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

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Abstract

Objective

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.

Methods

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).

Results

PT/OT patients (N = 84) were 64.63 ± 11.04 years 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).

Conclusion

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.

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Data availability

Data and materials are available upon request to the corresponding author.

Code availability

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Notes

  1. https://www.apta.org/your-practice/payment/coding-billing/tiered-evaluation-codes/tiered-codes-evaluation-table

  2. https://www.aota.org/~/media/Corporate/Files/Advocacy/Federal/Evaluation-Codes-Overview-2016.pdf

References

  1. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34. https://doi.org/10.3322/caac.21551

    Article  PubMed  Google Scholar 

  2. Carter J, Huang HQ, Armer J et al (2021) The Lymphedema and Gynecologic cancer (LeG) study: the impact of lower-extremity lymphedema on quality of life, psychological adjustment, physical disability, and function. Gynecol Oncol 160:244–251. https://doi.org/10.1016/J.YGYNO.2020.10.023

    Article  PubMed  Google Scholar 

  3. Reb AM, Cope DG (2019) Quality of life and supportive care needs of gynecologic cancer survivors. West J Nurs Res 41:1385–1406. https://doi.org/10.1177/0193945919846901

    Article  PubMed  Google Scholar 

  4. Gonzalez BD, Manne SL, Stapleton J et al (2017) Quality of life trajectories after diagnosis of gynecologic cancer: a theoretically based approach. Support Care Cancer 25:589–598. https://doi.org/10.1007/S00520-016-3443-4/TABLES/4

    Article  PubMed  Google Scholar 

  5. Zandbergen N, de Rooij BH, Vos MC, Pijnenborg JMA, Boll D, Kruitwagen RFPM, van de Poll-Franse LV, Ezendam NPM (2019) Changes in health-related quality of life among gynecologic cancer survivors during the two years after initial treatment: a longitudinal analysis. Acta Oncol 58(5):790–800. https://doi.org/10.1080/0284186X.2018.1560498

    Article  PubMed  Google Scholar 

  6. Teo I, Cheung YB, Lim TYK et al (2018) The relationship between symptom prevalence, body image, and quality of life in Asian gynecologic cancer patients. Psychooncology 27:69–74. https://doi.org/10.1002/PON.4457

    Article  PubMed  Google Scholar 

  7. Doll KM, Barber EL, Bensen JT et al (2016) The impact of surgical complications on health-related quality of life in women undergoing gynecologic and gynecologic oncology procedures: a prospective longitudinal cohort study. Am J Obstet Gynecol 215:457.e1-457.e13. https://doi.org/10.1016/J.AJOG.2016.04.025

    Article  Google Scholar 

  8. Pergolotti M, Bailliard A, McCarthy L, et al (2020) Women’s experiences after ovarian cancer surgery: distress, uncertainty, and the need for occupational therapy. Am J Occup Ther 74:. https://doi.org/10.5014/ajot.2020.036897

  9. National Comprehensive Cancer Network (2021) Survivorship (Version 1.2021)

  10. Oza S, Badillo SA, Breevoort S (2020) Florendo J (2020) Women’s cancer rehabilitation: a review of functional impairments and interventions among breast and gynecologic cancer survivors. Curr Phys Med Rehabil Reports 83(8):217–228. https://doi.org/10.1007/S40141-020-00261-9

    Article  Google Scholar 

  11. Pergolotti M, Covington KR, Lightner AN et al (2021) Association of outpatient cancer rehabilitation with patient-reported outcomes and performance-based measures of function. Rehabil Oncol 39:137–142. https://doi.org/10.1097/01.REO.0000000000000245

    Article  Google Scholar 

  12. Leach HJ, Covington K, Pergolotti M et al (2018) Translating research to practice using a team-based approach to cancer rehabilitation: a physical therapy and exercise-based cancer rehabilitation program reduces fatigue and improves aerobic capacity. Rehabil Oncol 36:206–213. https://doi.org/10.1097/01.REO.0000000000000123

