A randomized control trial of outpatient occupational and physical therapy for older adults with cancer: The CARE program.
Pergolotti, M; Deal, AM; Williams, GR; Bryant, AL; McCarthy, L; Coffman, E; Basch, EM; Reeve, BB; Muss, HB
Published in: Journal of Clinical Oncology
10038 Background: Limitations in functional status and reduced health status are common among older adults with cancer, yet occupational and physical therapy (OT/PT) remain underutilized (Pergolotti, et.al. JGO,2015). For this population, we evaluated an outpatient CAncer REhabilitation (CARE) program and compared it to usual care (UC). Methods: We recruited adults 65 years and older who had a diagnosis of cancer or recurrence within 5 years and had at least one functional limitation as measured by a geriatric assessment (GA). Participants were then randomized to OT/PT (CARE) or UC. CARE delivered individualized outpatient intervention; OT addressed functional activities, and PT strength/endurance needs. UC participants received a brochure on supportive care services. Primary outcome was functional status (Nottingham Extended Activities of Daily Living Scale [NEADL] (range 0-22)) and secondary outcomes were global Mental and Physical Health, and ability to participate in Social Roles (SR) and activities (Patient-Reported Outcomes Measurement Information System [PROMIS] (range 0-100)), for all measures, higher scores indicate better health. We used t-tests to compare groups. Results: 51 adults were randomized: median age 73 years, 55% male, 92% White, 33% with Leukemia/lymphoma, 26% Breast, 22% Colorectal, 67% in active treatment, and 37% with Stage 3 or 4. After 3 months, both groups experienced a significant decline in functional status ( p = .046; p = .005), but change in functional status (-1.5 UC, -1.1 CARE, p = .637) , physical health status (0.0 UC, 2.4 CARE, p = .121) and participation in SR (.11 in UC, 3.71 CARE, p = .088) between UC and CARE were not significant. However, change in mental health (-1.0 in UC, 3.0 CARE, p= .032) significantly different between groups. Conclusions: CARE was associated with a significant improvement in participant’s mental health status compared to a decline in UC. Results suggest CARE may influence ability to participate in social roles and activities and physical health, but further study is needed with larger sample sizes. We demonstrated that for older adults with cancer, OT/PT are promising interventions to improve mental health. Clinical trial information: NCT02306252.
