CENTENNIAL TOPICS

Systematic Review of Occupational Therapy and AdultCancer Rehabilitation: Part 2. Impact of MultidisciplinaryRehabilitation and Psychosocial, Sexuality, andReturn-to-Work Interventions

Elizabeth G. Hunter, Robert W. Gibson, Marian Arbesman,

Mariana D’Amico

Elizabeth G. Hunter, PhD, OTR/L, is Assistant

Professor, Graduate Center for Gerontology, University of

Kentucky, Lexington; eghunt2@uky.edu

Robert W. Gibson, PhD, MS, OTR/L, FAOTA, is

Professor and Director of Research, Department of

Emergency Medicine, Medical College of Georgia,

Augusta University, Augusta.

Marian Arbesman, PhD, OTR/L, FAOTA, is

Consultant, Evidence-Based Practice Project, American

Occupational Therapy Association, Bethesda, MD;

President, ArbesIdeas, Inc., Williamsville, NY; and Adjunct

Associate Professor, Department of Clinical Research and

Leadership, School of Medicine and Health Sciences,

George Washington University, Washington, DC.

Mariana D’Amico, EdD, OTR/L, BCP, FAOTA, is

Associate Professor, Department of Occupational Therapy,

Nova Southeastern University, Fort Lauderdale, FL.

This article is the second part of a systematic review of evidence for the effectiveness of cancer rehabilitation

interventions within the scope of occupational therapy that address the activity and participation needs

of adult cancer survivors. This article focuses on the use of multidisciplinary rehabilitation and inter-

ventions that address psychosocial outcomes, sexuality, and return to work. Strong evidence indicates

that multidisciplinary rehabilitation benefits cancer survivors and that psychosocial strategies can re-

duce anxiety and depression. Moderate evidence indicates that interventions can support survivors in

returning to the level of sexuality desired and help with return to work. Part 1 of the review also appears

in this issue.

Hunter, E. G., Gibson, R. W., Arbesman, M., & D’Amico, M. (2017). Centennial Topics—Systematic review of occupational

therapy and adult cancer rehabilitation: Part 2. Impact of multidisciplinary rehabilitation and psychosocial, sexuality, and

return-to-work interventions. American Journal of Occupational Therapy, 71, 7102100040. https://doi.org/10.5014/

ajot.2017.023572

Advances in treatment have improved survival rates in patients with cancer,

including those who emerge from cancer treatment needing rehabilitation.

Consequently, patients are living longer with the physical impairments that

result from their disease and its treatment in addition to comorbidities they

acquire as they age (American Cancer Society, 2015; Ries et al., 2002). As of

January 2014, the United States had nearly 14.5 million cancer survivors

(American Cancer Society, 2015). The number of survivors is projected to

grow to 18 million by 2022 (Howlader et al., 2009). Cancer can now be

categorized as a chronic condition for many people, resulting in a stronger

focus on return to function, participation, and quality of life (Howlader et al.,

2009).

The potential for cancer to result in disability can increase the cost and

burden for cancer survivors, highlighting the importance of long-term health

outcomes (Cohen, 2010; Extermann, 2007). Research has shown that func-

tional measures are strong predictors of survival for older adults living in the

Note. Each issue of the 2017 volume of the American Journal of Occupational Therapy features a special CentennialTopics section containing several articles related to a specific theme; for this issue, the theme is occupationaltherapy’s role in cancer treatment and recovery. The goal is to help occupational therapy professionals take stockof how far the professionhas comeandspark interest in themanyexcitingpaths for the future. Formore information,see the editorial in the January/February issue, https://doi.org/10.1054/ajot.2017.711004.

The American Journal of Occupational Therapy 7102100040p1

community (Keeler, Guralnik, Tian, Wallace, & Reuben,

2010). Functional decline increases significantly among

people with cancer age ³65 yr, and older cancer survi-

vors experience more functional decline than older

adults without cancer (Lunney, Lynn, Foley, Lipson,

& Guralnik, 2003; Sweeney et al., 2006). Cancer and

its treatment can cause interruptions to daily routines,

self-care, work, and leisure and social activities (Longpre

& Newman, 2011).

Objective of the Systematic Review

The objective of this review was to systematically search for

and assess the evidence supporting interventions within

the scope of occupational therapy to improve occupational

engagement. The focused question guiding selection of

research studies for review was “What is the effectiveness

of cancer rehabilitation interventions within the scope of

occupational therapy practice to address the activity and

participation needs of adult cancer survivors in activities

of daily living (ADLs), instrumental activities of daily

living, work, leisure, social participation, and rest and

sleep?”

This systematic review was supported by the American

Occupational Therapy Association (AOTA) as part of the

Evidence-Based Practice (EBP) Project (Lieberman &

Scheer, 2002). Because of the breadth of the systematic

review, the results were divided into two parts. This ar-

ticle presents Part 2 of the systematic review, which is

focused on the benefits of multidisciplinary rehabilitation

and interventions that address psychosocial outcomes,

sexuality, and return to work.

Method

Process

Search terms for the reviews were developed by the

methodology consultant to the AOTA EBP Project and

AOTA staff, along with the review authors and the ad-

visory group. The search terms were related to population

(adult cancer survivors), types of intervention, outcomes,

sequelae, and types of study design to be included in the

systematic review. Databases and sites searched included

Medline, PsycINFO, CINAHL, and OTseeker. In ad-

dition, consolidated information sources, such as the

Cochrane Database of Systematic Reviews, were included

in the search.

Eligibility Criteria

Included in the review were peer-reviewed scientific ar-

ticles on adults with cancer published in English between

1995 and 2014 and within the scope of practice of oc-

cupational therapy. The review excluded data from pre-

sentations, conference proceedings, non–peer-reviewed

research literature, dissertations, and theses. The review

also excluded studies focusing on caregivers, family mem-

bers, or friends rather than cancer survivors; studies of

childhood cancer; and interventions that required an aca-

demic degree other than occupational therapy (e.g., music

therapy). AOTA uses standards of evidence modeled on

those developed in evidence-based medicine (Sackett,

Rosenberg, Gray, Haynes, & Richardson, 1996):

• Level I: Systematic reviews, meta-analyses, randomized

controlled trials (RCTs)

• Level II: Two-group, nonrandomized studies (e.g., co-

hort, case control)

• Level III: One-group, nonrandomized studies (e.g.,

pretest and posttest)

• Level IV: Descriptive studies that include analysis of

outcomes (e.g., single-subject design, case series)

• Level V: Case reports and expert opinion that include

narrative literature reviews and consensus statements.

Studies included in the review provide Level I, II, and

III evidence. Level IV evidence was included only when

higher level evidence on a given topic was not found;

no Level V evidence was included in this part of the

review.

Data Extraction

A team of three reviewers (Hunter, Gibson, and D’Amico)

worked together to evaluate all articles at all stages of the

review. The synthesis entailed a detailed reading of the

studies and the completion of the evidence table de-

scribing each study specifically. Figure 1 in Part 1 of the

review depicts the flow of abstracts and articles through

the process (Hunter, Gibson, Arbesman, & D’Amico,

2017; see https://doi.org/10.5014/ajot.2017.023564). The

evidence table for Part 2 is provided in Supplemental

Table 1 (available online at http://otjournal.net; navigate

to this article, and click on “Supplemental”). The articles

were grouped into themes and analyzed and reported by

theme.

Analysis

Analysis of study design, outcomes, and risk of bias de-

termined which studies were assessed as strong or mod-

erate evidence. Strong evidence typically includes two or

more well-designed RCTs. Moderate evidence includes

one RCT, two or more studies providing lower level

evidence, or inconsistent findings from well-designed

projects. Only selected articles from the systematic review

are mentioned in this article.

7102100040p2 March/April 2017, Volume 71, Number 2

Results

The review team identified a total of 138 articles for

inclusion in the final qualitative synthesis; 52 articles are

described in this article (Part 2). Forty-five articles provide

Level I evidence, 3 provide Level II evidence, 3 provide

Level III evidence, and 1 provides Level IV evidence.

