Audio-only rehab improves activity participation among cancer survivors

A telephone-based rehabilitation intervention improved participation in daily activities among breast cancer survivors but did not otherwise accelerate their recovery, according to a study published in JAMA Network Open.

Cancer survivors face restrictions in work, recreational, and daily activities, and these can persist two years to six years after breast cancer treatment, the study noted. Thus, a team of researchers from Massachusetts, New Hampshire, and Alabama developed and pilot-tested a telephone-based coaching intervention that integrated rehabilitation principles and behavioral therapies to promote activity participation among breast cancer survivors.

As part of the intervention, nine occupational therapist coaches conducted nine behavioral activation and problem-solving intervention sessions via the telephone. These sessions involved coaches guiding participants through a goal-setting, problem-solving, and action-planning worksheet. Participants planned at least one self-selected activity each session to perform in the coming week.

Eight therapists and one nurse delivered nine attention control sessions through the telephone. In these sessions, participants reviewed weekly topics related to behavioral activation and problem-solving with their coaches, discussing whether the information resonated with their experience and identifying a new topic for the following week.

The researchers recruited study participants from two cancer centers between August 28, 2019, and April 30, 2022. Eligible participants included women 18 or older who had completed primary treatment for stage I to III breast cancer within the last year and reported restrictions to participation in daily activities.

Of 1,996 women identified, 303 enrolled in the study, and 144 completed baseline and final assessments. These 144 women were divided into two groups: 118 women were placed in the behavioral activation and problem-solving intervention group and 113 in the attention control group.

The two groups had no statistically significant differences in Patient-Reported Outcomes Measurement Information System (PROMIS) scores, a social participation satisfaction measure. The improvement in mean PROMIS scores from baseline to final assessments exceeded the threshold for clinically meaningful improvement in both groups.

However, Canadian Occupational Performance Measure individual activity target scores revealed that intervention participants reported more significant improvements in activity satisfaction and performance. Intervention participants also had higher Goal Adjustment and Disengagement Scale scores than attention control participants in the final assessments.

Further, the study shows no differences in quality of life and distress outcomes or adaptive coping over time, with improvements in all these measures for both groups.

Thus, researchers concluded that the behavioral activation and problem-solving intervention improved individual activity targets and goal disengagement but did not outperform the education-based attention control approach on other outcomes.

“In sum, there may be multiple paths to reducing participation restrictions. The behavioral activation and problem-solving condition may reduce restrictions by repeated practice of self-selected valued activities; the attention control condition might reduce restrictions by providing education and support to manage late effects of cancer treatment,” they wrote.

This is the latest study to indicate that virtual care modalities can effectively support cancer care.

A study published by the Moffitt Cancer Center last year revealed that telehealth-based cancer care led to higher rates of patient satisfaction with care access compared to in-person encounters.

The cancer center polled 39,268 patients who participated in over 50,000 visits from April 1, 2020, to June 30, 2021. Of the total patient population, 33,318 patients had in-person visits, and 5,950 participated in telehealth visits.

The survey shows that 75.8 percent of telehealth users were satisfied with their visit, compared to 62.5 percent of those who received in-person care. In addition, 90.7 percent of telehealth users were satisfied with the extent to which their provider showed concern during their visit versus 84.2 percent of in-person care patients.