What is covered by "cancer rehabilitation" in PubMed? A review of randomized controlled trials 1990-2011.

OBJECTIVE: This focused review examines randomized controlled studies included by the term "cancer rehabilitation" in PubMed. The research questions concern the type of interventions performed and their methodological quality. DESIGN: Using the Medical Subject Headings (MeSH) terms: neoplasm AND rehabilitation, all articles with randomized controlled studies that included adult cancer patients, written in English, were extracted from PubMed. Papers covering physical exercise, psychiatric/psychological treatment or social support only were excluded as they had been reviewed recently. Abstracts and papers were assessed by 3 pairs of reviewers, and descriptive information was extracted systematically. Methodological quality was rated on a 10-item index scale, and the cut-off for acceptable quality was set at ≥ 8. RESULTS: A total of 132 (19%) of the 683 identified papers met the eligibility criteria and were assessed in detail. The papers were grouped into 5 thematic categories: 44 physical; 15 art and expressive; 47 psycho-educative; 21 emotionally supportive; and 5 others. Good quality of design was observed in 32 studies, 18 of them uni-dimensional and 14 multi-dimensional. CONCLUSION: Published randomized controlled studies on cancer rehabilitation are heterogeneous in terms of content and samples, and are mostly characterized by suboptimal design quality. Future studies should be more specific and well-designed with sufficient statistical strength.

"The impact of cancer scale" version 1: psychometric testing of the Norwegian translation in a heterogeneous sample of cancer survivors.

PURPOSE: The impact of cancer scale version 1 (IOC-1) from 2006 has only been tested psychometrically in a heterogeneous sample of 193 American long-term cancer survivors (LTSs). The Norwegian version of IOC-1 compares the psychometric findings of that study with those observed in a heterogeneous sample of 809 Norwegian LTSs. METHODS: We performed exploratory (EFA) and confirmatory (CFA) factor analyses, tests of internal consistency, correlational studies with various other tests and a change over time examination in order to test reliability and validity of the IOC-1. RESULTS: The American factor structure of the IOC-1 with 10 dimensions showed adequate fit with CFA in the Norwegian sample, but internal consistency was insufficient in 2 dimensions. EFA of the Norwegian sample found a 9 factor solution that also showed adequate fit on CFA, and with sufficient internal consistencies for all dimensions. The SF-36 dimensions, anxiety, depression, neuroticism, fatigue and body image all showed low correlations with the positive dimensions of the IOC-1, but higher correlations with the IOC-1 negative dimensions. The IOC-1 dimensions showed considerable stability over time. CONCLUSIONS: In our big heterogeneous sample of LTSs, the Norwegian version of the IOC-1 showed discriminant and concurrent validity, and reliability was supported.

A comparative study of cancer patients with short and long sick-leave after primary treatment.

BACKGROUND: Sick-leave after primary cancer treatment has hardly been studied. This study compares Norwegian cancer patients (CPs) with shorter (≤8 months) and longer (≥9 months) sick-leave after primary cancer treatment. Our aim was to characterize factors associated with these two types of sick-leave in order to identify possible factors for interventions by which long-term sick-leaves may be avoided. METHODS: A mailed questionnaire was completed by a sample of Norwegian CPs 15 to 39 months after primary treatment of the ten most common invasive types of cancer. The groups with shorter (n=359) and longer (n=481) sick-leaves (SSL vs LSL) were compared with each other by self-reported information as to socio-demographic and cancer-related variables, health, quality of life, work ability, work situation and supportive interventions. RESULTS: The LSL consisted of 78% females, and 76% of them had breast or gynaecological cancer. A higher proportion of patients with low level of education, economical problems, treated with chemotherapy, hormones and multimodal treatment belonged to LSL compared to SSL. Significantly more LSL had recurrences of cancer, co-morbidity, regular use of medication, and poorer self-rated health, quality of life and work ability. Compared to SSL, more LSL reported needs for and offers of supportive care such as physiotherapy, physical activities and psychosocial support. A multivariate regression analysis showed that reduced work ability, changes in employment due to cancer, lack of support from supervisors at work, and having had combined treatment were significantly associated with being LSL. CONCLUSIONS: Longer sick-leave after primary cancer treatment is associated with combined cancer treatment, lack of support from supervisors and reduced overall work ability. Interventions and counselling related to the work place and reduced work ability could be of value for prevention of long-term sick-leaves.