Articles were organized into four broad intervention areas:

multidisciplinary rehabilitation (18 articles), psychosocial

outcomes (29 articles), sexuality (2 articles), and return to

work (3 articles).

Risk of Bias

Risk of bias was assessed using the Cochrane risk-of-bias

guidelines described by Higgins, Altman, and Sterne

(2011; see Supplemental Table 2, online). The method

for assessing the risk of bias of systematic reviews was

based on the Assessment of Multiple Systematic Reviews

system developed by Shea et al. (2007; see Supplemental

Table 3, online).

Outcome Measures

Although many studies discussed ADLs, function, return

to work, participation, and sleep as a goal, few if any

measured these constructs. Instead, the measurement tools

used addressed quality of life (e.g., SF–12, SF–36) and

symptom control, which many authors indicated would

allow return to previous activities. Other studies discussed

these constructs generically in their findings as wellness,

health, and quality of life. Most studies discussed the

interventions provided, even occupation-based interven-

tions, in terms of addressing mental or emotional health,

physical activity, symptom management, and well-being.

Only a few studies discussed occupation-based outcomes

or outcome measures.

Interventions in MultidisciplinaryRehabilitation Programs

Multidisciplinary rehabilitation programs use a team ap-

proach that includes occupational therapy, physical therapy,

and other allied health professions. Eighteen articles related

to the use of multidisciplinary rehabilitation programs met

the criteria and were included in the review; 2 were Level I

systematic reviews, 12 were Level I RCTs, 2 were Level II

studies, 1 was a Level III study, and 1 article provided

Level IV evidence.

Strong Evidence. Strong evidence indicates that re-

habilitation programs benefit survivors with many types of

cancer. Multidisciplinary rehabilitation programs resulted

in improved function and participation regardless of type

of cancer, stage of cancer, or age of survivor (Level I: Cinar

et al., 2008; Khan, Amatya, Pallant, Rajapaksa, & Brand,

2012; Lapid et al., 2007; Scott et al., 2013; Level II:

Gordon, Battistutta, Scuffham, Tweeddale, & Newman,

2005; Level III: Hanssens et al., 2011).

Moderate Evidence. Moderate evidence indicates that

rehabilitation can be beneficial both before and after

treatment (Level I: Benzo et al., 2011). Cognitive re-

habilitation improved attention and overall quality of life

(Level I: Cherrier et al., 2013). Aquatic therapy and ex-

ercise were beneficial for breast cancer survivors (Level I:

Cuesta-Vargas, Buchan, & Arroyo-Morales, 2014). Re-

habilitation in advanced, progressive, recurrent cancer

was found to be cost-effective and to increase quality of

life (Level I: Jones, Fitzgerald, et al., 2013).

Psychosocial Interventions

Twenty-nine articles related to psychosocial interventions

met the criteria for the review: 6 Level I systematic reviews,

21 Level I RCTs, 1 Level II, and 1 Level III studies. Such

interventions included life review, stress management,

expressive or disclosure groups, problem-solving therapy,

mindfulness-based therapy, and cognitive–behavioral

therapy.

Strong Evidence. Strong evidence indicates that psy-

chosocial strategies, including cognitive–behavioral and

educational interventions (e.g., problem solving, knowl-

edge of illness and side effects), reduce anxiety >3 mo

posttreatment and depression 1–3 mo posttreatment

(Level I: Chien, Liu, Chien, & Liu, 2014).

Moderate Evidence. Moderate evidence supports a

variety of psychosocial interventions. A systematic review

found that psychosocial interventions increased quality

of life for people with advanced-stage cancer (Level I:

Uitterhoeve et al., 2004). Short-term life review increased

spiritual well-being for people with terminal cancer (Level I:

Ando, Morita, Akechi, & Okamoto, 2010), and stress

management groups increased psychosocial adjustment

among breast cancer survivors (Level I: Antoni et al.,

2006).

Problem-solving therapy using home-based care training

by phone helped women with breast cancer reduce stress

(Level I: Allen et al., 2002), and cognitive–behavioral

therapy decreased symptom limitations for people under-

going chemotherapy and those with advanced-stage cancer

(Level I: Doorenbos et al., 2005; Sherwood et al., 2005).

Self-management training was beneficial in both group and

individual interventions for improving quality of life (Level I:

Korstjens et al., 2008). Expressive writing about one’s

breast cancer experience significantly improved quality of

life outcomes for early-stage breast cancer survivors (Level

I: Craft, Davis, & Paulson, 2013).

The American Journal of Occupational Therapy 7102100040p3

Interventions for Sexuality

Two articles related to sexuality and sexual function met

the criteria for the review, 1 Level I systematic review and 1

Level I RCT.

Moderate Evidence. Moderate evidence supports ex-

ercise as beneficial for prostate cancer patients reporting

an interest in sex (Cormie et al., 2013). The system-

atic review pointed to three types of intervention used

for return to sexual function: exercise, medical, and

psychoeducational.

Limited Evidence. Limited evidence supports the ef-

fectiveness of couple-based and psychoeducational inter-

ventions (Taylor, Harley, Ziegler, Brown, & Velikova,

2011).

Interventions for Return to Work

Three articles related to intervention for return to work

met the criteria for the review: 1 Level I systematic review,

1 Level I RCT, and 1 Level III study. Moderate evidence

indicates that high-intensity exercise (strength, interval,

and home based) helped patients minimize the decrease

in work ability after cancer and treatment (Thijs et al.,

2012) and that multidisciplinary interventions that in-

clude physical and psychological aspects in addition to

vocational support provided return-to-work benefits (de

Boer et al., 2011). Finally, a Level III study provided

limited evidence related to an occupational therapy

intervention to help cancer patients return to work

(Desiron, 2010).

Discussion

This systematic review examined the evidence for the

effectiveness of interventions within the scope of occu-

pational therapy practice to improve the activity and

participation needs of adult cancer survivors in all areas of

occupation. Part 2 is focused on the effects of multidis-

ciplinary rehabilitation and interventions for psychosocial

outcomes, sexuality, and return to work.

Strong evidence indicates that multidisciplinary re-

habilitation programs are helpful for cancer survivors

regardless of cancer type or stage of cancer. Such programs

may be beneficial before treatment of some types of cancer

and are beneficial during and after treatment. Moderate to

strong evidence indicates that addressing the psychosocial

components of cancer survivorship is beneficial for sur-

vivors regardless of age or type or stage of cancer and can

improve anxiety, depression, and quality of life.

Limited research has been conducted on interventions

related to sexuality. This area of rehabilitation is relevant

for occupational therapists, and more high-quality studies

should be conducted in this area in the future. Moderate

evidence supports interventions to address sexuality in

cancer patients and survivors. The strongest evidence

related to sexuality supports physical exercise for survivors,

an important area to address for numerous types of cancer.

Return to prediagnosis sexual ability and activity is a goal

for many cancer survivors.

Moderate evidence supports rehabilitation interven-

tions addressing return to work for cancer patients and

survivors. Return to work is an important part of recovery

and rehabilitation for many adults with cancer, but limited

research has addressed this component of return to par-

ticipation. Return to the valued and needed role of worker

is important for occupational therapy practitioners to

facilitate.

Implications for OccupationalTherapy Practice

Cancer rehabilitation interventions benefit patients and

survivors with a wide variety of cancers. The evidence

demonstrates that this impact takes place at all stages of

cancer and at all points on the cancer survivorship con-

tinuum. Consequently, occupational therapy practitioners

should be involved in all stages of cancer rehabilitation.

The types of services occupational therapy practi-

tioners might provide are broad. Interventions such as

problem solving and stress reduction address survivorship

issues such as depression, anxiety, and cancer-related fa-

tigue. Return to work is an up-and-coming area in cancer

survivorship interventions; current evidence regarding

effective strategies for return to work is limited. Research

describing the negative effects of not returning to work

highlights how important it is to address this area of

participation. Finally, occupational therapy providers can

work with multidisciplinary teams to address the variety of

issues related to psychosocial issues associated with cancer,

return to work, and sexuality among cancer survivors.

