European Cancer Rehabilitation and Survivorship Symposium 2012

Workshop on municipal rehabilitation Sunday 16 September 2012 10:30-16:00

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Schedule 10:30-10:45 Welcome Remarks. Jette 10:45-11:00 Patient story 11:00-11:30 The role of communities in cancer rehabilitation. Efforts and challenges in Denmark. Bo

11.30-11:45 Break 11:45-12:15 Practical rehabilitation effort, City of Copenhagen. Jette & Karen 12:15-13:00 Lunch 13:00-13:30 Practical rehabilitation effort, City of Gladsaxe. Pia 13:30-13:45 Research and evaluation in Copenhagen Centre for Cancer and Health. Jette & Karen 13:45-14:00 Coffee break 14:00-15:00 Group discussion. Pia

15:00-15:45 Municipal-based rehabilitation and support in everyday living. Karen la Cour 15:45-16:00 Perspective. Jette kraeftcenter-kbh.dk

Practical rehabilitation effort Intentions: • Insight into rehabilitation programs offered patients with cancer, living in the City of Copenhagen

• Insight into our experience in the field collected since 2007

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“This was not just about crying. It was some good advices from other cancer survivors. Who had a longer experience in what to do, when you got real sick from chemotherapy. And I think we had so much fun….”

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“My contact person called me and explained about the health care center. Then he made a plan just for me – that person really knows me. He called me when I was home, sick: What is wrong and when will you be back again? Can we help you in any way? I fell in safe hands here”

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MUNICIPAL REHABILITATION FOR PATIENTS WITH CANCER

Cancer patients´ course of disease Follow-up

Cancer treatment

Diagnosis

Rehabilitation program at Copenhagen Centre for Cancer and Health Referral Contact person A physiotherapist, nurse or dietician is assigned to each patient throughout the program

Assessment Assessment interview An individualized rehabilitation program is planned by patient and contact person in cooperation

Follow-up interviews Adjustment of rehabilitation program involving everyday life and disease status

Multidisciplinary intervention program Physical activity Strength - and cardiovascular training, stability training, nature activities, running teams, dance

Last follow-up interview Focus on completion of the program

Dietary guidance Individual - and group counseling, cooking

Completion interview Focus on adherence to the changed life style

Social counseling Individual counseling, rights, return to work Patient Education Disease/medication, lifestyle issues, coping skills, experience sharing

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Completion

Other options Smoking cessation, meetings for relatives, counseling, yoga and mindfulness provided by the Danish Cancer Society

Rehabilitation in Denmark • According to The Health Act the responsibility is diveded between the municipalities and the hospitals • Hospitals are responsible for interventions if the patient is in need of efforts that requires medical specialists or out of consideration for the safety of the patient requires the possibility of assistance from health care professionals only found in hospitals kraeftcenter-kbh.dk

The aim of the Centre • The objectives for rehabilitation programs is for the patient with cancer to experience an active everyday life adapted to the widest extent possible to a life with or after cancer disease and treatment • Essential terms • • •

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Right after diagnosis Based on life situation In parallel with treatment

About the centre • Opened April 2007 (September 2011) • Located 400 meters from Rigshospitalet • All patients with cancer (living in Copenhagen) can be referred for rehabilitation at the center • Referral from hospital or GP

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A unique partnership • Rehabilitation unit - Municipality of Copenhagen • Counseling unit - The Danish Cancer Society

Common offices and facilities Common and separate programs

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A multidisciplinary team Rehabilitation unit

Counseling unit

•



Jette Vibe-Petersen

Head of counseling (psychologist)

Head of Centre (medical doctor)

• • • • • • • • • • kraeftcenter-kbh.dk

1 deputy manager 4 nurses 11 physiotherapists 3 dieticians 2 administrative staff members 1 social worker 1 academic 1 research coordinator 1 cafe employee 2 service assistents

Marie Lawætz

   



2 psychologists 2 social workers 1 psychotherapist 1 administrative staff member 80 volunteers - Professionals - Former patients

Two units Rehabilitation unit

Counseling unit

(City of Copenhagen)

(The Danish Cancer Society)

The first two years: - Lung cancer - Breast cancer - Colorectal cancer

 No relation to municipality

 Now all diagnoses

 ”Users”

 Referral needed!  Citizens with cancer or patients with cancer

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 All cancer diagnoses  No referral

Patients diagnosed with cancer Denmark • 32.000 new cancer patients per year • 230.000 cancer survivors

City of Copenhagen • Around 3.200 new cancer patients per year • 23.000 cancer survivors

