Standards and Guidelines for Rehabilitation in Lung Cancer Patients

STANDARDS AND GUIDELINES FOR REHABILITATION IN LUNG CANCER PATIENTS. MERSEYSIDE AND CHESHIRE PALLIATIVE CARE AUDIT GROUP

Guidelines

. For lung cancer patients, rehabilitation needs may include the following symptoms or issues:[1] (Level 4)

o Pain

o Dyspnoea

o Fatigue

o Dysphagia

o Anorexia and cachexia

o Anxiety / stress

o Impaired mobility

o Reduction in independence for activities of daily living

o Need for specific equipment

o Communication difficulties

o Difficulties with work and leisure activities

. Ideally, for all lung cancer patients, their rehabilitation needs should be reviewed at the following different stages of their illness.[2] (Level 4):

1. Diagnosis

1 2. Treatment

3. Post treatment

4. Monitoring and survivorship

5. Palliative care

6. End of life

. A key worker for each individual patient should be identified to provide continuity of care throughout the patient pathway.[3] (Level 4)

. Exercise is a simple low-risk intervention and should be considered to help patients suffering from cancer-related fatigue both during and after treatment. [4] (Level 1+)

. A referral for more intensive non-pharmacological and psychological intervention should be considered for lung cancer patients to help improve both their dyspnoea and functioning level.[5](Level 1+)

. Simple measures like the use of walking aids and breathing re-training should be considered to help lung cancer patients manage their breathlessness.[6] (Level 2+)

. Relaxation therapy should be considered as an intervention not only to help lung cancer patients with psychological symptoms but to also help with somatic symptoms such as pain.[7] (Level 1-)

. Although the evidence for acupuncture and massage is more limited, these can still be beneficial interventions for some lung cancer patients.[7,8] (Level 4)

2 Standards

. All lung cancer patients at the palliative or end-of-life care stage of their illness should have their need for rehabilitation services assessed.[9,10] (Grade D)

o use of a holistic assessment tool (e.g. distress thermometer, SPARC)

. Lung cancer patients with palliative and end-of-life care needs should be able to access the rehabilitation services they need in a timely manner, as and when they need it.[11] (Grade D)

o generally < 2 weeks for most patients

o < 48 hours for certain clinical situations e.g. patient at high risk of falls, hospital admission likely without intervention, patient in at the end of life.

. A cancer rehabilitation team should consist of, but not be limited to, the following five key Allied Health Professionals:[11]

o Physiotherapist

o Occupational therapist

o Speech and language therapist

o Dietician

o Lymphoedema specialist (Grade D)

3 . There should be clear contact points for referral to general rehabilitation services and specialist AHP services (who can deliver rehabilitation interventions) for all healthcare professionals.[11] (Grade D)

4 REFERENCES

(1) NHS National Cancer Action Team. Rehabilitation Care Pathway Lung. Crown

(2) Dietz. Rehabilitation in Cancer Care. Oxford: Wiley-Blackwell 1981.

(3) Merseyside and Cheshire Cancer Network. Key worker guideline 2010.

(4) Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults.

Cochrane Database Syst Rev 2008;2:CD006145.

(5) Bredin M, Corner J, Krishnasamy M et al. Multicentre randomised controlled trial of

nursing intervention for breathlessness in patients with lung cancer. BMJ

1999;318:901-4.

(6) Bausewein C, Booth S, Gysels M et al. Non-pharmacological interventions for

breathlessness in advanced stages of malignant and non-malignant diseases.

Cochrane Database Syst Rev 2008;2:CD005623.

(7) Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in

reducing treatment-related symptoms and improving emotional adjustment in acute

non-surgical cancer treatment: a meta-analytical review. Psychooncology

2001;10:490-502.

5 (8) Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer:

systematic review. J Adv Nurs 2008;63:430-9.

(9) National Institute for Clinical Excellence. Guidance on Cancer Services: Improving

Supportive and Palliative Care for Adults with Cancer 2004.

(10) National End of Life Care Programme. Holistic Common Assessment of supportive

and palliative care needs for adults requiring end-of-life care 2010.

(11) NHS National Cancer Action Team. National Cancer and Palliative Care Rehabilitation

Workforce Project: project overview report 2010.