Implications for Research

In general, more rigorous, well-designed research is needed

to understand which people need what type of inter-

vention at what point in their cancer care and survivorship.

Specifically, increased research is needed addressing

occupational therapy interests such as participation and

occupation-based outcomes and interventions. All of

the research projects evaluated in this review were

within the purview of occupational therapy; however,

very few addressed return to participation or included

occupation-based interventions.

7102100040p4 March/April 2017, Volume 71, Number 2

Rehabilitation services can potentially be incorporated

before, during, and after medical treatment. However,

little research evidence is available to support clinical

decisions such as when to assess survivors, at what point in

the cancer continuum services would be optimal, and

which survivors are in greatest need of rehabilitation.

Sexuality and return to work are two specific areas that are

open to opportunities for new research.

Finally, very few of the studies reviewed used specific

assessments of function other than health-related quality of

life. The majority of studies did not include assessments or

outcome measures specifically addressing return to mean-

ingful activity and participation. Future research needs to

specifically include participation and return to meaningful

activities rather than simply global quality of life.

Limitations

Limitations of the systematic review include the design

and methodology of the individual studies, such as small

sample sizes, short intervention periods, limited use of

standardized assessments, and short follow-up periods.

Many of the studies included multiple interventions, so

pinpointing the effects of each individual intervention

was not always possible. Finally, although comprehensive

literature search strategies were used, it is possible that

eligible studies were missed and that publication selection

bias may have resulted.

Conclusion

Occupational therapy practitioners working with cancer

survivors of all types, stages, and points on the survivorship

trajectory (diagnosis through long-term survivorship) have

some evidence to support practice. The interventions

presented in this review are part of an emerging body of

research; more research is needed to support occupation-

based interventions for this growing population. Occu-

pational therapy practitioners are well suited to investigate

occupational performance, occupation-based strategies,

quality of life, and participation status to support client-

centered interventions before, during, and after treatment

of clients with cancer diagnoses. s

Acknowledgments

We thank Deborah Lieberman, Program Director, AOTA

Evidence-Based Practice Project, for her guidance and

support during the process of this review. Marian Arbesman

is methodology consultant, AOTA Evidence-Based Practice

Project; no other potential conflicts of interest are reported.

ReferencespAhlberg, A., Engstrom, T., Nikolaidis, P., Gunnarsson, K.,

Johansson, H., Sharp, L., & Laurell, G. (2011). Early self-care rehabilitation of head and neck cancer patients. ActaOto-Laryngologica, 131, 552–561. https://doi.org/10.3109/00016489.2010.532157

pAllen, S. M., Shah, A. C., Nezu, A. M., Nezu, C. M., Ciambrone,D., Hogan, J., & Mor, V. (2002). A problem-solvingapproach to stress reduction among younger women withbreast carcinoma: A randomized controlled trial. Cancer,94, 3089–3100. https://doi.org/10.1002/cncr.10586

American Cancer Society. (2015). American Cancer Society:Cancer facts and figures. Atlanta: Author.

pAndo, M., Morita, T., Akechi, T., & Okamoto, T.; JapaneseTask Force for Spiritual Care. (2010). Efficacy of short-term life-review interviews on the spiritual well-being ofterminally ill cancer patients. Journal of Pain and SymptomManagement, 39, 993–1002. https://doi.org/10.1016/j.jpainsymman.2009.11.320

pAntoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R.,Sifre, T., Urcuyo, K. R., . . . Carver, C. S. (2006). Howstress management improves quality of life after treatmentfor breast cancer. Journal of Consulting and Clinical Psy-chology, 74, 1143–1152. https://doi.org/10.1037/0022-006X.74.6.1143

pBenzo, R., Wigle, D., Novotny, P., Wetzstein, M., Nichols,F., Shen, R. K., . . . Deschamps, C. (2011). Preoperativepulmonary rehabilitation before lung cancer resection:Results from two randomized studies. Lung Cancer, 74,441–445. https://doi.org/10.1016/j.lungcan.2011.05.011

pBuss, T., de Walden-Gałuszko, K., Modlinska, A., Osowicka,M., Lichodziejewska-Niemierko, M., & Janiszewska, J.(2010). Kinesitherapy alleviates fatigue in terminal hospicecancer patients—An experimental, controlled study. Sup-portive Care in Cancer, 18, 743–749. https://doi.org/10.1007/s00520-009-0709-0

pCarmack, C. L., Basen-Engquist, K., Yuan, Y., Greisinger, A.,Rodriguez-Bigas, M., Wolff, R. A., . . . Pennebaker, J. W.(2011). Feasibility of an expressive-disclosure group inter-vention for post-treatment colorectal cancer patients: Re-sults of the Healthy Expressions study. Cancer, 117,4993–5002. https://doi.org/10.1002/cncr.26110

pCherrier, M. M., Anderson, K., David, D., Higano, C. S.,Gray, H., Church, A., & Willis, S. L. (2013). A randomizedtrial of cognitive rehabilitation in cancer survivors.Life Sciences, 93, 617–622. https://doi.org/10.1016/j.lfs.2013.08.011

pChien, C. H., Liu, K. L., Chien, H. T., & Liu, H. E. (2014).The effects of psychosocial strategies on anxiety and de-pression of patients diagnosed with prostate cancer: Asystematic review. International Journal of Nursing Studies,51, 28–38. https://doi.org/10.1016/j.ijnurstu.2012.12.019

pCimprich, B., Janz, N. K., Northouse, L., Wren, P. A.,Given, B., & Given, C. W. (2005). Taking CHARGE:A self-management program for women following breastcancer treatment. Psycho-Oncology, 14, 704–717. https://doi.org/10.1002/pon.891

pIndicates studies that were systematically reviewed for this article.

The American Journal of Occupational Therapy 7102100040p5

pCinar, N., Seckin, U., Keskin, D., Bodur, H., Bozkurt, B., &Cengiz, O. (2008). The effectiveness of early rehabilitationin patients with modified radical mastectomy. CancerNursing, 31, 160–165. https://doi.org/10.1097/01.NCC.0000305696.12873.0e

Cohen, H. J. (2010). Functional assessment and the cancer sur-vivor: Something old, something new. Journal of theNational Cancer Institute, 102, 1450–1451. https://doi.org/10.1093/jnci/djq365

pCormie, P., Newton, R. U., Taaffe, D. R., Spry, N., Joseph,D., Akhlil Hamid, M., & Galvao, D. A. (2013). Exercisemaintains sexual activity in men undergoing androgensuppression for prostate cancer: A randomized controlledtrial. Prostate Cancer and Prostatic Diseases, 16, 170–175.https://doi.org/10.1038/pcan.2012.52

pCraft, M. A., Davis, G. C., & Paulson, R. M. (2013). Ex-pressive writing in early breast cancer survivors. Journal ofAdvanced Nursing, 69, 305–315. https://doi.org/10.1111/j.1365-2648.2012.06008.x

pCuesta-Vargas, A. I., Buchan, J., & Arroyo-Morales, M.(2014). A multimodal physiotherapy programme plusdeep water running for improving cancer-related fatigueand quality of life in breast cancer survivors. EuropeanJournal of Cancer Care, 23, 15–21. https://doi.org/10.1111/ecc.12114

pDale, H. L., Adair, P. M., & Humphris, G. M. (2010).Systematic review of post-treatment psychosocial and be-haviour change interventions for men with cancer. Psycho-Oncology, 19, 227–237. https://doi.org/10.1002/pon.1598

pde Boer, G., Taskila, T., Tamminga, S. J., Frings-Dresen,M. H., Feuerstein, M., & Verbeek, J. H. (2011). Interven-tions to enhance return-to-work for cancer patients. CochraneDatabase of Systematic Reviews, 2011, CD007569. https://doi.org/10.1002/14651858.CD007569.pub2

pDesiron, H. (2010). Occupational therapy and return to workfor breast cancer survivors. WFOT Bulletin, 61, 45–51.https://doi.org/10.1179/otb.2010.61.1.013

pDoorenbos, A., Given, B., Given, C., & Verbitsky, N.(2006). Physical functioning: Effect of behavioral inter-vention for symptoms among individuals with cancer.Nursing Research, 55, 161–171. https://doi.org/10.1097/00006199-200605000-00002

pDoorenbos, A., Given, B., Given, C., Verbitsky, N., Cimprich,B., & McCorkle, R. (2005). Reducing symptom limita-tions: A cognitive behavioral intervention randomized trial. Psy-cho-Oncology, 14, 574–584. https://doi.org/10.1002/pon.874

