary Ann Liebert Inc 12:181–187Google Scholar
  22. 22.
    Hoerger M, Greer JA, Jackson VA, Park ER, Pirl WF, El-Jawahri A et al (2018) Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. J Clin Oncol 36:1096–1102CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Regional Health Research, Department of Oncology, Palliative Team, Vejle HospitalUniversity of Southern DenmarkVejleDenmark
  2. 2.Danish Colorectal Cancer Center South, Vejle Hospital, Institute of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
  3. 3.The Research Unit, Department of Palliative Medicine, Bispebjerg HospitalCopenhagen University HospitalCopenhagenDenmark
  4. 4.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark

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