Efficacy of the Rehabilitation Planning Consult for Survivors of Head and Neck Cancer: A Phase 2 Randomized Controlled Trial.

PURPOSE: Survivors of head and neck cancer may have significant lasting impairments and poor access to rehabilitation. To address this, our group developed and evaluated a rehabilitation planning consult (RPC). The RPC is conducted through an initial consultation and a single follow-up session with a rehabilitation professional. During the initial consultation, rehabilitation needs are determined and the survivor sets individualized goals and plans. They then implement their plans independently and are facilitated to evaluate and modify plans as necessary during the follow-up session. METHODS AND MATERIALS: We used a waitlist control design to compare the proportion of participants attaining a minimally importantly different change in quality of life (QOL) on the Short Form 36 Physical Health Summary Score from baseline to 3 months after study enrollment, between patients randomized to receive (n = 77) or wait 14 ± 3 weeks to receive (n = 76) the RPC. Additional outcomes included goal attainment indicators measured using the Brief Rehabilitation Assessment for Survivors of Head and Neck Cancer (BRASH). RESULTS: Of 153 participants recruited, 95 (62%) completed the intervention; 57 were in the immediate (RPC) group and 38 were in the waiting list control (WLC) group. No significant between-group differences were seen in the proportion of patients achieving a minimally important improvement (2.5 units) on the Physical Health Summary Score from baseline to 3 months after recruitment. No between-group differences were seen on any secondary QOL indicators. Among the 67 (RPC n = 42, WLC n = 22) participants who set individualized rehabilitation goals, BRASH scores on goal performance and satisfaction with goal performance were significantly better in the RPC group. CONCLUSIONS: Our results suggest that the RPC may provide benefit in patients' individualized domains of choice among those who set goals, without affecting overall QOL. Future work could refine the subset of patients who benefit and explore the optimal timing and intensity of the intervention.

Adoption of enhanced recovery after surgery and intraoperative transverse abdominis plane block decreases opioid use and length of stay in very large open ventral hernia repairs.

BACKGROUND: The effect of an enhanced recovery after surgery (ERAS) pathway including liposomal bupivacaine transversus abdominus plane (TAP)-blocks for abdominal wall reconstruction (AWR) on opioids use is not clear. METHODS: A prospective, tertiary hernia center database of patients undergoing AWR before and after ERAS and operative TAP-blocks was matched in large ventral hernias. RESULTS: In 106 patients, non-TAP-block and TAP-block groups were comparable in mean BMI (p = 0.694), hernia defect size (p = 0.424), components separation (p = 0.610), complete fascial closure (p = 1.0), and panniculectomy (p = 1.0). The total morphine milligram equivalents (MME) used during hospitalization was reduced by 3-fold in the TAP-block group (p < 0.001), and opioid usage decreased by 35%-71% during days 1-5. Length of stay (LOS) was shorter in the TAP-block group by average of 1 day (p = 0.011). CONCLUSION: ERAS and TAP-block in AWR leads to a decrease in mean opioid usage by 65% and decreased LOS by an average of 1 day.

Evaluation of a rehabilitation planning consult for survivors of head and neck cancer.

BACKGROUND: The rehabilitation planning consult (RPC) is a novel, transdisciplinary rehabilitation intervention for survivors of head and neck cancer. The study aimed to: (1) estimate recruitment and withdrawal rates, and adverse events; and (2) estimate the effect on rehabilitation indicators in survivors of head and neck cancer. METHODS: A single group pre-post study with follow-up was conducted with survivors of head and neck cancer who had completed treatment within 18 months. Outcome measures included goal attainment and quality of life indicators. RESULTS: Thirty participants (30) completed the RPC, and 20 completed follow-up. The average age was 59.8 years (SD 13.3), 23 were men, and 23 set rehabilitation goals. At follow-up, there was a large effect on goal performance (d = 1.5) and satisfaction (d = 1.5), and on the Short Form Health Survey-36 (SF-36) physical role and social functioning subscales (d = 1.0 and 0.8). There was a small to moderate effect on most other outcomes. CONCLUSION: The RPC is a promising transdisciplinary rehabilitation intervention warranting further study with a controlled trial.

Head and Neck Cancer Survivorship: Learning the Needs, Meeting the Needs.

Cancers of the head and neck and the treatments required to control them frequently result in serious and persistent impairments that can affect participation and quality of life. Increased recognition of the needs of cancer survivors and their caregivers has prompted research focused on the unique concerns of this complex group. Unmet needs have been identified among 60-70% of patients and a similar proportion of their partners; impacts can include profound social effects, isolation, and psychiatric conditions. Interprofessional teams, supplementing oncology nursing and physicians with physical rehabilitation, occupational therapy, speech-language pathology, nutrition and psychological disciplines is important to address the spectrum of emotional, cognitive, physical and functional, and pragmatic issues. In addition to investigating modified anti-cancer therapy intended to reduce the frequency of long-term toxicities, supportive care strategies that may be effective include physical activity, nutritional intervention, behavioral and cognitive-behavioral therapy, psycho-education and goal management therapy. This article addresses identified needs across varied domains, the current state of research surrounding them, and their impact on quality of life, while also describing one cancer center's approach to head and neck cancer survivorship.

"I didn't actually know there was such a thing as rehab": survivor, family, and clinician perceptions of rehabilitation following treatment for head and neck cancer.

PURPOSE: The purpose of this study was to obtain first-hand contributions from survivors, family members, and front-line health care professionals regarding the rehabilitation needs for head and neck cancer (HNC) patients, to inform development of a rehabilitation intervention. METHODS: The researchers conducted a series of focus groups with the three key stakeholder groups. RESULTS: A total of seven focus groups with 40 participants were conducted, two with survivors, one with family members, and four with health care professionals. All three participant groups reported that motivation based on a strong desire to return to meaningful roles and activities, and rehabilitation resources embedded within the cancer system were important facilitators of functional recovery. Lack of access to rehabilitation services was a concern expressed repeatedly. CONCLUSION: While generalization is limited by the small sample size, findings include a comprehensive list of rehabilitation needs following treatment for HNC, factors that facilitate and hinder recovery of functional health, and specific suggestions for the development of rehabilitation consult intervention for survivors of HNC.