Hanssens, S., Luyten, R., Watthy, C., Fontaine, C., Decoster, L., Baillon, C., . . . De Grève, J. (2011). Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer. Oncology Nursing Forum, 38, E418–E424.

To evaluate the effects of a rehabilitation program on quality of life (QOL), fatigue, fear of movement (kinesiophobia), distress, anxiety, depression, and physical condition.

The intervention consisted of a 12-week comprehensive rehabilitation program based on Herstel and Balans’s 12-week program. The program combined physical exercise, psychoeducation, and individual counseling. Each component consisted of 

• Physical training to enhance cardiorespiratory and muscular capacity. Physical training occurred three times a week for 60 minutes and was led by an expert physiotherapist.
• Psychoeducation to enhance self-confidence, autonomy, and coping skills. Psychoeducation occurred eight times. Each session lasted 90 minutes.
• Individual counseling to improve patients' follow-up and provide an individualized program. Individual counseling consisted of a 10-minute session at the start of the program, at the beginning of every exercise session, and at the end of the program.

The intervention was provided at no cost to patients.

• The sample was comprised of 36 patients (83% female, 17% male).  
• Mean age was 50 years (standard deviation [SD] = 12 years; range 28–75 years).
• The majority of patients (n = 27) had breast cancer.
• Patients had completed all cancer treatments, except long-term hormone treatment. Patients had received diverse treatments (i.e., chemotherapy, radiotherapy, surgery, and biotherapy) before the intervention.
• Time lapse since the last treatment varied, with a mean of nine months (SD = 14 months; range 0–60 months).
• Twenty patients were on hormone treatment during the intervention.

• Single site
• Outpatient
• University hospital in Belgium

• Patients were undergoing the transition after initial treatment phase of care.
• The study has clinical applicability for late effects and survivorship.

The study used a prospective, one-group pre-/posttest design.

• European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), to measure global QOL and physical functioning and condition
• Functional Assessment of Cancer Therapy–Fatigue (FACT-F), to measure fatigue
• Hospital Anxiety and Depression Scale (HADS), to measure depression and anxiety
• RAND 36-Item Health Survey (RAND-36), to measure general health-related QOL
• Tampa Scale of Kinesiophobia, to measure fear of movement or injury
• Distress Barometer, to measure distress
• Tecumseh Step Test, to measure cardiorespiratory fitness

• The authors noted significant improvements in QOL (p < 0.001), physical condition (p = 0.007), fatigue (p = 0.01), and depression (p = 0.012).
• Kinesiophobia (p = 0.229), distress (p = 0.344), and anxiety (p = 0.101) did not change significantly.
• In regard to depression, HADS scores changed from 5.71 (SD = 4.7) to 4.13 (SD = 4.36). This change was statistically significant.

The rehabilitation program was associated with a positive effect on depression, fatigue, and QOL; however, weaknesses in study design may preclude making a definitive conclusion based on the study. Prospective randomized studies must determine the long-term impact and the relative contribution of the program versus spontaneous recovery. Future research should also consider the cost-effectiveness of the rehabilitation program.

• The small sample size and nature of the sample (i.e., patients with early stage breast cancer) threaten the external validity of the study.
• The study did not include an appropriate control group. The lack of control group threatens the internal validity of the study. Thus, statistically significant effects may be placebo effects or time effects.
• The study did not include information regarding the scale and range of scores and method of score computation; therefore, the credibility of analysis based on the scores is unknown.
• The authors did not report whether patients were clinically depressed and if the improvement in the depression score indicates a clinically significant change.
• For various reasons, more than half (51%) of the patients who had an intake interview did not participate in the study. This may generate problems associated with the applicability of the program to patients with cancer.

Multidisciplinary rehabilitation can be one way to manage depression and fatigue in patients with cancer.