Using Telerehabilitation to Improve Function and Pain in Advanced Cancer Patients

April 10, 2019

Telerehabilitation and pharmacological pain management approaches were tested in patients with advanced cancers, including prostate cancer, to see if pain and function could be improved.

A collaborative telerehabilitation approach offered modest improvements to pain and function in patients with advanced cancers, including prostate, breast, and other malignancies. The addition of pharmacological pain management generally did not improve these outcomes further.

Approaches such as the Collaborative Care Model (CCM) have been shown to effectively deliver supportive care to improve pain, mood, and other quality of life–related outcomes. “Despite the CCM’s robust benefits across delivery modes, populations, and treatment targets, the model has not been extended to function-directed care,” wrote study authors led by Andrea L. Cheville, MD, of the Mayo Clinic in Rochester, Minnesota. “Furthermore, it is unclear whether the effects achieved with center-based cancer rehabilitation programs can be matched with a more accessible telecare-based approach.”

To address these gaps, researchers conducted a three-arm randomized trial including a total of 516 patients with advanced cancer. A control group received automated function and pain monitoring, a telerehabilitation arm included the same remote monitoring along with an individualized physical conditioning program delivered telephonically, and a third arm added pharmacological pain management.

Prostate cancer represented the most common individual malignancy, in 17.8% of participants; all hematologic malignancies accounted for 20.2% of the cohort, and other cancers included breast (14.0%), gastrointestinal malignancies (10.1%), lung cancer (7.2%), and others. Patients had a mean age of 65.6 years, and there were 257 women and 259 men included. Results of the study were published in JAMA Oncology.

Function was assessed using the Activity Measure for Postacute Care computer adaptive test (AM-PAC-CAT). Compared with the control group, the telerehabilitation group had a greater improvement in function (P = .03); the improvement was greater than the prespecified minimally clinically important difference for this specific test. There was no significant difference between the control group and the pharmacological pain management group.

Both the telerehabilitation groups saw better improvement in pain interference than the control group (P = .01 for both). The same was true for average pain intensity (P = .02 for telerehabilitation only and P = .006 with the addition of pharmacological management).

During the study period, patients in the control group had a total of 335 hospital days, which was 57% higher than patients in the telerehabilitation group (213 days) and 18% higher than those in the telerehabilitation/pharmacological management group (284 days). This was a result of shorter hospital stays rather than fewer stays.

“Emphasis on rehabilitative rather than pharmacological pain management approaches may partially mediate these benefits and warrants further study,” the authors wrote.

In an accompanying editorial, Manali I. Patel, MD, MPH, of Stanford University School of Medicine in Stanford, California, noted that the patient population was relatively homogenous, composed of mostly non-Hispanic white patients with almost universal availability of in-home caregivers. “These factors are strongly associated with increased adherence to rehabilitation, and may inhibit the generalizability of this approach for other populations and in different settings,” Patel wrote.

In spite of that, the improvement in patient-reported outcomes and in-hospital stays may be enough to justify integration of this sort of intervention into routine care, she wrote. “Embracing low-tech approaches to enhance local delivery of supportive cancer care, such as rehabilitation, may be a smart move to effectively improve patient-reported outcomes and keep patients at home.”