Extermann, M. (2007). Interaction between comorbidity andcancer. Cancer Control, 14, 13–22.

pFaller, H., Schuler, M., Richard, M., Heckl, U., Weis, J., &Kuffner, R. (2013). Effects of psycho-oncologic interven-tions on emotional distress and quality of life in adultpatients with cancer: Systematic review and meta-analysis.Journal of Clinical Oncology, 31, 782–793. https://doi.org/10.1200/JCO.2011.40.8922

pGordon, L. G., Battistutta, D., Scuffham, P., Tweeddale, M.,& Newman, B. (2005). The impact of rehabilitation sup-port services on health-related quality of life for womenwith breast cancer. Breast Cancer Research and Treatment,93, 217–226. https://doi.org/10.1007/s10549-005-5151-5

pGuo, Z., Tang, H. Y., Li, H., Tan, S. K., Feng, K. H.,Huang, Y. C., . . . Jiang, W. (2013). The benefits ofpsychosocial interventions for cancer patients undergoingradiotherapy. Health and Quality of Life Outcomes, 11,121. https://doi.org/10.1186/1477-7525-11-121

pHanssens, S., Luyten, R., Watthy, C., Fontaine, C., Decoster,L., Baillon, C., . . . De Greve, J. (2011). Evaluation of acomprehensive rehabilitation program for post-treatmentpatients with cancer. Oncology Nursing Forum, 38, E418–E424. https://doi.org/10.1188/11.ONF.E418-E424

pHayama, Y., & Inoue, T. (2012). The effects of deep breathingon “tension-anxiety” and fatigue in cancer patients undergo-ing adjuvant chemotherapy. Complementary Therapies inClinical Practice, 18, 94–98. https://doi.org/10.1016/j.ctcp.2011.10.001

pHegel, M. T., Lyons, K. D., Hull, J. G., Kaufman, P.,Urquhart, L., Li, Z., & Ahles, T. A. (2011). Feasibilitystudy of a randomized controlled trial of a telephone-delivered problem-solving occupational therapy interventionto reduce participation restrictions in rural breast cancersurvivors undergoing chemotherapy. Psycho-Oncology, 20,1092–1101. https://doi.org/10.1002/pon.1830

pHenderson, V. P., Clemow, L., Massion, A. O., Hurley,T. G., Druker, S., & Hebert, J. R. (2012). The effectsof mindfulness-based stress reduction on psychosocial out-comes and quality of life in early-stage breast cancerpatients: A randomized trial. Breast Cancer Research andTreatment, 131, 99–109. https://doi.org/10.1007/s10549-011-1738-1

Higgins, J. P. T., Altman, D. G., & Sterne, J. A. C. (2011).Assessing risk of bias in included studies. In J. P. T. Higgins& S. Green (Eds.), Cochrane handbook for systematic reviewsof interventions (Version 5.1.0). London: Cochrane Collec-tion. Retrieved from http://handbook.cochrane.org

pHopko, D. R., Armento, M. E., Robertson, S. M., Ryba,M. M., Carvalho, J. P., Colman, L. K., . . . Lejuez,C. W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients:Randomized trial. Journal of Consulting and Clinical Psy-chology, 79, 834–849. https://doi.org/10.1037/a0025450

Howlader, N., Noone, A. M., Krapcho, M., Neyman, N.,Aminou, R., Waldron, W., . . . Cronin, K. A. (Eds.).(2009). SEER cancer statistics review, 1975–2009 (vintage2009 populations). Bethesda, MD: National Cancer Institute.Retrieved from http://seer.cancer.gov/csr/1975_2009_pops09/

Hunter, E. G., Gibson, R. W., Arbesman, M., & D’Amico, M.(2017). Systematic review of occupational therapy andadult cancer rehabilitation: Part 1. Impact of physical ac-tivity and symptom management interventions. AmericanJournal of Occupational Therapy, 71, 7102100030. https://doi.org/10.5014/ajot.2017.023564

pJones, J. M., Cheng, T., Jackman, M., Walton, T., Haines, S.,Rodin, G., & Catton, P. (2013). Getting back on track:Evaluation of a brief group psychoeducation interventionfor women completing primary treatment for breast can-cer. Psycho-Oncology, 22, 117–124. https://doi.org/10.1002/pon.2060

pJones, L., Fitzgerald, G., Leurent, B., Round, J., Eades, J.,Davis, S., . . . Tookman, A. (2013). Rehabilitation in

7102100040p6 March/April 2017, Volume 71, Number 2

advanced, progressive, recurrent cancer: A randomizedcontrolled trial. Journal of Pain and Symptom Management,46, 315–325.e3. https://doi.org/10.1016/j.jpainsymman.2012.08.017

pKangas, M., Milross, C., Taylor, A., & Bryant, R. A. (2013).A pilot randomized controlled trial of a brief early inter-vention for reducing posttraumatic stress disorder, anxietyand depressive symptoms in newly diagnosed head andneck cancer patients. Psycho-Oncology, 22, 1665–1673.https://doi.org/10.1002/pon.3208

Keeler, E., Guralnik, J. M., Tian, H., Wallace, R. B., & Reuben,D. B. (2010). The impact of functional status on lifeexpectancy in older persons. Journals of Gerontology, SeriesA: Biological Sciences and Medical Sciences, 65, 727–733.https://doi.org/10.1093/gerona/glq029

pKhan, F., Amatya, B., Pallant, J. F., Rajapaksa, I., & Brand,C. (2012). Multidisciplinary rehabilitation in women fol-lowing breast cancer treatment: A randomized controlledtrial. Journal of Rehabilitation Medicine, 44, 788–794.https://doi.org/10.2340/16501977-1020

pKorstjens, I., May, A., van Weert, J., Mester, I., Tan, F., Ros,W., . . . van den Borne, B. (2008). Quality of life afterself-management cancer rehabilitation: A randomized con-trolled trial comparing physical and cognitive-behavioraltraining versus physical training. Psychosomatic Medicine, 70,422–429. https://doi.org/10.1097/PSY.0b013e31816e038f

pKorstjens, I., Mesters, I., van der Peet, E., Gijsen, B., & vanden Borne, B. (2006). Quality of life of cancer survivorsafter physical and psychosocial rehabilitation. EuropeanJournal of Cancer Prevention, 15, 541–547. https://doi.org/10.1097/01.cej.0000220625.77857.95

pLapid, M. I., Rummans, T. A., Brown, P. D., Frost, M. H.,Johnson, M. E., Huschka, M. M., . . . Clark, M. M.(2007). Improving the quality of life of geriatric cancerpatients with a structured multidisciplinary intervention:A randomized controlled trial. Palliative and SupportiveCare, 5, 107–114. https://doi.org/10.1017/S1478951507070174

pLemoignan, J., Chasen, M., & Bhargava, R. (2010). A retro-spective study of the role of an occupational therapist inthe cancer nutrition rehabilitation program. SupportiveCare in Cancer, 18, 1589–1596. https://doi.org/10.1007/s00520-009-0782-4

