Effectiveness of Multidimensional Cancer Survivor Rehabilitation and Cost‐Effectiveness of Cancer Rehabilitation in General: A Systematic Review

• Published in: The oncologist (Dayton, Ohio) Vol. 17; no. 12; pp. 1581 - 1593
• Main Authors: Mewes, Janne C., Steuten, Lotte M.G., IJzerman, Maarten J., Harten, Wim H.
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.12.2012
• Subjects: Cost-Benefit Analysis; Cost‐effectiveness; Humans; Meta-Analysis as Topic; Multidimensional; Neoplasms; Neoplasms - economics; Neoplasms - rehabilitation; Outcome Assessment, Health Care; Practice Guidelines as Topic; Quality-Adjusted Life Years; Rehabilitation; Survivors; Symptom Management and Supportive Care; Systematic review
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2012-0151

Introduction. Many cancer survivors suffer from a combination of disease‐ and treatment‐related morbidities and complaints after primary treatment. There is a growing evidence base for the effectiveness of monodimensional rehabilitation interventions; in practice, however, patients often participate in multidimensional programs. This study systematically reviews evidence regarding effectiveness of multidimensional rehabilitation programs for cancer survivors and cost‐effectiveness of cancer rehabilitation in general. Methods. The published literature was systematically reviewed. Data were extracted using standardized forms and were summarized narratively. Results. Sixteen effectiveness and six cost‐effectiveness studies were included. Multidimensional rehabilitation programs were found to be effective, but not more effective than monodimensional interventions, and not on all outcome measures. Effect sizes for quality of life were in the range of −0.12 (95% confidence interval [CI], −0.45–0.20) to 0.98 (95% CI, 0.69–1.29). Incremental cost‐effectiveness ratios ranged from −€16,976, indicating cost savings, to €11,057 per quality‐adjusted life year. Conclusions. The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over monodimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favorable cost‐effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost‐effectiveness of multidimensional programs. 摘要 引言. 很多癌症幸存者遭受疾病相关以及治疗相关的共病困扰，经常以此为初始治疗后的主诉。越来越多的证据显示了单维度康复干预的有效性；然而，实际上患者常参与多维度管理。本研究系统性回顾了关于癌症幸存者多维度康复管理的有效性以及总体癌症康复的成本‐效益。 方法. 系统回顾已发表的文献。采用标准化格式提取数据，并进行描述性总结。 结果. 共纳入16项有效性研究，6项成本‐效益研究。研究表明多维度康复管理是有效的，但并未优于单维度干预，且并非所有结果测量指标都是如此。生活质量的效应量范围为‐0.12[95% 可信区间（CI），‐0.45 ˜ 0.20] ˜ 0.98（95% CI，0.69 ˜ 1.29）。增量成本‐效益比率范围为‐€16 976（表示成本节约）˜ €11 057/质量调整生命年。 结论. 康复的多维度干预与经济学影响研究非常少，且主要局限在乳腺癌领域。据迄今为止已发表的研究报告，与常规管理相比，多维度干预具有统计学意义上的显著获益，这一点尤其体现在乏力和躯体功能这两个结果上。尚未发现多维度康复比单维度康复的获益更大，但仅有极少数散在报告。现有的经济学分析评估了各种截然不同的康复干预。然而，虽然可比性较差，但均显示出良好的成本‐效应比率。将来的研究设计应着重于多维度管理的有效性和成本‐效益比较评估。 Evidence regarding the effectiveness of multidimensional rehabilitation programs for cancer survivors and the cost‐effectiveness of cancer rehabilitation in general were systematically reviewed.