Systematic Review of Functional Outcomes in Cancer Rehabilitation.

OBJECTIVE: To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION: Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION: Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS: Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS: These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.

Nasometer 6200 Versus Nasometer II 6400: Effect on Measures of Nasalance.

Objective : This study compared measures of nasalance obtained using the Nasometer 6200 versus the Nasometer II 6400 in typically speaking young adult males and females for the nonnasal Zoo Passage, the phonetically balanced Rainbow Passage, and the Nasal Sentences. Design : Participants read passages at a comfortable pitch and loudness twice while wearing Nasometer 6200 or Nasometer II 6400 headgear. The order of Nasometer system was counterbalanced across participants, and the order of the reading passage was randomized. Participants : Participants consisted of 25 males (mean age = 21.22 years) and 25 females (mean age = 23.83 years). Main Outcome Measures : The main outcomes measures were nasalance scores (%) obtained for each system × passage per participant. Results : Results showed that the Nasometer 6200 and the Nasometer II 6400 differed significantly on mean nasalance for the Zoo Passage (mean difference = 7.15%) and the Rainbow Passage (mean difference = 3.05%) but not for the Nasal Sentences (mean difference = 0.77%). Intersystem correlations and measures of predictive accuracy indicated that the ability to predict Nasometer 6200 nasalance scores from Nasometer II 6400 scores was relatively weak. Conclusions : In addition to such factors as age, gender, and regional dialect, normative nasalance expectations and normal versus disordered nasalance cutoff scores must be considered with full knowledge of the specific system that was used to acquire the nasalance data. Intrasubject changes in nasalance can only be validly assessed when test versus retest measurements have been acquired using the same nasalance system.

The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review.

PURPOSE: To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS: A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS: Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS: The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS: Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.

Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function.

BACKGROUND: This study investigated the effects of 2 different swallowing exercise regimens performed during radiation therapy with/without chemotherapy on swallowing function. METHODS: Fifty patients were recruited prospectively to 2 groups (the exercise group, n = 26 and the repetitive swallow group, n = 24). Functional Oral Intake Scale (FOIS) scores and percutaneous endoscopic gastrostomy (PEG) placements were compared at posttreatment and at 3 months. RESULTS: The exercise group eliminated significantly more PEG tubes at 3 months posttreatment compared to the swallow group (16% vs 50%). Among patients who received both radiation and chemotherapy, the exercise group had significantly less PEG tubes immediately posttreatment as well as 3 months posttreatment (35% and 10%), compared to the swallow group (69% and 50%). CONCLUSION: Findings indicate significant benefits of the exercise group's exercise regimen in reducing PEG dependence and oral intake difficulties.