Lieberman, D., & Scheer, J. (2002). AOTA’s Evidence-BasedLiterature Review Project: An overview. American Journalof Occupational Therapy, 56, 344–349. https://doi.org/10.5014/ajot.56.3.344

pLloyd-Williams, M., Cobb, M., O’Connor, C., Dunn, L., &Shiels, C. (2013). A pilot randomised controlled trial toreduce suffering and emotional distress in patients withadvanced cancer. Journal of Affective Disorders, 148, 141–145. https://doi.org/10.1016/j.jad.2012.11.013

Longpre, S., & Newman, R. (2011). The role of occupationaltherapy in oncology. Bethesda, MD: American Occupa-tional Therapy Association. Retrieved from https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Oncology%20fact%20sheet.pdf

pLuckett, T., Britton, B., Clover, K., & Rankin, N. M. (2011).Evidence for interventions to improve psychological out-comes in people with head and neck cancer: A systematic

review of the literature. Supportive Care in Cancer, 19,871–881. https://doi.org/10.1007/s00520-011-1119-7

Lunney, J. R., Lynn, J., Foley, D. J., Lipson, S., & Guralnik,

J. M. (2003). Patterns of functional decline at the end of

life. JAMA, 289, 2387–2392. https://doi.org/10.1001/

jama.289.18.2387pManos, D., Sebastian, J., Mateos, N., & Bueno, M. J. (2009).

Results of a multi-componential psychosocial intervention

programme for women with early-stage breast cancer in

Spain: Quality of life and mental adjustment. EuropeanJournal of Cancer Care, 18, 295–305. https://doi.org/10.1111/j.1365-2354.2008.00978.x

pPitceathly, C., Maguire, P., Fletcher, I., Parle, M., Tomenson,

B., & Creed, F. (2009). Can a brief psychological interven-

tion prevent anxiety or depressive disorders in cancer pa-

tients? A randomised controlled trial. Annals of Oncology,20, 928–934. https://doi.org/10.1093/annonc/mdn708

pPool, M. K., Nadrian, H., & Pasha, N. (2012). Effects of a

self-care education program on quality of life after sur-

gery in patients with esophageal cancer. GastroenterologyNursing, 35, 332–340. https://doi.org/10.1097/SGA.

0b013e3182605f86Ries, L. A. G., Eisner, M. P., Kosary, C. L., Hankey, B. F.,

Miller, B. A., Clegg, L., . . . Edwards, B. K. (Eds.). (2002).

SEER cancer statistics review, 1975–2002. Bethesda, MD:

National Cancer Institute. Retrieved from http://seer.

cancer.gov/csr/1975_2002/pRuff, R. L., Adamson, V. W., Ruff, S. S., & Wang, X. (2007).

Directed rehabilitation reduces pain and depression while

increasing independence and satisfaction with life for pa-

tients with paraplegia due to epidural metastatic spinal

cord compression. Journal of Rehabilitation Research andDevelopment, 44, 1–10. https://doi.org/10.1682/JRRD.

2005.10.0168Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B.,

& Richardson, W. S. (1996). Evidence based medicine:

What it is and what it isn’t. BMJ, 312, 71–72. https://doi.org/10.1136/bmj.312.7023.71

pSchofield, P., & Payne, S. (2003). A pilot study into the use

of a multisensory environment (Snoezelen) within a

palliative day-care setting. International Journal of Pal-liative Nursing, 9, 124–130. https://doi.org/10.12968/ijpn.2003.9.3.11485

pSchofield, P., Ugalde, A., Gough, K., Reece, J., Krishnasamy,

M., Carey, M., . . . Aranda, S. (2013). A tailored, sup-

portive care intervention using systematic assessment

designed for people with inoperable lung cancer: A rand-

omised controlled trial. Psycho-Oncology, 22, 2445–2453.

https://doi.org/10.1002/pon.3306pScott, D. A., Mills, M., Black, A., Cantwell, M., Campbell,

A., Cardwell, C. R., . . . Donnelly, M. (2013). Multidi-

mensional rehabilitation programmes for adult cancer sur-

vivors. Cochrane Database of Systematic Reviews, 2013,CD007730. https://doi.org/10.1002/14651858.CD007730.

pub2pSemple, C., Parahoo, K., Norman, A., McCaughan, E.,

Humphris, G., & Mills, M. (2013). Psychosocial inter-

ventions for patients with head and neck cancer. Cochrane

The American Journal of Occupational Therapy 7102100040p7

Database of Systematic Reviews, 2013, CD009441. https://doi.org/10.1002/14651858.CD009441.pub2

Shea, B. J., Grimshaw, J. M., Wells, G. A., Boers, M., Andersson,N., Hamel, C., . . . Bouter, L. M. (2007). Development ofAMSTAR: A measurement tool to assess the methodologicalquality of systematic reviews. BMC Medical Research Meth-odology, 7, 10. https://doi.org/10.1186/1471-2288-7-10

pSherwood, P., Given, B. A., Given, C. W., Champion, V. L.,Doorenbos, A. Z., Azzouz, F., . . . Monahan, P. O. (2005).A cognitive behavioral intervention for symptom manage-ment in patients with advanced cancer. Oncology NursingForum, 32, 1190–1198. https://doi.org/10.1188/05.ONF.1190-1198

pSmeenk, F. W., van Haastregt, J. C., de Witte, L. P., &Crebolder, H. F. (1998). Effectiveness of home care pro-grammes for patients with incurable cancer on their qual-ity of life and time spent in hospital: Systematic review.BMJ, 316, 1939–1944. https://doi.org/10.1136/bmj.316.7149.1939

pStigt, J. A., Uil, S. M., van Riesen, S. J., Simons, F. J., Denekamp,M., Shahin, G. M., & Groen, H. J. (2013). A randomizedcontrolled trial of postthoracotomy pulmonary rehabilita-tion in patients with resectable lung cancer. Journal ofThoracic Oncology, 8, 214–221. https://doi.org/10.1097/JTO.0b013e318279d52a

Sweeney, C., Schmitz, K. H., Lazovich, D., Virnig, B. A., Wallace,R. B., & Folsom, A. R. (2006). Functional limitations inelderly female cancer survivors. Journal of the National CancerInstitute, 98, 521–529. https://doi.org/10.1093/jnci/djj130

pTaylor, S., Harley, C., Ziegler, L., Brown, J., & Velikova, G.(2011). Interventions for sexual problems following treat-ment for breast cancer: A systematic review. Breast CancerResearch and Treatment, 130, 711–724. https://doi.org/10.1007/s10549-011-1722-9

pThijs, K. M., de Boer, A. G. E. M., Vreugdenhil, G., van deWouw, A. J., Houterman, S., & Schep, G. (2012). Re-habilitation using high-intensity physical training andlong-term return-to-work in cancer survivors. Journal ofOccupational Rehabilitation, 22, 220–229. https://doi.org/10.1007/s10926-011-9341-1

pUitterhoeve, R. J., Vernooy, M., Litjens, M., Potting, K., Bensing,J., De Mulder, P., & van Achterberg, T. (2004). Psychosocialinterventions for patients with advanced cancer—A sys-tematic review of the literature. British Journal of Cancer, 91,1050–1062. https://doi.org/10.1038/sj.bjc.6602103

pYang, E. J., Lim, J. Y., Rah, U. W., & Kim, Y. B. (2012).Effect of a pelvic floor muscle training program on gyne-cologic cancer survivors with pelvic floor dysfunction: Arandomized controlled trial. Gynecologic Oncology, 125,705–711. https://doi.org/10.1016/j.ygyno.2012.03.045

7102100040p8 March/April 2017, Volume 71, Number 2

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

MultidisciplinaryRehabilitation

Ahlberg

etal.(201

1)

https://do

i.org/10.3109

/00

0164

89.2010.5321

57

LevelI

RCT

N5

374patientswith

head

andneck

cancer.

Interventiongrou

p,n5

184.

Con

trol

grou

p,n5

190.

