Department of Hematology/Oncology Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia.
Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland.
CA Cancer J Clin. 2021 Mar;71(2):149-175. doi: 10.3322/caac.21639. Epub 2020 Oct 27.
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
指南促进高质量的癌症护理。肿瘤学指南中的康复建议尚未得到描述，可能为改善康复在肿瘤学护理中的整合提供了一些见解。本报告是世界卫生组织（WHO）康复 2030 倡议的一部分，旨在确定肿瘤学护理指南中针对康复的具体建议。对指南进行了系统评价。仅纳入了 2009 年至 2019 年期间发表的英文指南，这些指南针对癌症成人患者的康复转诊和评估或干预提供了建议。共确定了 13840 篇文章。在去除重复项和应用过滤器后，筛选出 4897 篇文章。确定了 69 项有康复具体建议的指南。其中 37 项指南支持向康复服务转诊，但没有提供关于评估或干预的具体建议。69 项指南中有 32 项符合全部纳入标准，并使用 AGREE II 工具进行了评估。其中 21 项指南的 AGREE II 质量评分≥45 分，并进行了全面提取。排除了专门针对药物干预和补充替代干预的指南。研究结果表明，许多癌症类型和各种癌症治疗后果都推荐康复服务，这表明康复是肿瘤学护理的一个公认组成部分。然而，这些发现与临床报告中康复利用率低的情况相矛盾，这表明指南建议可能被忽视。考虑到功能障碍会影响大多数癌症幸存者，改善与指南一致的康复护理可能会对癌症幸存者的功能和生活质量产生重大影响。
