Summary
A 3-week cancer rehabilitation program was conducted at the Humanomed Zentrum Althofen, comprising therapy of organic defects, lifestyle modification, and psycho-social support. Therapeutic efficacy was assessed in comprehensive surveys before and after the therapy, and after 6 and 12 months. The study covers a 5-year period with data from 3233 patients. Parameters of subjective health assessed according to the European Quality of Life – 5 Dimensions (EuroQol EQ-5D) standard and signifying quality of life showed significant improvement both immediately after the therapy, and after 6 and 12 months. Anxiety and depression, assessed according to the Hospital Anxiety and Depression Scale, were significantly and persistently diminished, and the sense of coherence elevated. Therapeutic success was somewhat dependent on socio-economic parameters, but was largely independent of income and cancer type. This study thus clearly documents the significant efficacy of a rehabilitation treatment based on bio-psycho-social concepts, which may be further improved by additional ambulant or stationary care.
Zusammenfassung
Ein 3‑wöchiges Rehabilitationsprogramm für Krebspatienten wurde am Humanomed Zentrum Althofen durchgeführt, fokussiert auf eine Therapie organischer Defekte, Lebensstilmodifikationen und psychosoziale Unterstützung. Die therapeutische Wirksamkeit wurde mittels umfangreicher Befragungen zu Beginn und am Ende der Therapie sowie nach 6 und 12 Monaten erhoben. Die Studie umfasst einen Zeitraum von 5 Jahren und Daten von 3233 Personen. Parameter zur subjektiven Einschätzung des Gesundheitszustands gemäß „European Quality of Life – 5 Dimensions“(EuroQol-EQ-5D)-Standard, und damit der Lebensqualität, waren unmittelbar nach Therapieende sowie auch nach 6 und 12 Monaten signifikant verbessert. Ängstlichkeit und Depressivität gemäß Hospital Anxiety and Depression Scale waren signifikant und bleibend vermindert, das Kohärenzgefühl erwies sich als signifikant verbessert. Der Therapieerfolg war zu einem gewissen Grad von sozioökonomischen Parametern abhängig, jedoch weitgehend unabhängig vom Einkommen und der spezifischen Krebsform. Die nach biopsychosozialen Gesichtspunkten konzipierte Rehabilitationsbehandlung war folglich in signifikanter Weise wirksam, zur weiteren Verbesserung könnten zusätzliche ambulante oder stationäre Behandlungen beitragen.
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References
Erwerbstaetigenquoten_nach_alter_und_geschlecht_seit_1994.pdf. Statistik Austria; 2016. Erhältlich auf: http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/arbeitsmarkt/erwerbstaetige/index.html. Accessed: 20.12.2016.
Delbrück H, Witte M. Vergleich onkologischer Rehabilitationsmaßnahmen und -strukturen in Ländern der Europäischen Gemeinschaft. Wuppertal: Nordrhein-Westfälischer Forschungsverbund Rehabilitationswisssenschaften; 2004. Erhältlich auf: http://www.refonet.net/rehaforschung_nrw/forsch_proj/documents/Abschlussbericht_2002_2006_Internet.pdf#page=48.
Deck R. Soziale Ungleichheit in der medizinischen Rehabilitation. Gesundheitswesen. 2008;70(10):582–9.
Maier C, Razum O, Schott T. Medizinische Rehabilitation und Behandlungserfolg bei Patienten mit türkischem Migrationshintergrund. In: Muthny FA, Bermejo I, editors. Interkulturelle Medizin. Laientheorien, Psychosomatik und Migrationsfolgen. Köln: Deutscher Ärzte-Verlag; 2009. pp. 85–103.
Kobelt A, Lieverscheidt B, Grosch E, Petermann F. Ambulante psychosomatische Nachsorge und soziale Ungleichheit. Katamnestische Studie vor dem Hintergrund überwunden geglaubter Schichtspezifität. Psychotherapeut. 2010;55(1):43–8.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36.
Van de Velde D, Eijkelkam A, Peersman W, De Vriendt P. How competent are healthcare professionals in working according to a bio-psycho-social model in healthcare? The current status and validation of a scale. PLoS ONE. 2016;11(10):e164018.
Baumann FT, Hallek M, Meyer J, Galvão DA, Bloch W, Elter T. Evidence and recommendations for oncologic clinical exercise—a personalized treatment concept for cancer patients. Dtsch Med Wochenschr. 2015;140(19):1457–61.