Intervention

Earlypreventiverehabilitationby

speech–

lang

uage

patholog

yandPTto

reduce

swallowingproblems,

mouth

opening,

andneck

stiffness.

Con

trol

Usualcare.

•QOL

•Anxiety

anddepression

•Weigh

tloss

•2-yr

survival

•Self-reported

function

•Returnto

work

Moreinterventiongroupparticipants

hadnot

returned

towork6moaftertreatm

ent.

Thecontrolgrou

prepo

rted

sign

ificantlyless

swallowingdifficulty,andtheintervention

grouphadmorespeech

problems.

Nodifference

was

foundin

neck

andshoulder

stiffness

at6mo.

Nopo

sitiveeffect

was

foun

don

self-care.

Benzo

etal.(201

1)

https://do

i.org/10.1016

/j.lung

can.20

11.05.011

LevelI

RCT

N5

28patientswho

underwentlung

cancer

resectionby

open

thoracotom

yor

video-

assisted

thoracoscopy

andwho

had

mod

erateto

severe

COPD.

InterventionGroup

1,n5

5.

Con

trol

Group

1,n5

4.

InterventionGroup

2,n5

10.

Con

trol

Group

2,n5

9.

Intervention

Group

1:4wkof

guideline-based

pulmon

aryrehabilitation.

Group

2:10

preoperativepu

lmon

ary

rehabsessions

usingacustom

ized

protocol

with

nonstand

ardcompo

nents

(exerciseprescriptionbasedon

self-

efficacy,

inspiratorymuscletraining

,and

slow

breathing).

Con

trol

Groups1and2:

Usualcare.

•Leng

thof

stay

•Postoperativecomplications

NodifferenceswerefoundbetweenGroup

1andthecontrolgrou

p.

Group

2hadshortermeanlength

ofho

spital

stay

by3days

(p5

.058

),fewer

prolon

ged

chesttubes(11%

vs.6

3%,p

5.03),and

fewer

days

needingachesttube

(8.8

vs.4.3days,

p5

.04)

comparedwith

thecontrolgrou

p.

Busset

al.(201

0)

https://do

i.org/10.1007

/s005

20-009-070

9-0

LevelI

RCT

N5

49participants

inho

spiceforcancer.

Interventiongrou

p,n5

30.

Con

trol

grou

p,n5

19.

Intervention

Exercisesindividuallysupervised

byaPT

followingacarefully

workedoutplan,2

0–30

min

3·/wkfor3–

4wk.

Con

trol

NoPT.

•Fatigue

•QOL

•Rotterdam

Sym

ptom

Checklist

•Brief

Fatigue

Inventory

•VASfatigue

Intensity

offatigue

decreasedsignificantly

intheinterventiongroupafter3wkof

PT.

Intensity

ofphysicalsymptom

sdecreased

significantlyafter2wkof

PTintheintervention

groupandincreasedinthecontrolgroupafter

2wkof

observation.

Cherrieret

al.(201

3)

https://do

i.org/10.1016

/j.lfs.2013.08.011

LevelI

RCT

N5

28participants

(Mage5

58yr)a

medianof

3(±6)

yrafterprimaryor

adjuvant

treatm

entforvariouscancers(breast,

bladder,prostate,colon,

uterine).

Intervention

Group

cognitive

rehabilitationworkshop,

71-hr

sessions

over

7consecutivewk.

Con

tent

includ

edmem

oryaids

(e.g.,

calendar,reminders,no

tetaking

,study

aids),mem

oryskills(e.g.,habit

form

ation,

metho

dof

loci,chun

king,

learning

names),and1sessionon

•Sym

ptom

questionn

aires

•Neurocogn

itive

tests(e.g.,

FACT–

Cog

)

Com

paredwith

baseline,theinterventiongroup

demonstratedimprovem

ents

inperceived

cogn

itive

impairments

(p5

.01),cogn

itive

abilities(p

5.01),overallQOLwith

regard

tocogn

itive

symptom

s(p

5.01),andob

jective

measuresof

attention(p

5.05)

andshow

eda

trendtowardimprovem

enton

verbal

mem

ory.

(Con

tinued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 1

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Interventiongrou

p,n5

14.

Con

trol

grou

p,n5

14.

mindfulness

meditation.Participantswere

also

assigned

homew

ork.

Con

trol

Stand

ardcare.

Not

allcognitive

testsindicatedsignificant

improvem

ent.

Cinar

etal.(200

8)

https://do

i.org/10.1097

/01.

NCC.000

0305

696.1287

3.0e

LevelI

RCT

N5

57wom

enaftermastectom

y.

Interventiongrou

p,n5

27.

Con

trol

grou

p,n5

30.

Intervention

15sessions

ofindividual

rehabilitation

andhome-basedphysical

activity

prog

ram.

Con

trol

Hom

eexercise.

•ROM

ofshou

lder

joint

•Upp

er-extremity

circum

ferential

differences

•Functionalstatus

Theinterventiongrou

pexperiencedgreater

improvem

entinmeasuresof

flexion,abduction,

andaddu

ctionof

theshou

lder

jointand

functionalqu

estionn

aire

scores

comparedwith

thecontrolgrou

p.

Neither

grou

pexperiencedsign

ificant

differencesin

lymphedem

aandpo

stop

erative

complications.

Cuesta-Vargas,

Buchan,

&Arroyo-Morales

(201

4)

https://do

i.org/10.1111

/ecc.12114

LevelI

RCTpilot

N5

42primarybreast

cancer

survivors(age

rang

e5

25–65yr)£1

yraftercancer

diagnosiswho

hadcompleted

postcancer

treatm

entwithin

thepast

6moandwere

cancer-freeat

thetim

eof

studyenrollm

ent.

Interventiongrou

p,n5

22.

Con

trol

grou

p,n5

20.

Intervention

Multim

odalPTprog

ram

incorporating

deep

water

runningandeducationbased

oncognitive–behavioralprinciples,1-hr

sessions

3·/wkfor8wk.

Con

trol

Leafletcontaining

instructions

tocontinue

with

norm

alactivities.

•PFS–R

•Physicalandmentalgeneral

health

•QOL

Significantdifferences

betweengroups

were

foundin

PFS–R

totalscore(d

50.7,

p5

.001)

andinthebehavioral/severity

(d5

0.6,p5

.05),

affective/meaning

(d5

1.0,

p5

.001),and

sensory(d

50.3,

p5

.03)

domains.

Significantdifferences

betweengroups

werealso

foundforgeneralhealth

(d5

0.5,

p<.05)

and

QOL(d

51.3,

p<.05).

Multim

odalPTincorporatingdeep

water

runningdecreasedcancer-related

fatigue

and

improved

generalhealth

andQOLin

breast

cancer

survivors.

Thehigh

levelof

adherence

andlack

ofadverseevents

indicate

such

aprogram

issafe

andfeasible.

Gordon,

Battistutta,Scuffham,

Tweedd

ale,&New

man

(200

5)

https://do

i.org/10.1007

/s105

49-005-515

1-5

LevelII

Non

random

ized

clinicaltrial

N5

275wom

en(age

rang

e5

25–74yr)with

primaryun

ilateralbreast

cancer

who

hadno

cogn

itive

prob

lems.

Group

1,n5

36.

Group

2,n5

31.

Con

trol

grou

p,n5

208.

Intervention

Group

1:Earlyho

me-basedPT

intervention.

Group

2:Group-based

exercise

and

psychosocialintervention.

Con

trol

Nointervention.

•FACT–

BHRQOL

•FACT–

BArm

Morbidity

Group

1experiencedbenefitsinfunctionalw

ell-

being,

includ

ingredu

ctions

inarm

morbidity

andupper-body

disability,

at1–2moafter

diagno

sis.

Group

2show

edminimalchangesat4moafter

diagno

sis.

MeanHRQOLscores

(adjustedforage,

chem

otherapy,ho

rmon

etherapy,

high

bloo

dpressure,andoccupationtype)improved

gradually

inallgroups

at6and12

moafter

diagno

sis,

andno

prom

inentdifferenceswere

foun

d.

