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Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 1/2021

Open Access 01-02-2021 | Fatigue

Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

Authors: Charlotte IJsbrandy, Petronella B. Ottevanger, Winald R. Gerritsen, Wim H. van Harten, Rosella P. M. G. Hermens

Published in: Journal of Cancer Survivorship | Issue 1/2021

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Abstract

Purpose

To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center.

Methods

We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2).

Results

Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47–2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31–2.45), referral to PCRPs (OR 1.81, 95% CI 1.18–2.78), participation in PCRPs (OR 2.04, 95% CI 1.43–2.91), and PAU (OR 1.69, 95% CI 1.25–2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators.

Conclusions

The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care.

Implications for Cancer Survivors

Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.
Appendix
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Metadata
Title
Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study
Authors
Charlotte IJsbrandy
Petronella B. Ottevanger
Winald R. Gerritsen
Wim H. van Harten
Rosella P. M. G. Hermens
Publication date
01-02-2021
Publisher
Springer US
Keyword
Fatigue
Published in
Journal of Cancer Survivorship / Issue 1/2021
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-020-00921-8

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