    Article  Google Scholar 

  13. Kirkham AA, Klika RJ, Ballard T et al (2016) Effective translation of research to practice: hospital-based rehabilitation program improves health-related physical fitness and quality of life of cancer survivors. J Natl Compr Canc Netw 14:1555–1562

    Article  Google Scholar 

  14. Rooij BH de, Hagan T, Post KE, et al (2018) Survivorship care planning in gynecologic oncology: perspectives from patients, caregivers, and health care providers. 101200/JCO2018367_suppl63 36:63–63. https://doi.org/10.1200/JCO.2018.36.7_SUPPL.63

  15. Horn SD, Dejong G, Deutscher D (2012) Practice-based evidence research in rehabilitation: an alternative to randomized controlled trials and traditional observational studies. Arch Phys Med Rehabil 93:S127–S137. https://doi.org/10.1016/J.APMR.2011.10.031

    Article  PubMed  Google Scholar 

  16. (2020) Current Procedural Terminology (CPT)® 2021 Professional Edition. American Medical Association, Chicago, IL

  17. Dotson P (2013) CPT ® codes: what are they, why are they necessary, and how are they developed? Adv wound care 2:583–587. https://doi.org/10.1089/WOUND.2013.0483

    Article  Google Scholar 

  18. Reichheld FF (2003) The one number you need to grow. In: Harv. Bus. Rev. https://hbr.org/2003/12/the-one-number-you-need-to-grow. Accessed 27 May 2022

  19. Measuring Your Net Promoter Score | Bain & Company. https://www.netpromotersystem.com/about/measuring-your-net-promoter-score. Accessed 27 May 2022

  20. Beresford L, Norwood T (2022) The effect of mobile care delivery on clinically meaningful outcomes, satisfaction, and engagement among physical therapy patients: observational retrospective study. JMIR Rehabil Assist Technol 9:.https://doi.org/10.2196/31349

  21. Baratta-Ziska DPTF, Oledzka M, Fritz Eannucci E, Slevin C (2021) Patient satisfaction utilizing telehealth for pediatric physical and occupational therapy during COVID-19. Arch Phys Med Rehabil 102:e107. https://doi.org/10.1016/J.APMR.2021.07.503

    Article  PubMed Central  Google Scholar 

  22. de Vet HC, Terwee CB, Ostelo RW et al (2006) Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 4:54. https://doi.org/10.1186/1477-7525-4-54

    Article  PubMed  PubMed Central  Google Scholar 

  23. Binkley JM, Stratford PW, Lott SA, Riddle DL (1999) The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther 79:371–383. https://doi.org/10.1093/PTJ/79.4.371

    Article  CAS  PubMed  Google Scholar 

  24. Rietberg MB, Van Wegen EEH, Kwakkel G (2010) Measuring fatigue in patients with multiple sclerosis: reproducibility, responsiveness and concurrent validity of three Dutch self-report questionnaires. 103109/09638281003734458 32:1870–1876. https://doi.org/10.3109/09638281003734458

  25. Stratford P, Gill C, Westaway M, Binkley J (2009) Assessing disability and change on individual patients: a report of a patient specific measure. 103138/ptc474258 47:258–263. https://doi.org/10.3138/PTC.47.4.258

  26. Weiss J, Daniel T (2018) Validation of the lymphedema life impact scale version 2: a condition- specific measurement tool for persons with lymphedema. Rehabil Oncol 36:28–36. https://doi.org/10.1097/01.REO.0000000000000096

    Article  Google Scholar 

  27. Mehta SP, Fulton A, Quach C et al (2016) Measurement properties of the Lower Extremity Functional Scale: a systematic review. J Orthop Sports Phys Ther 46:200–216. https://doi.org/10.2519/JOSPT.2016.6165/ASSET/IMAGES/LARGE/JOSPT-200-FIG001.JPEG

