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Collaborative Telerehabilitation in Patients With Advanced Cancer

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Key Points

  • Subjects assigned to telerehabilitation alone had the largest benefits: higher levels of function and independence, lessened pain, and fewer days spent in hospitals and nursing homes.
  • Outcomes were not enhanced with the addition of pharmacologic pain management.

Recent research suggests that remotely delivering rehabilitation services to patients with advanced cancer may improve their physical function, pain, and quality of life, while allowing them to spend less time in hospitals and nursing homes. These findings were published by Cheville et al in JAMA Oncology.

“Patients with late-stage cancers often lose their functional abilities and, with this loss, have a poorer quality of life and lowered ability to tolerate their cancer treatments,” said first study author Andrea Cheville, MD, a Mayo Clinic physical medicine and rehabilitation physician. “We know that rehabilitation and exercise can reverse or slow these losses, but it is often hard for patients to find—much less get—these services … We were interested in finding out whether an easily accessible telerehabilitation program could improve the function and independence of these patients.”

Methods

The trial involved 516 participants with late-stage cancers who were experiencing functional limitations. Subjects were randomly assigned to one of three groups: the first was a control group, where patients continued their usual care and activities; the second group received the telerehabilitation intervention; and a third group received medication-based pain management in addition to telerehabilitation. This third group was included to assess whether the addition of pain management would enhance benefits of telerehabilitation.

Telerehabilitation began with a physical therapist delivering individualized physical conditioning programs to participants by telephone. Progress was monitored, and feedback about patients' level of pain and physical function was shared between the physical therapists and patients online or by telephone, depending on patient preference. When necessary, patients were referred to local physical therapists for further refinement of their programs.

Findings

The results indicated that the subjects assigned to telerehabilitation alone had the largest benefits: higher levels of function and independence, lessened pain, and fewer days spent in hospitals and nursing homes.

“We were not surprised that telerehabilitation was beneficial, but we were very surprised that the addition of medication-based pain management did not further improve outcomes. We plan to explore this finding in future research,” said Dr. Cheville.

The authors concluded, “Collaborative telerehabilitation modestly improved function and pain, while decreasing hospital length of stay and the requirement for postacute care, but these outcomes were not enhanced with the addition of pharmacological pain management.”

Disclosure: The study authors’ full disclosures can be found at jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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