Work-related medical rehabilitation in patients with cancer-Postrehabilitation results from a cluster-randomized multicenter trial.

BACKGROUND: Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors. In Germany, inpatient work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. The authors tested the effectiveness of a work-related medical rehabilitation program compared with conventional medical rehabilitation using a cluster-randomized multicenter trial (German Clinical Trial Register: DRKS00007770). METHODS: In total, 484 patients with cancer were recruited at 4 rehabilitation centers. Patients at a center who started their rehabilitation in the same week represented a cluster. These clusters were randomly assigned using computer-generated randomization schedules either to an intervention group (IG) or to a control group (CG). The primary outcome was role functioning. Secondary outcomes were other quality-of-life domains and the return to work. RESULTS: In total, 425 patients (210 in the IG) were included in the analysis at the 3-month follow-up. There was no significant difference between the IG and CG in role functioning (b = 3.55; 95% CI, -1.18 to 8.29; P = .142). Participants in the IG reported better physical functioning (b = 5.99; 95% CI, 3.33-8.65; P < .001), less physical fatigue (b = -5.09; 95% CI, -9.62 to -0.56; P = .028), and less pain (b = -6.24; 95% CI, -11.24 to -1.23; P = .015). CONCLUSIONS: Work-related medical rehabilitation had no effect on the primary outcome compared with conventional medical rehabilitation but may enhance physical functioning and reduce physical fatigue and pain.

Work-Related Medical Rehabilitation in Cancer: A Cluster-Randomized Multicenter Study.

BACKGROUND: Current guidelines recommend rehabilitative measures to alleviate dis- turbances resulting from cancer and its treatment. To give cancer survivors further assistance in getting back to work, work-related medical rehabilitation is currently being tested in Germany. In this cluster-randomized, multicenter trial, we studied the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation (trial no. DRKS00007770 in the German Clinical Trials Registry). METHODS: A total of 484 cancer survivors of working age who were candidates for rehabilitation were recruited and assigned at random to either the intervention group (IG; work-related medical rehabilitation) or the control group (CG). The primary end- point was self-assessed function in a role one year after the end of rehabilitation, as evaluated with the health-related quality of life questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30). Further endpoints included symptom and function scales, subjective ability to work, coping with illness, and return to work. Neither the medical personnel nor the subjects were blinded. RESULTS: One year after the end of rehabilitation, data from 379 subjects who par- ticipated in the last follow-up survey were evaluated. The intervention and control groups did not differ significantly either in the primary endpoint of role function (IG = 60.8 vs. CG = 57.6 out of a maximum of 100 points; p = 0.204) or in any of the secondary endpoints. A last observation carried forward analysis yielded com- parable results. At 12 months, 28.5% of the subjects in the IG and 25.3% of those in the CG were still unable to work. CONCLUSION: This study did not reveal any significant clinically relevant advantage of work-related medical rehabilitation at one year. Future studies should determine whether a second period of rehabilitation might be helpful and whether selected subjects might benefit from the assistance of case managers beyond the period of rehabilitation.