According to a new study, telerehabilitation can help patients with advanced cancer by improving function and decreasing pain, length of hospital stay, and requirements for postacute care.
Patients with advanced cancer can experience disabling losses of function that impact their quality of life and increase their use of health care services. In addition, impaired mobility can increase the frequency and length of hospital stays. Rehabilitation services and conditioning activities can help to reduce loss of mobility and function, but few patients with cancer receive this care, especially in the early stages of disability, when it would be most effective.
In order to increase access to rehabilitation services, researchers set out to investigate whether supportive care delivered via telerehabilitation with or without pharmacological pain management could improve function, diminish pain, and reduce inpatient hospital stays among patients with reduced mobility and stage IIIC or IV solid or hematologic cancer.
For the study, published in JAMA Oncology, 516 patients were randomly assigned in a 1:1:1 ratio either to a control arm or to one of two therapeutic intervention arms: telerehabilitation alone or telerehabilitation in combination with nurse-coordinated pharmacological pain management. The study population included 257 women and 259 men, with a mean age of 65.6 years.
In comparison with the control arm, the telerehabilitation-only arm had improved function, improved quality of life, and fewer days in the hospital. Both the telerehabilitation-only and telerehabilitation/pain management arms had reductions in pain interference and average intensity, as well as higher odds of home discharge. The researchers conclude that collaborative telerehabilitation modestly improved outcomes for function and pain and decreased hospital length of stay and postacute care needs, but the addition of pharmacological pain management did not enhance these outcomes.
"Our finding of reduced hospital use among participants in the telerehabilitation arms adds to growing evidence that proactively addressing functional impairment among vulnerable patients reduces hospital utilization," comment the study authors, led by Andrea L. Cheville, MD, MSCE, Professor and Chair for Research in the Department of Physical Medicine & Rehabilitation at Mayo Clinic in Rochester, Minnesota. "Although strongly associated with health care use, functional impairment has been limitedly targeted in efforts to reduce overall costs of care. Reducing the requirement for institutional care among patients with late-stage cancer has the potential for high financial return given that hospitalizations account for a large proportion of health care spending in this population, drive regional variation in costs of care, and are not associated with survival or [quality of life]."
The study authors emphasize the applicability of their outcomes: "Collaborative telerehabilitation that integrates impairment and pain management may be considered a viable component of comprehensive cancer care for patients with advanced-stage cancer experiencing mild disability."
For More Information
Cheville AL, Moynihan T, Herrin J, et al (2019). Effect of collaborative telerehabilitation on functional impairment and pain among patients with advanced-stage cancer: a randomized clinical trial. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2019.0011
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