Oncological Geriatric Rehabilitation: past, present and future

Background and relevance

The incidence and prevalence of cancer are rising globally and cancer is most prevalent in older people and consequently, more older and frail patients will be treated for cancer. This heterogeneous group is characterized by a high prevalence of frailty and an increased risk of complications and functional decline. A selection of these frail patients, however, are resilient and have the potential to recover and regain functionality. With current knowledge correctly identifying resilience is challenging. A selection of these older or frail patients are referred to Oncological Geriatric Rehabilitation (ONCO-GR) during cancer treatment although official figures are missing. GR is a multidimensional approach of diagnostic and therapeutic interventions, which focuses on optimizing functional capacity, promoting activity and preserving functional reserve and social participation in older people with disabling impairments. Patients with cancer are referred to GR for optimizing personal fitness prior to (prehabilitation), in between (perirehabiliation), or after cessation of cancer treatment. Most referred patients have been or will be treated with curative intent.

In practice, it turns out that patients admitted for ONCO-GR are extremely frail, often have limited physical capacity and can be rehabilitated to varying degrees of success. A small Dutch study (n=51) showed that patients in ONCO-GR form a heterogeneous group of people and only less than half of whom could be discharged home and 39% died during GR. In comparison, in general, 80% of GR patients go home after admission and less than 10% dies. In short, significant insight and evidence about the current ONCO-GR is still lacking. This is reflected in the oncological GR treatment program of the Integral Cancer Center of the Netherlands, which contains hardly any evidence-based oncological GR-specific recommendations. In 2015, the description and development of the ONCO-GR were already explicitly mentioned in the Position Paper on scientific priorities in GR.

Problem definition and objectives

With the growing number of older adults with cancer, ONCO-GR could be an important intervention, however, the current practice is challenging. First, many of its patients are considered very frail, as a possible consequence ONCO-GR has relatively low discharge rates. Second, the feasibility and evidence of successful intervention within ONCO-GR are lacking. Third, guidelines on the indication and possibilities of ONCO-GR are lacking. The objectives are:

• Description of the current practice of ONCO-GR in the Netherlands.
• Systematic description of the literature on the feasibility and effects of ONCO-GR.
• To identify the experiences, needs and wishes of those involved, i.e. referring to, receiving and providing ONCO-GR.
• Description of important physical and rehabilitation parameters during ONCO-GR.
• Setting up a feasibility study with a novel ONCO-GR intervention.

Plan of approach

1. Description of the current ONCO-GR practice by means of data from Statistics Netherlands (CBS) and ´Leren van Data’ / Gerimedica data source on patients ≥70 years with cancer.
2. Systematic review and meta-analysis of the feasibility and effect of ONCO-GR.
3. Qualitative study with patients and professionals on the possibilities and challenges of ONCO-GR.
4. Prospective study with a description of important physical and rehabilitation parameters during ONCO-GR.
5. Feasibility study, set up to develop and test a novel intervention for ONCO-GR.

Intervention

Oncological Geriatric Rehabilitation

Intended results and impact

The program will lead to a systematic description of the need, possibilities, feasibility and evidence for oncological geriatric rehabilitation as well as an innovative intervention. It will result in a Ph.D. thesis, with ≥4 publications and presentations at (inter)national conferences