Are there sex differences in the work ability of cancer survivors? Norwegian experiences from the NOCWO study.

BACKGROUND: This study investigated gender differences concerning work ability in working cancer survivors (CSs) and compared them to those of matched population-based controls. METHODS: A mailed questionnaire was completed by 446 Norwegian CSs (226 breast cancer, 166 testicular and 54 prostate cancer) with good prognosis 2-6 years after primary treatment and 588 controls (319 females and 269 males). Overall current work ability (OCWA) was the primary outcome measure, and ten indices of the physical, mental and social skill aspects of work ability (WA) were also studied. RESULTS: The mean OCWA score was higher amongst male CSs compared to females (p = 0.04). The mean OCWA score was similar in male CSs and controls (p = 0.17), whilst female CSs had significantly lower mean OCWA score than controls (p < 0.001). Mental WA neuroticism was higher amongst women in both CSs (p = 0.009) and controls (p = 0.001), and the same pattern was found for physical WA concerning the symptom score (p = 0.003 and <0.001, respectively). Sex had no significant association with OCWA in multivariate analyses. Significant associations were observed for physical and mental WA, but not for social skills. CONCLUSIONS: OCWA was significantly better in male CSs than in female CSs. Male CSs did not differ from their controls, whilst female CSs scored significantly poorer than their controls. CSs with reduced overall work ability should be identified, and their mental and physical work ability should be examined independent of sex.

A study of work changes due to cancer in tumor-free primary-treated cancer patients. A NOCWO study.

GOALS OF WORK: The goal of this study is to explore the characteristics of tumor-free cancer survivors (CSs) who after their primary treatment were still working but made work changes due to cancer and compare them to survivors who did not. PATIENTS AND METHODS: The sample consisted of 431 CSs (219 females with breast cancer, 212 males with testicular (N = 150) or prostate cancer (N = 62)) diagnosed 2-6 years prior to the study. All CSs had good prognosis and had returned to work after primary treatment. All CSs filled in a mailed questionnaire covering demography, morbidity, life style, mental distress, fatigue, quality of life and job strain. RESULTS: Seventy-two CSs (17%) had made work changes due to cancer during the observation period, and 359 (83%) had not. Among CSs who made work changes, significantly more were females; they showed significantly poorer physical and mental work ability, worked fewer hours per week, reported more comorbidity, and had lower physical and mental quality of life and more neuroticism, compared to the nonchange group. Work changes were moderately correlated with current work ability. CONCLUSIONS: The majority of CSs did not report any work changes due to cancer during the 2-6-year observation period, which is an encouraging finding. A minority had done work changes, and this group consisted mainly of women and was also characterized by poorer physical and mental quality of life and poorer mental work ability due to cancer. The issue of work changes and work ability should be considered in the follow-up of cancer survivors.

A controlled study of job strain in primary-treated cancer patients without metastases.

To explore job strain in Norwegian primary-treated cancer survivors compared to matched controls from the general population. The study has a cross-sectional, matched case-control design. A sample of 417 employed cancer survivors (208 females with breast cancer and 209 males with testicular or prostate cancer) who had been diagnosed 1-5 years prior to the study and were tumor-free rated themselves on the Demands-Control-Support Questionnaire (DCSQ). Their ratings were compared to those of 417 employed controls from the general population, matched with the survivors on time of investigation, gender, age and municipality of living. No differences in job strain were observed between cancer survivors and controls, or between subgroups of survivors, except that female survivors experienced more strain than males. In certain subgroups statistically significant differences on the DCSQ were found: older survivors showed higher scores on demands than their controls, female survivors reported lower control and higher strain than male survivors, and older male survivors felt higher demands than younger ones. However, the effect sizes of these differences were so small (< 0.20) that they hardly were relevant for the work situation. In multivariate analyses survivorship versus control status was not significantly associated with any of the DCSQ measures. The job strain of these cancer survivors did not differ in any work relevant way from their controls, and survivorship status was not significantly associated with job strain. A longer follow-up of survivors is necessary in order to draw conclusion about the stability of these findings over time.