The evidence base for rehabilitation in palliative care (#123)
As effective medical treatments prolong survival rates for people with non curative illness, people are living for longer with increasing debility and functional decline. However, rehabilitation to optimise function for those receiving palliative care has received sporadic attention. Although presented as an integral part of care throughout the cancer trajectory since the 1970s, research into the feasibility and efficacy of cancer rehabilitation has been limited, particularly in palliative care.
People with advanced cancer have a range of unmet needs that can be addressed through rehabilitation. Screening to identify these needs is vital, which may include optimising independence in activities of daily living that are related to self care but also participation in other valued activities such as driving, family life and employment. Rehabilitation may address physical impairment in addition to cognitive impairment and psychological issues associated with functional decline. However, evidence suggests there can be discrepancies between patient and clinician perspectives about priorities at the end-of-life. Clinician attitudes towards rehabiliation and the settings in which patients are seen have an impact on referrals to palliative rehabilitation.
A number of retrospective studies have demonstrated significant gains for cancer patients in both functional status and psychological well being following rehabilitation. Functional gains were achieved irrespective of age, cancer type and stage, and concomitant medical treatment such as chemotherapy and radiotherapy. While patients with metastatic disease were included in these studies they did not achieve gains as significant as patients earlier in the disease trajectory.
More recent studies have examined the feasibility and role of structured exercise programs and multidisciplinary rehabilitation programs aimed at optimising function. Patient rehabilitation goals and preparedness to engage in such programs have also been explored. While results demonstrate some benefits, more rigorous research is required to evaluate the efficacy of rehabilitation for those with advanced disease including mode and timing of delivery, and screening for functional impairment. Provision of rehabilitation for people with advanced cancer presents challenges for palliative care as well as acute and rehabilitation sectors.