RESTART: Rehabilitation Evaluation in Survivors of Testicular cancer After Radical Treatment: Pilot study effect on adjustment and psycho-social functioning


Year:

Session type:

Christopher Hewitt1, Jeff White1, Jamie Stobo1, Elaine McCartney1, Jennifer Harrington2, Sandra White3, Lesley Somerville1, Teresa Young4, Gordon Rustin4, Jim Paul1, Claire Lawless1
1Beatson West of Scotland Cancer Centre, Glasgow, UK, 2Li Ka Shing Cancer Centre, Cambridge, UK, 3NHS Ayrshire and Arran, Ayrshire, UK, 4Mount Vernon Cancer Centre, Middlesex, UK

Background

Most testis cancer (TC) patients are cured, but some experience longer term physical and psycho-social consequences e.g. anxiety and reduced quality of life (QoL). Multi-dimensional rehabilitation programmes havelargely been studied in breast cancer and it is thought that these may be beneficial to other groups of patients, particularly TC patients. Addressing the current ‘Survivorship Agenda', we performed a study of feasibility, composition and acceptability of a rehabilitation programme for TC patients who had completed treatment.

Method

TC patients, aged >=16, who completed all radical treatment within the preceding 8 weeks, with no major cardio-respiratory problems were eligible. The 6 week programme consisted of; exercise, psychological wellbeing, nutrition, finance, fertility, return to work and follow up. Primary endpoint was change in HADS anxiety sub-score from pre (Week 1) to post-programme (Week 6). To detect a within patient change of 1.5 in the HADS anxiety sub-score (90% power, 10% 1-sided significance level), 26 evaluable participants were required. Secondary endpoints included HADS depression sub-score, QoL (EORTC QLQ-C30 and TC26), self-efficacy for managing chronic disease, exercise capacity and BMI.

Results

35 patients were recruited between February and November 2012 from 2 UK Cancer Centres; 32 patients were evaluable. Both HADS anxiety (mean -1.94, p<0.001)) and depression (mean -0.84, p=0.016) sub-scores showed statistically significant reductions between weeks 1 and 6. There was a significant improvement in self-efficacy for managing chronic disease, QLQ-C30 global score and future perspective. The impact of side-effects (QLQ-TC26) also decreased.

Attendance was good (≥80%) with participants rating the overall course an average of 9 out of 10.

Conclusion

A multi-faceted rehabilitation programme appears deliverable and acceptable in TC patients. Programme participation demonstrates a positive effect, reducing HADS anxiety and depression sub-scores and improving QoL. Having established its feasibility, a RCT of this programme vs. standard care is planned.