Division of Preventive Oncology, German Cancer Research Center (DKFZ)-National Center for Tumor Diseases (NCT), Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
Acta Oncol. 2021 Jan;60(1):124-134. doi: 10.1080/0284186X.2020.1828620. Epub 2020 Oct 19.
Colorectal cancer (CRC) and its treatment can lead to several physical and psychosocial impairments. Cancer rehabilitation aims to reduce morbidity and improve quality of life. The objective of this review was to summarize and evaluate evidence on changes in health-related outcomes among CRC patients undergoing inpatient rehabilitation therapy and on the effectiveness of such treatment.
We conducted a systematic literature search including the electronic databases Pubmed and Web of Science to find observational and interventional studies, which investigated changes in health-related outcomes among CRC patients undergoing multidisciplinary inpatient rehabilitation programs or treatment effects. Study findings were synthesized narratively.
Eleven studies were eligible and included in this review. Eight patient cohort studies addressed outcomes such as physical and functional status, fecal incontinence, anxiety and depression, and quality of life. Positive changes during rehabilitation therapy were observed for physical health (functional and physical status, fecal incontinence), and several dimensions of quality of life. Study findings concerning anxiety and depression were not conclusive. Studies that additionally conducted long-term follow-ups indicated that the improved health status after rehabilitative treatment waned over time. One RCT reported no effect of inpatient rehabilitation on distress and two randomized trials reported effects of exercise intensity on oxidative stress and immune response. Sample sizes were low (<100 included CRC patients) in eight studies and only the RCT included a comparison group (non-rehabilitants).
The scientific evidence level was very limited. Due to the lack of a comparison group in most studies, we were only able to evaluate changes during/after inpatient rehabilitation therapy but not the effectiveness of treatment. However, study findings suggest that physical health and functional independence improve during inpatient rehabilitation, but improvements wane over time. Further large representative studies, in particular RCTs with long-term follow-up, are essential to evaluate the effectiveness of inpatient rehabilitation and identify determinants of treatment success.
结直肠癌（CRC）及其治疗可导致多种身体和心理社会功能障碍。癌症康复旨在降低发病率并提高生活质量。本综述的目的是总结和评估CRC 患者接受住院康复治疗后健康相关结局的变化，并评估这种治疗的效果。
我们进行了系统的文献检索，包括电子数据库 Pubmed 和 Web of Science，以查找调查 CRC 患者接受多学科住院康复计划后健康相关结局变化或治疗效果的观察性和干预性研究。研究结果以叙述性方式进行综合。
11 项研究符合条件并纳入本综述。8 项患者队列研究涉及身体和功能状态、粪便失禁、焦虑和抑郁以及生活质量等方面的结果。在康复治疗过程中观察到身体状况（身体和功能状态、粪便失禁）和生活质量的几个维度都有积极的改善。关于焦虑和抑郁的研究结果没有定论。另外进行长期随访的研究表明，康复治疗后改善的健康状况随着时间的推移而减弱。一项 RCT 报告住院康复对痛苦没有影响，两项随机试验报告了运动强度对氧化应激和免疫反应的影响。8 项研究的样本量较小（<100 例包括 CRC 患者），只有 RCT 包括对照组（非康复者）。
科学证据水平非常有限。由于大多数研究中缺乏对照组，我们只能评估住院康复期间/之后的变化，而不能评估治疗的效果。然而，研究结果表明，身体康复和功能独立性在住院康复期间得到改善，但随着时间的推移改善会减弱。进一步开展大型代表性研究，特别是具有长期随访的 RCT，对于评估住院康复的效果和确定治疗成功的决定因素至关重要。