Estimated users of the center • 1000 patients per year kraeftcenter-kbh.dk

Annual number of referrals

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Some of our experiences • Age 18-85 years • Half of our patients are curable and half are palliative • Increasing proportion of men – predominantly exercise and cooking classes • 98 % are satisfied or very satisfied with our program

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Focus group interviews 2007 - 2009 • Supervised physical training has been a motivation for lifestyle changes • More than half have maintained their new lifestyle • The contact person is of crucial importance to the patient's experience of coherence • The program at the centre has played a positive role in the everyday life of the citizens after the cancer diagnosis kraeftcenter-kbh.dk

Evaluation 2009 – physical activity • 43% of the patients join in strength- and cardiovascular training classes twice weekly • Approximately 40% of planned exercise times are cancelled by the patient because of out-patient hospital visits, treatment, side effects etc • Individual counselling and therapy are highly sought

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Dietary guidance of cancer patients A complex process

Patient categories  A wide spectre of cancer diagnoses  Finalized treatment  During treatment  With late effects  With relapse kraeftcenter-kbh.dk

Many players  Employees at the Health Care Centre  Patient’s GP  Treating hospital  Palliative team

Summery • Rehabilitation programs at Copenhagen Centre for Cancer and Health offered to a broad range of cancer patients is feasible and safe • Ongoing process to ensure that hospital or GP refers to rehabilitation center • Need for a clarity concerning the division of responsibility between the municipalities and the hospitals kraeftcenter-kbh.dk

BREAK

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Research and development - Copenhagen Centre for Cancer and Health • PROLUCA - a ongoing randomized clinical trial • Rehabilitation needs

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Research • A body of research provides evidens that exercise and psychosocial intervention might be beneficial for cancer patients • The challenge is to identify outcome measures and not only assess patientreported outcomes • And to identify screening tools

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PROLUCA

Perioperative Rehabilitation in Operations for LUng CAncer – a randomised clinical trial with blinded effect evaluation: rationale and design kraeftcenter-kbh.dk

PROLUCA • Title: Perioperative Rehabilitation in Operations for LUng CAncer – a randomised clinical trial with blinded effect evaluation: rationale and design (PROLUCA) • Purpose: In a non-hospital setting, to investigate the efficacy of preoperative and early postoperative rehabilitation in patients with operable lung cancer with focus on exercise training kraeftcenter-kbh.dk

PROLUCA • Performed by:  The Municipality of Copenhagen  The University of Copenhagen  The Capital Region of Denmark (tree hospitals) • A part of CIRE  Centre for Integrated Rehabilitation  Established and supported by The Danish Cancer Society and The Novo Nordisk Foundation kraeftcenter-kbh.dk

Methods • Using a 2x2 factorial design with continuous effect endpoint (VO2peak) • 380 subjects (95 patients/study arm) with histological evidence of non-small cell lung cancer (NSCLC) at disease stage I-IIIa, referred for surgical resection at Department of Cardiothoracic surgery RT, Rigshospitalet • Randomly assigned to one of four groups (three intervention groups and one control group)

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Figure 1. PROLUCA: STUDY TIMELINE (three intervention groups and one control group)

Diagnose

Surgery

2 weeks Enrollment

2 weeks

Home exercise Home exercise

6 weeks

14 weeks

18 weeks

26 weeks

52 weeks

Early initiated rehabilitation Rehabilitation Early initiated rehabilitation Rehabilitation

Follow-up

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Follow-up

Intervention Preoperative home-based exercise: • Cardiovascular excercise 30 minutes a day

The postoperative rehabilitation program: • Initiated two or six weeks after surgery • Cardiovascular and resistance training • Two sessions weekly for 12 weeks, a total of 24 sessions • Individual counselling kraeftcenter-kbh.dk

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Aim of the study (1) • To clarify the need for rehabilitation in a Danish cohorte of newly diagnosed cancer patients

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Cooperation • Project between Rigshospitalet, Centre for Cancer and Health and IFCV • Rigshospitalet has just accepted to participate • The work will start this automn

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Aim of the study (2) • Evaluate the need of rehabilitation on basis of rehabilitation interviews at the hospitals at three predefined times • Estimate whether a rehabilitation need is due to loss of physical ability or an expectation of this (health prevention)

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Aim of the study (3) • Evaluate which activities every patient has been participating in • Registrate the distribution of rehabilitation interventions between municipality and hospital • Estimate whether municipality based rehabilitation contributes to a sustainable return to labour market

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