    Article  PubMed  Google Scholar 

  28. Dingemans SA, Kleipool SC, Mulders MAM et al (2017) Normative data for the Lower Extremity Functional Scale (LEFS). Acta Orthop 88:422. https://doi.org/10.1080/17453674.2017.1309886

    Article  PubMed  PubMed Central  Google Scholar 

  29. Fisk JD, Ritvo PG, Ross L et al (1994) Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 18:S79–S83. https://doi.org/10.1093/CLINIDS/18.SUPPLEMENT_1.S79

    Article  PubMed  Google Scholar 

  30. Academy of Neurologic Physical Therapy ANPT Outcome Measures Recommendations. https://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations. Accessed 5 May 2022

  31. Nicholas P, Hefford C, Tumilty S (2012) The use of the Patient-Specific Functional Scale to measure rehabilitative progress in a physiotherapy setting. J Man Manip Ther 20:147–152. https://doi.org/10.1179/2042618612Y.0000000006

    Article  PubMed  PubMed Central  Google Scholar 

  32. Durlak JA (2009) How to select, calculate, and interpret effect sizes. J Pediatr Psychol 34:917–928. https://doi.org/10.1093/JPEPSY/JSP004

    Article  PubMed  Google Scholar 

  33. Marshall TF, Alfano CM, Sleight AG, et al. (2019) Consensus-building efforts to identify best tools for screening and assessment for supportive services in oncology. DisabilRehabil 1–8. https://doi.org/10.1080/09638288.2018.1555621

  34. Pergolotti M, Alfano CM, Cernich AN et al (2019) A health services research agenda to fully integrate cancer rehabilitation into oncology care. Cancer. https://doi.org/10.1002/cncr.32382

    Article  PubMed  Google Scholar 

  35. Do JH, Choi KH, Ahn JS, Jeon JY (2017) Effects of a complex rehabilitation program on edema status, physical function, and quality of life in lower-limb lymphedema after gynecological cancer surgery. Gynecol Oncol 147:450–455. https://doi.org/10.1016/J.YGYNO.2017.09.003

    Article  PubMed  Google Scholar 

  36. Dunberger G, Lindquist H, Waldenström A-C et al (2013) Lower limb lymphedema in gynecological cancer survivors—effect on daily life functioning. Support Care Cancer 21:3063–3070. https://doi.org/10.1007/s00520-013-1879-3

    Article  PubMed  Google Scholar 

  37. Hazewinkel MH, Sprangers MAG, Taminiau-Bloem EF et al (2010) Reasons for not seeking medical help for severe pelvic floor symptoms: a qualitative study in survivors of gynaecological cancer. BJOG 117:39–46. https://doi.org/10.1111/J.1471-0528.2009.02411.X

    Article  CAS  PubMed  Google Scholar 

  38. Yang EJ, Lim JY, Rah UW, Kim YB (2012) Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial. Gynecol Oncol 125:705–711. https://doi.org/10.1016/J.YGYNO.2012.03.045

    Article  PubMed  Google Scholar 

  39. (2021) Cancer Stat Facts. In: Natl. Cancer Inst. Surveillance, Epidemiol. End Results Progr. https://seer.cancer.gov/statfacts/. Accessed 12 Jun 2021

  40. Hediya Putri R, Afiyanti Y, Ungsianik T, Milanti A (2018) Supportive care needs and quality of life of patients with gynecological cancer undergoing therapy. Enferm Clin 28:222–226. https://doi.org/10.1016/S1130-8621(18)30072-X

    Article  Google Scholar 

  41. Jeppesen MM, Mogensen O, Dehn P, Jensen PT (2015) Needs and priorities of women with endometrial and cervical cancer. J Psychosom Obstet Gynecol 36:122–132. https://doi.org/10.3109/0167482X.2015.1059417

    Article  Google Scholar 

  42. National Comprehensive Cancer Network (2021) Uterine Neoplasms Guidelines

  43. Lin KY, Edbrooke L, Granger CL et al (2019) The impact of gynaecological cancer treatment on physical activity levels: a systematic review of observational studies. Brazilian J Phys Ther 23:79–92

