Identifying Clinically Important Functional Impairments and Rehabilitation Needs in Cancer Survivors and a Pilot Validation of the Cancer Rehabilitation Questionnaire

Abstract

Objectives: Despite the availability of cancer rehabilitation, utilization at our institution was low. We designed the Cancer Rehabilitation Questionnaire (CRQ) to investigate the prevalence of functional impairments amongst cancer survivors and attitudes towards rehabilitation participation. We evaluated the performance of CRQ as a screening tool for detecting clinically important physical dysfunction.
Design: A cross-sectional study was performed, recruiting cancer survivors at a university outpatient oncology clinic. Cancer survivors completed the CRQ and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire – Core 30 Questionnaires. Descriptive statistical analysis and receiver operator characteristics analysis were performed to assess the ability of the CRQ to detect clinically important physical dysfunction, as measured by the EORTC QLQ-C30.
Results: Of 204 participants, 87.3% reported impairments in at least 1 CRQ domain. Pain and weakness were most common. The number of positive items correlated with EORTC global health status and functional scales. A cut-off of ≥ 4 on the CRQ predicted clinically important physical dysfunction (sensitivity 61.8%, specificity 75.5%). Of those with impairments, 53.9% were unwilling to participate in rehabilitation. Transportation, need for caregivers, and cost were the main barriers.
Conclusion: Our findings will guide resource allocation to overcome barriers to participation. The CRQ can help to stratify cancer survivors requiring further rehabilitation interventions.

LAY ABSTRACT
Functional impairments due to cancer and its treatment are common, and can be effectively addressed with rehabilitation. To better provide cancer rehabilitation, the Cancer Rehabilitation Questionnaire was designed to investigate what functional problems cancer survivors have and their attitudes towards participation in rehabilitation. We compared the cancer rehabilitation questionnaire with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) to see if it could be used as a screening tool for rehabilitation needs. Of 204 participants, 87.3% reported functional impairments in at least 1 Cancer Rehabilitation Questionnaire domain. Pain and weakness were most common. The number of positive Cancer Rehabilitation Questionnaire items correlated with EORTC scales: ≥ 4 positive items in the Cancer Rehabilitation Questionnaire indicated that the number of physical impairments was clinically significant. Among participants with impairments, 53.9% were unwilling to participate in rehabilitation. Transportation, need for caregivers, and cost were cited as barriers. A simple screening tool, such as the Cancer Rehabilitation Questionnaire can help to stratify cancer patients requiring further rehabilitation and intervention.