(Con

tinued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 2

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Hanssenset

al.(201

1)

https://do

i.org/10.1188

/11.

ONF.E418

-E42

4

LevelIII

One-group

pre–po

st

N5

36patientswho

hadcompleted

cancer

treatm

entwith

acurativepo

tential.

Intervention

12-wkprog

ram

combining

physical

exercise,psychoeducation,

andindividual

coun

seling.

Con

trol

Nocontrolgrou

p.

•EO

RTC

QLQ

–C30

•FACT–

F•HADS

•SF–36

•Tampa

ScaleforKinesioph

obia

•DistressBarom

eter

•TecumsehStepTest

Significantimprovem

entwas

observed

inQOL

(p<.001),physicalcondition

(p5

.007),fatigue

(p5

.01),anddepression

(p5

.012).

Kinesiophobia(p

5.229),distress

(p5

.344),

andanxiety(p

5.101)didnotchange

significantly.

Multidisciplinaryrehabilitationshould

bepartof

thetotalcare

plan

forpatientswith

cancer.

Hegelet

al.(201

1)

https://do

i.org/10.1002

/po

n.18

30

LevelI

RCTpilot

N5

31ruralbreast

cancer

patients(Stages

I–III)un

dergoing

chem

otherapy.

Interventiongrou

p,n5

15.

Con

trol

grou

p,n5

16.

Intervention

OTtelephoneproblem-solving

intervention

in6weeklysessions.Apatient

manual

containedalaydescriptionof

theproblem-

solvingprocess,worksheetsto

beused

duringtreatm

entsessions,guidelines

for

energy

conservationto

addressfatigue,and

acompact

disc

with

aprogressivemuscle

relaxationexercise

personallyrecorded

bytheOT.

Con

trol

Usualcare.

•Satisfaction

•Com

pletionrate

forho

mew

ork

•Function

•QOL

•Em

otionalstate

OTinterventionwas

foundto

befeasibleand

beneficial,andan

efficacyRCTshou

ldbe

cond

ucted.

Jones,Fitzgerald,et

al.(201

3)

https://do

i.org/10.1002

/po

n.20

60

LevelI

RCT

N5

41patientswith

advanced,recurrent

hematologicalandbreast

malignancies.

Interventiongrou

p,n5

21.

Con

trol

grou

p,n5

20.

Intervention

Com

plex

rehabilitationintervention

delivered

byahospice-based

multidisciplinaryteam

.

Con

trol

Usualcare.

•Psycholog

ical,Physical,and

Patient

Caresubscalesof

the

Sup

portiveCareNeeds

Survey

•Psychological

status

•Con

tinuity

ofcare

•QOL

•Resou

rceuse

Psycholog

ical,ph

ysical,andpatient

care

measuresandself-reported

health

state

improved

significantly

intheintervention

grou

p.

Theincrem

entalcost-effectivenessratio

was

£19,390perquality-adjustedlifeyear.

Khan,

Amatya,Pallant,

Rajapaksa,&

Brand

(2012)

https://do

i.org/10.2340

/16

5019

77-102

0

LevelI

RCT

N5

85wom

enwho

hadcompleted

defin

itive

breast

cancer

treatm

entin

anAustralian

commun

itycoho

rt.

Interventiongrou

p,n5

43.

Con

trol

grou

p,n5

42.

Intervention

Individualized

high-intensity

rehabilitation

prog

ram.

Con

trol

Usualactivity.

•DepressionAnxiety

StressScale

•Restrictionin

participation

•Perceived

Impact

Problem

Profile

•CARES

–SF

•FIM

®Motor

subscale

Significantdifferencesfavoring

theintervention

grou

pwerefoundin

depression

,mobility,and

participationandin

CARES

–SFGlobalscore.

Nodifference

betweengrou

pswas

notedinFIM

scores.

(Con

tinued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 3

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Lemoign

an,Chasen,

&Bhargava(201

0)

https://doi.org/10.1007

/s005

20-009-078

2-4

LevelIV

Retrospectivereview

N5

62patientswith

cancer

who

had

received

interventions

byan

OT.

Intervention

OTsessions

addressing

self-care,

prod

uctivity,andleisure.

Control

Nocontrolgrou

p.

Checklistmeasuring

intervention

use

36%

oftheOT’stim

ewas

spentassessing

patients’functionalcapacity

and64

%in

providinginterventions.TheOT’s

interventions

addressedleisureandexercise

(54%

),prod

uctiveactivities

such

asho

usew

ork

andpaid

employment(32%

),andbasicADLs

(14%

).

Ruff,Adam

son,

Ruff,&Wang

(2007)

https://doi.org/10.1682

/JR

RD.200

5.10.0168

LevelII

Non

rand

omized

N5

42veterans

who

wereno

nambulatory

afterspinal

epiduralmetastasistreatm

ent.

Interventiongrou

p,n5

12.

Control

grou

p,n5

30.

Intervention

Directedrehabilitationfor2wk.

Control

Historicalcontrolgrou

pof

paraplegic

veterans

who

didno

treceive

rehabilitation.

•Painlevel

•Depression

•Satisfactionwith

life

•Con

sumptionof

painmedication

Theinterventiongrouphadless

pain,

consum

edless

pain

medication,

wereless

depressed,andhadhigher

satisfactionwith

life.

Thesebenefitspersistedun

tilparticipants’

death.

Schofi

eld&Payne

(200

3)

https://doi.org/10.1296

8/ijpn.20

03.9.3.114

85

LevelI

RCTpilot

N5

26palliativedaycare

patientswith

advanced

cancer.

Interventiongrou

p,n5

13.

Control

grou

p,n5

13.

Intervention

Snoezelen

room

(lights,

music,arom

as,

tactile

stimulation,

taste).

Control

Quiet

room

.

•Anxiety

•Depression

Theinterventiongroupexperienceda

significant

redu

ctionin

anxietybu

tno

difference

inQOL.

Results

shou

ldbe

view

edwith

cautionbecause

ofdifferencesbetweenthegrou

ps.

Scottet

al.(201

3)

https://doi.org/10.1002

/14

6518

58.CD00

7730.pub2

LevelI

Systematic

review

N5

12RCTs.

N5

1,669adultcancer

survivors.

Intervention

Multidisciplinaryrehabilitationprograms

tomaintainor

improvephysicaland

psycho

social

well-being.

•Physicalhealth

•Psychosocialhealth

Themosteffectivemodeof

servicedelivery

was

face-to-face

contactsupplementedwith

atleast1follow-upteleph

onecall.

Noevidence

indicatedthat

multidisciplinary

rehabilitationprogramslasting>6

moimproved

outcom

esbeyond

thelevelattained

at6mo.

Noevidence

suggestedthatservices

weremore

effectiveifdelivered

byaparticular

type

ofhealth

professional.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 4

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plem

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ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Smeenk,vanHaastregt,de

Witte,

&Crebo

lder

(199

8)

https://doi.org/10.1136

/bm

j.316

.714

9.19

39

LevelI

Systematic

review

N5

9prospectivecontrolledstud

ies.

N5

4,249participantswith

incurablecancer.

Intervention

Com

prehensive

homecare

prog

ramsto

maintainQOLandredu

cereadmission

time.

Control

Stand

ardcare.

QOL

Non

eof

thestud

iesshow

edanegative

influence

ofhomecare

interventions

onQOL.

Asignificantly

positiveinflu

ence

ontheou

tcom

emeasureswas

seen

in2of

the5studies

measuring

patients’satisfactionwith

care,in

3of

7studiesmeasuring

physicaldimensionsof

QOL,

in1of

6studiesmeasuring

psychosocial

dimensions,

andin

2of

5studiesmeasuring

readmission

time.

Incorporationof

team

mem

bers’visits

topatientsat

homeor

regularmultidisciplinary

team

meetings

into

theinterventionprogram

was

relatedto

positiveresults.