    Article  Google Scholar 

  44. Suubi Muliira R, Natarajan J, Vergara G (2016) A review of interventions to enhance the quality of life for gynaecological cancer patients. Clin Obstet Gynecol Reprod Med 2:. https://doi.org/10.15761/COGRM.1000158

  45. Longpre S, Newman RM (2011) Occupational therapy’s role with oncology, Fact Sheet

  46. American Physical Therapy Association (2021) Physical Therapy Guide to Cancer. https://www.choosept.com/guide/physical-therapy-guide-cancer

  47. Al Maqbali M, Hughes C, Dunwoody L et al (2019) Exercise interventions to manage fatigue in women with gynecologic cancer: a systematic review. Oncol Nurs Forum 46:71–82

    Google Scholar 

  48. Huang HQ, Brady MF, Cella D et al (2007) Validation and reduction of FACT/GOG-Ntx subscale for platinum/paclitaxel-induced neurologic symptoms: a gynecologic oncology group study. Int J Gynecol Cancer 17:387–393. https://doi.org/10.1111/J.1525-1438.2007.00794.X

    Article  CAS  PubMed  Google Scholar 

  49. Polson K, Reid Duncan D, McNair PJ, Larmer P (2010) Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther 15:404–407. https://doi.org/10.1016/J.MATH.2010.03.008

    Article  PubMed  Google Scholar 

  50. Fritz JM, Irrgang JJ (2001) A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 81:776–788. https://doi.org/10.1093/PTJ/81.2.776

    Article  CAS  PubMed  Google Scholar 

  51. Anagnostis C, Gatchel RJ, Mayer TG (2004) The pain disability questionnaire: a new psychometrically sound measure for chronic musculoskeletal disorders. Spine (Phila Pa 1976) 29:2290–2302. https://doi.org/10.1097/01.BRS.0000142221.88111.0F

  52. Chok B, Gomez E (2000) The reliability and application of the Neck Disability Index in physiotherapy. Physiother Singapore 3:16–19

    Google Scholar 

  53. Schepens S, Goldberg A, Wallace M (2010) The short version of the Activities-specific Balance Confidence (ABC) scale: its validity, reliability, and relationship to balance impairment and falls in older adults. Arch Gerontol Geriatr 51:9–12. https://doi.org/10.1016/J.ARCHGER.2009.06.003

    Article  PubMed  Google Scholar 

  54. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395. https://doi.org/10.1067/MOB.2001.118659

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank the patients who participated in the therapy, Stacye Mayo for manuscript review, Tiffany Croteau for her administrative support, and Select Medical leadership and therapists in the following divisions/markets: Baylor Scott & White Institute for Rehabilitation, SSM Health Physical Therapy, Banner Physical Therapy, NovaCare Rehabilitation, and KORT Physical Therapy.

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Contributions

Authors Wood, Pergolotti, Kendig, Leiser, and Buckley conceptualized the study. Dr. Wood led data extraction, analysis, and initial manuscript preparation with support from Bartram, Hidde, Kendig, and Pergolotti. All authors reviewed and advised on the study and manuscript at each stage.

Corresponding author

Correspondence to Kelley C. Wood.

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This study was approved by the University of Southern Maine Institutional Review Board for the protection of human subjects (IRB #: 20–08-1521).

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Competing interests

Authors Wood, Pergolotti, and Kendig receive salaries from Select Medical. Author Bertram receives a salary from Baylor Scott and White Institute for Rehabilitation. The remaining authors have no relevant financial or non-financial interested to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of Select Medical or Baylor Scott and White Institute for Rehabilitation.

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Wood, K.C., Bertram, J., Kendig, T. et al. Community-based outpatient cancer rehabilitation services for women with gynecologic cancer: acceptability and impact on patient-reported outcomes. Support Care Cancer 30, 8089–8099 (2022). https://doi.org/10.1007/s00520-022-07227-8

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