Impact of a Short-Term Occupation-Based Program on Improving Pain,Fatigue,and Occupational Performance in Women With Cancer Living in the Community

PURPOSE: Improvements in medical treatments have led to women with cancer living longer in the community. However, there are a limited number of services that help these women re-engage in occupations on completion of treatment (Pergolotti, Cutchin, Weinberger, & Meyer, 2014). The demand to provide services for this growing population of cancer survivors is becoming a national concern, and requires occupational therapists to address their needs. The purpose of this study was to engage women diagnosed with cancer in activities that have a physical, social, and emotional impact and to evaluate if they show improvements in occupational performance and a decrease in pain and fatigue.

DESIGN: This study used a prospective, one group pretest-posttest design. Women diagnosed with cancer living in the community were purposively recruited. We targeted underserved communities in urban, suburban and rural areas. Recruitment flyers were posted in clinics, hospitals, churches, and support communities. Eligibility criteria for this study were women diagnosed with cancer, 21+ years, and clearance from an MD to participate in the program. We recruited 90 women for this study over three years.

METHOD: The intervention was a one-week activity based program, based on the Occupational Therapy Practice Framework (AOTA, 2014). Activities included physical, emotional, spiritual, sensory, and educational components. Three outcome measures were used: 1) Canadian Occupational Performance Measure (COPM) that measures changes in a client’s perception of occupational performance and satisfaction over time (Dedding, Cardol, Eyssen, & Beelen, 2004), 2) Brief Pain Inventory (BPI) that measures pain severity and interference with function (Cleeland, 2006), and, 3) Brief Fatigue inventory (BFI) that measure fatigue severity and interference with function. All three assessments were administered at pretest (day 1), post-test (day 5) and at 6-week follow-up. Data was analyzed using IBM SPSS 23.0 (Version 23; IBM Corp., Armonk, NY). Six repeated measures ANOVA’s were conducted to evaluate differences between the three time points for the COPM, BPI and BFI. Partial Eta Squared (η_p ²) were used to calculate effect sizes.

RESULTS: A significant difference was obtained in the pain interference scale (p=0.01, η_p ² = 0.058) and the fatigue interference scale (p=0.000, η_p ² = 0.112) with small effect sizes across the three time points. COPM performance scores differed statistically significantly with a small effect size (p = 0.000, η_p ² = 0.180). COPM satisfaction was also statistically significant with a small effect size (p = 0.000, η_p ² = 0.213). Post-hoc analyses for COPM performance and satisfaction, pain interference, and fatigue interference across the different time points showed that all comparisons were significant (p<0.000) with small effect sizes.

CONCLUSION: This study established the effectiveness of an activity program in improving the perception of occupational performance and satisfaction and decreasing pain and fatigue of women diagnosed with cancer living in the community. This implies that participation in the program translated to improvements in occupational functioning. This has tremendous implications that highlight the role of being engaged in activities and its impact on functioning.

IMPACT: This study tested a community-based intervention for women with cancer. Community practice and health of women is an emerging area of OT practice and this study provides an evidence-based intervention. This type of programming, though of a short duration, has a long-term impact on women with cancer living in the community, who typically do not receive occupational therapy services.

References

AOTA (2014). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 68(1), S1–S48. doi:10.5014/ajot.2014.682006

Dedding, C., Cardol, M., Eyssen, I. C., & Beelen, A. (2004). Validity of the Canadian Occupational Performance Measure: A client centered outcome measurement. Clinical Rehabiliation, 18(6), 660-667.

Pergolotti, M., Cutchin, M. P., Weinberger, M., & Meyer, A. M. (2014). Occupational therapy use by older adults with cancer. American Journal of Occupational Therapy, 68(5), 597-607.

Cleeland, C. S. (2006). The measurement of pain from metastatic bone disease: capturing the patient’s experience. Clinical Cancer Research, 12(20), 6236s-6242s.