Cancer Rehabilitation
Health Services Research
Oral Presentation
Andrea Cheville, MD
Director of Cancer Rehabilitation
Mayo Clinic
Rochester, Minnesota
Timothy Moynihan, MD
Professor
Mayo Clinic
Kasson, Minnesota
Jeph Herrin, PhD
Professor
Yale University
Kasson, Minnesota
Kurt Kroenke, MD
Professor
Regenstrief Institute
Kasson, Minnesota
Charles Loprinzi, MD
Professor
Mayo Clinic
Rochester, Minnesota
Objective : To determine whether collaborative tele-rehabilitation and pharmacological pain management improve function and pain, and reduce hospital and post-acute care facility use.
Design :
The Collaborative Care to Preserve Performance in Cancer (COPE) study was a 3-arm randomized trial conducted between March 2013 and follow up concluded October 2016.
Setting : Three large medical centers within a single health system and collectively comprising a NCI-designated comprehensive cancer center
Participants (or Animals, Specimens, Cadavers) : Participants (N=516) were low-level community or household ambulators with Stage IIIC or IV solid or hematologic cancers.
Interventions : Participants were randomly assigned to: 1) control, 2) tele-rehabilitation, and 3) tele-rehabilitation + pharmacological pain management. All underwent automated function and pain monitoring with data reporting to their care teams. Participants in Arms 2 and 3 received 6 months of centralized tele-rehabilitation provided by a physical therapist-physician team. Those in Arm 3 also received nurse-coordinated pharmacological pain management.
Main Outcome Measure(s) : Blinded assessment at baseline and months 3 and 6 for function (Activity Measure for Post Acute Care [AM-PAC]), pain interference and average intensity (BPI), and quality of life (EQ-5D-3L). Hospitalizations and discharges to post-acute care facilities were recorded.
Results :
Compared with the control group, the tele-rehabilitation Arm 2 group had improved function (1.3; 95% confidence interval [CI] 0.08 to 2.35; P=0.03) and quality of life (0.04; 95% CI 0.004 to 0.07; P=0.01), while both tele-rehabilitation Arm 2 and 3 groups had reduced pain interference (respectively, -0.4; 95% CI -0.78 to -0.09; P=0.01, and -0.4; 95% CI -0.79 to -0.10; P=0.01), and average intensity (respectively, -0.4; 95% CI -0.78 to -0.07; P=0.02, and -0.5; 95% CI -0.84 to -0.11; P=0.006). Tele-rehabilitation was associated with higher odds of home discharge in Arms 2 (OR 4.3; 95% CI 1.3 to 14.3; P=0.02) and 3 (OR 3.8; 95% CI 1.1 to 12.4; P=0.03) and shorter hospitalizations in Arm 2 (difference -3.9 days; 95% CI -2.4 to -4.6; P=0.01).
Conclusions :
Collaborative tele-rehabilitation modestly improved function and pain, while decreasing hospital lengths of stay and requirement for post-acute care, but was not enhanced with pharmacological pain management.