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Randomized Controlled Trial
. 2019 May;67(5):953-960.
doi: 10.1111/jgs.15930.

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

Mackenzi Pergolotti  1   2   3 , Allison M Deal  1 , Grant R Williams  1   4 , Ashley L Bryant  1 , Lauren McCarthy  1 , Kirsten A Nyrop  1 , Kelley R Covington  2 , Bryce B Reeve  1   5 , Ethan Basch  1 , Hyman B Muss  1
Affiliations
Randomized Controlled Trial

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

Mackenzi Pergolotti et al. J Am Geriatr Soc. 2019 May.

Abstract

Objectives: The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown.

Design: Two-arm single-institution randomized controlled trial of outpatient OT/PT.

Setting: Comprehensive cancer center with two off-site OT/PT clinics.

Participants: We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care.

Intervention: Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs.

Measurements: Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient-Reported Outcomes Measurement Information System-Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self-efficacy (Possibilities for Activity Scale [PActS]).

Results: Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow-up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow-up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided.

Conclusion: OT/PT may positively influence activity expectations and self-efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953-960, 2019.

Keywords: aging; cancer; cancer rehabilitation; geriatric assessment; geriatric oncology.

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Conflict of interest statement

DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST

The authors declare that they have no conflicts of interest related to this research.

Figures

Figure 1.
Figure 1.
Consort diagram of RCT of Occupational and Physical Therapy for Older Adults with Cancer with Function Needs
Figure 2.
Figure 2.
Percentage of Participants by Geriatric Assessment-based Occupational and Physical Therapy Need. IADL = Instrumental Activities of Daily Living. TUG = Timed Up and Go. ADL = Activities of Daily Living.
See this image and copyright information in PMC

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