Tschiesner U, Linseisen E, Coenen M, Rogers S, Harreus U, Berghaus A, Cieza A. Evaluating sequelae after head and neck cancer from the patient perspective with the help of the international classification of functioning, disability and health. Eur Arch Otorhinolaryngol. 2009;266(3):425–36.
Segal RJ, Reid RD, Courneya KS, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol. 2003;21:1653–9.
Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998;30:475–8.
van Weert E, Hoekstra-Weebers J, Otter R, et al. Cancer-related fatigue: predictors and effects of rehabilitation. Oncologist. 2006;11(2):184–96.
Gastl G. Schützt körperliche Aktivität vor Krebs und Nebenwirkungen einer Krebsbehandlung? Spectr Onkol. 2013;1:53–6.
Vermaete N, Wolter P, Verhoef G, et al. Physical activity, physical fitness and the effect of exercise training interventions in lymphoma patients: a systematic review. Ann Hematol. 2013;92(8):1007–21.
Moore SC, Lee IM, Weiderpass E, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA. 2016;176(6):816–25.
Ballard-Barbash R, Friedenreich CM, Courneya KS, et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40.
Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24(22):3535–41.
Chlebowski RT, Blackburn GL, Thomson CA, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst. 2006;98(24):1767–76.
James EL, Stacey F, Chapman K, et al. Exercise and nutrition routine improving cancer health (ENRICH): the protocol for a randomized efficacy trial of a nutrition and physical activity program for adult cancer survivors and carers. BMC Public Health. 2011;11:236.
Mustafa M, Carson-Stevens A, Gillespie D, et al. Psychological interventions for women withmetastatic breast cancer. Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD004253.pub4.
EuroQol BR. the current state of play. Health Policy (New York). 1996;37(1):53–72.
Franke GHBSI. Brief Symptom Inventory – Deutsche Version. Manual. Göttingen: Beltz; 2000.
Herrmann C, Buss U. Snaith RP Hospital anxiety and depression scale (HADS-D). Bern: Huber; 1995.
Schumacher J, Brähler E. Sense of Coherence Scale—Leipziger Kurzform (SOC-L9). Bern: Huber; 2000.
Hautzinger M, Keller F, Kühner C. BDI-II. Beck depressions inventar revision—Manual. Frankfurt: Harcourt Test Services; 2006.
Schmidt J, Lamprecht F, Wittmann WW. Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. Psychother Psychosom Med Psychol. 1989;39:248–55.
Dimeo FC, Thiel E. Körperliche Aktivität und Sport bei Krebspatienten. Onkologe. 2008;14(1):31–7.
Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25(7):1293–311.
Brown JC, Huedo-Medina TB, Pescatello LS, et al. The efficacy of exercise in reducing depressive symptoms among cancer survivors: a meta-analysis. PLoS ONE. 2012;7(1):e30955.
Hann D, Baker F, Denniston M, et al. The influence of social support on depressive symptoms in cancer patients: age and gender differences. J Psychosom Res. 2002;52(5):279–83.
Sanchez NF, Stierman B, Saab S, et al. Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population. Bmc Res Notes. 2012;5:312.
Frederiksen BL, Dalton SO, Osler M, et al. Socioeconomic position, treatment, and survival of non-Hodgkin lymphoma in Denmark—a nationwide study. Br J Cancer. 2012;106(5):988–95.
Islam T, Dahlui M, Majid HA, et al. MyBCC study group. Factors associated with return to work of breast cancer survivors: a systematic review. BMC Public Health. 2014;14(Suppl 3):S8.
Smith A, Crouch S, Howell D, et al. Impact of age and socioeconomic status on treatment and survival from aggressive lymphoma: a UK population-based study of diffuse large B‑cell lymphoma. Cancer Epidemiol. 2015;39(6):1103–12.
Acknowledgements
We thank the family of Dipl-Kfm Helmut Eder and the chief physicians of the PVA for support and cooperation during establishment of the project.
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J. Klocker, U. Klocker-Kaiser, W. Pipam, and D. Geissler declare that they have no competing interests.
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All patients agreed to take part in this study, filling out the questionnaires voluntarily. The study followed the principles of noninterventional (observational) studies and thus did not require assessment by an Ethic Committee. It was considered part of general quality management without any impact on the treatment of the patients.
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Klocker, J., Klocker-Kaiser, U., Pipam, W. et al. Long-term improvement of the bio-psycho-social state of cancer patients after 3 weeks of inpatient oncological rehabilitation. Wien Med Wochenschr 168, 350–360 (2018). https://doi.org/10.1007/s10354-018-0619-1
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DOI: https://doi.org/10.1007/s10354-018-0619-1