Date Presented 04/05/19
CRF is the most commonly reported ongoing negative symptom impacting cancer survivors. Cancer survivors experience difficulty managing work after cancer, citing CRF as a major barrier to workability. Currently, functional interventions are highly limited. This poster will introduce results from a research pilot, combining physical exercise with functional activities for cancer survivors experiencing CRF and progressing to their previous vocational roles
Primary Author and Speaker: Naomi Dolgoy
Contributing Authors: Margaret McNeely
PURPOSE: Cancer-related-fatigue (CRF) is the most commonly identified ongoing cancer-related issue, reported by cancer survivors; CRF is marked by ongoing, fluctuating energy loss, negatively impacting up to 90% of cancer populations [1]. There is a nationally identified unmet need for CRF management. In the United States, more than 50% of documented return to work (RTW) attempts are unsuccessful, compared to similar-aged non-cancer cohorts, with cancer survivors citing fatigue as a major barrier to workability [2]. Despite the high prevalence and societal impacts of CRF, minimal effective, empirically developed management strategies exist, with sparse focus on RTW goals as primary endpoints [3]. Current RTW programs for cancer survivors appear to largely focus on general exercise-based interventions. While effective for addressing some symptoms of CRF, these interventions lack incorporation of functional targets. The purpose of this pilot trial was to explore the benefit of adding and/or integrating a functions-informed intervention component (e.g. occupational therapy-based intervention) targeting RTW goals, to an existing exercise program, for cancer survivors with CRF, intending to progress to their previous vocations.
DESIGN: A mixed-methods exploratory pilot study was utilized to explore feasibility and preliminary efficacy of tailored interventions. The study consisted of two phases:
Phase I – qualitative interview and goal-related assessment to address the perspectives of past exercise program participants in the process of, or currently working. (n=12)
Phase II – a prospective 6-week intervention study (n=7)
Participants were recruited via the parent exercise study. These individuals included adults of working age (18-65) with a cancer diagnosis.
METHOD: In Phase I, participants completed an informal interview and the Canadian Occupational Performance Measure (COPM) [4]. Phase II was informed by Phase I. In Phase II, an initial session with an occupational therapist addressed work-related concerns using the COPM and lift tests. A functional intervention consisting of 3-5 work-related exercises was developed for each participant, and completed 2-3x weekly for 6 weeks. Change scores on the COPM, lift tests, attendance, and fatigue scores were measured at the beginning and end of the study.
RESULTS: In Phase I, content analysis by five reviewers, and overall scores on the COPM, showed that all participants reported concerns with CRF and RTW, and all felt they would benefit if tailored RTW functional components were incorporated into their exercise programs. Utilizing these results to develop Phase II, each participant received an individualized functional activity program. For Phase II, preliminary findings show all participants report significant changes (2 point differences) in satisfaction and performance in the problematic areas targeted by the intervention.
CONCLUSION: The results point to two important findings: (1) exercise and functional interventions (physical and occupational therapies) may be carried out simultaneously to support cancer survivors in improving CRF symptoms and increasing functional activity tolerance; (2) having opportunity to develop individualized goals and discuss work-related concerns may be beneficial for cancer survivors intending to work. This research project reflects the important contribution that occupational therapy can make in targeting functional issues for cancer survivors. This study reflects the first in a series of studies intended to develop occupational therapy involvement in CRF management. Upcoming studies are intended to be carried out over the next 2 years, with focus on functional outcomes in CRF management and workability.
References
1. Campos MPO, Hassan BJ, Riechelmann R, & Del Giglio A. (2011). Cancer-related fatigue: a practical review. Annals of Oncology 22 (6): 1273-1279.DOI: https://doi.org/10.1093/annonc/mdq458
2. Gehrke AK, & Feuerstein M. (2017). Cancer, comorbidity and workplace discrimination: The US experience. European journal of cancer care, 26(5), e12748.
3. Sleight AG, & Duker LIS. (2016). Toward a Broader Role for Occupational Therapy in Supportive Oncology Care. The American Journal of Occupational Therapy, 70(4), 7004360030p1–7004360030p8. http://doi.org/10.5014/ajot.2016.018101
4. Law MC, Baptiste S, Carswell A, McColl MA, Polatajko H, & Pollock N. (1998). Canadian Occupational Performance Measure: COPM. CAOT Publ. ACE.