Stigtet

al.(201

3)

https://doi.org/10.1097

/JTO.0b0

13e31827

9d52

a

LevelI

RCT

N5

49patientswho

hadun

dergon

ea

thoracotom

yforlung

cancer.

Interventiongrou

p,n5

23.

Control

grou

p,n5

26.

Intervention

Rehabilitationconsistingof

training

2·/

wkfor12

wkstarting1moafterho

spital

discharge,

scheduledvisits

topain

specialists,andmedicalsocialwork.

Control

Usual

care.

•QOL

•Pain

•Exercise

tolerance

RehabilitationdidnotresultinbetterQOL.Exercise

toleranceimproved

atthecostofmorepainandmore

limitations

becauseofphysicalproblems.

Theauthorssuggestedthatrehabilitationisbetter

postponedfor3–4moafterhospitaldischarge.

Thisstud

yclosed

prem

aturelybecauseof

the

introductionof

video-assisted

thoracoscopic

surgery.

Yan

g,Lim

,Rah

,&

Kim

(2012)

https://doi.org/10.1016

/j.ygyno

.201

2.03

.045

LevelI

RCT

N5

24patientswith

gynecologicalcancers.

Interventiongrou

p,n5

12.

Control

grou

p,n5

12.

Intervention

PelvicFloo

rRehabilitationProgram

consistingof

a45

-min

exercise

session

(biofeedback

andcore

exercise)anda30

-min

coun

selingsession1·

/wkfor4wk.

Control

Usual

care.

•Pelvicflo

orstreng

th•MEP

selicitedby

sacraland

transcranialmagnetic

stimulation

•PelvicFloorQuestionn

aire

•EO

RTC

QLQ

–C30

andQLQ

–CX24

Theinterventiongroupexperienced

significantlyimproved

pelvicflo

orstreng

thand

sexual

functioning.

Theinterventiongroupexperienced

significantly

improved

physical

andsexual

functioncomparedwith

thecontrolgrou

p.

Psychosocial

Allenet

al.(200

2)

https://doi.org/10.1002

/cncr.10586

LevelI

RCT

N5

164wom

en(age

£50yr)with

nohistory

ofbreast

carcinom

adiagnosedwith

Stage

I–IIIA

tumorswho

hadrecentlyinitiated

afirst

course

ofchem

otherapy.

Interventiongrou

p,n5

87.

Control

grou

p,n5

77.

Intervention

2in-personand4telephonesessions

with

anon

cology

nursewho

provided

prob

lem-solving

skillstraining

and

inform

ationalmaterialsover

a12

-wk

period

.

Control

Stand

ardcare.

•CARES

•Unm

etneed

forassistance

•MentalHealth

Inventory

•Im

pact

ofEventScale

•SocialProblem

-Solving

Inventory

Theinterventiongroupexperienced

improvem

entsinarangeof

problemsrelatedto

cancer

andits

treatm

ent,includingph

ysical

side

effects,

maritalandsexualdifficulties,and

psycho

logicalprob

lems.

Interventiongrou

pparticipants

with

poor

problem-solving

skillsbefore

theintervention

wereless

likelythan

thecontrolgrou

pto

resolvecancer-related

problems.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 5

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plem

entalTa

ble1.

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ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

And

o,Morita,Akechi,&

Okamoto(201

0)

https://doi.org/10.1016

/j.jpainsymman.2009.11.320

LevelI

RCT

N5

68term

inallyillcancer

patients.

Interventiongrou

p,n5

34.

Control

grou

p,n5

34.

Intervention

Short-term

life-review

interviewgroup.

Control

Usual

care.

•FACIT–S

pMeaning

ofLife

domain

•HADS

•Num

ericscaleforpsycho

logical

suffering

•Hope,

Burden,

Life

Com

pletion,

andPreparationitemsfrom

the

Goo

dDeath

Inventory

Theinterventiongroupshow

edsignificantly

greaterimprovem

entthan

thecontrolgroupin

Meaning

ofLife,Hope,

Life

Com

pletion,

and

Preparationscores

(p<.001).HADS(p

<.001),

Burden(p

<.007

),andSuffering

(p<.001

)scores

sugg

estedgreateralleviationof

sufferingin

theinterventiongroupcompared

with

thecontrolgrou

p.

Theauthorsconcludedthat

theintervention

was

effectivein

improvingspiritualwell-being,

alleviatingpsychosocialdistress,and

prom

otingago

oddeathin

term

inallyillcancer

patients.

Antoniet

al.(200

6)

https://doi.org/10.1037

/0022-

006X

.74.6.1143

LevelI

RCT

N5

199wom

enwith

nonm

etastatic

breast

cancer

(Stage

I–III)who

hadsurgeryfor

primarybreast

cancer

inthe8wkbefore

initialassessment.

Interventiongrou

p,n5

92.

Control

grou

p,n5

107.

Intervention

Closed,

structured,manualized

grou

pinterventionusingcognitive–behavioral

stress

managem

enttechniques

with

didactics,

includ

ingin-session

experientialexercisesandout-of-session

assignments

(e.g.,practicingrelaxation)

in2-hr

sessions

1·/wkfor10

wk.

Control

1-dayseminar

with

acond

ensed,

educationalversionof

theinform

ation

from

theinterventionlasting5–6hr.

•Illness-related

interpersonal

disruption

•State

ofmind

•Perceived

stress

managem

ent

skills

Theinterventiongrou

pexperiencedsubstantial

anddurableimprovem

ents

indiverseaspects

ofpsychosocialadjustment.Effectsem

erged

across

diversedo

mains;manyweresustained

9moaftertheintervention.

Carmacket

al.(201

1)

https://doi.org/10.1002

/cncr.26110

LevelI

RCT

N5

40po

sttreatm

entpatientswith

colorectal

cancer

(StagesI–III)identified

aspsychologically

distressed

with

theBSI.

Interventiongrou

p,n5

25.

Control

grou

p,n5

15.

Intervention

HealthyExpressionsintervention

consistingof

journalwritingand

discussion

facilitated

by2master’s-level

interventionistsin

121-hr

sessions

over

4mo.

Control

Stand

ardcare.

•BSIGlobalSeverity

Index

•CES

–D•EO

RTC

QLQ

–C30

Theinterventiongroupdemonstrated

significantly

greaterchangesin

distress

comparedwith

thecontrolgrou

pat

2mo.

Outcomemeasuresshow

edsignificant

(p<

.05)

improvem

ents

at4mo.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 6

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Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandCon

trol

Group

sOutcomeMeasures

Results

Chien,Liu,

Chien,&Liu

(201

4)

https://do

i.org/10.1016

/j.ijnurstu.20

12.12.019

LevelI

Systematic

review

N5

14stud

ies.

N5

1,363participants

with

prostate

cancer.

Intervention

Psychosocialstrategies

toaddress

anxietyanddepression

.

•Depression

•Anxiety

Only5stud

ieswereregarded

ashigh

quality.

12studiesdelivered

inform

ationaland

educationalor

cognitive–behavioral

interventions.

Theresults

show

that

psychosocialstrategies

substantially

reducedanxiety3moafter

intervention(p

<.0001)

andhadashort-term

effect

ondepression

(immediatelyafter

intervention,

p<.001;3moafterintervention,

p5

.04).

Cimprichet

al.(200

5)

https://do

i.org/10.1002

/po

n.89

1

LevelI

RCT

N5

49participants

(age

³25yr)who

had

completed

primarytreatm

entof

newly

diagno

sedearlyStage

Ior

IIbreast

cancer

andhadno

historyof

cogn

itive

impairment,

noaffectivedisorder

withintheprevious

year,

noprevious

historyof

cancer,andno

term

inalor

debilitatingillness.

Interventiongroup,

n5

25.

Con

trol

grou

p,n5

24.

Intervention

Taking

CHARGE,

aself-managem

ent

interventionconsistingof

2sm

all-group

sessions

and2individualtelephone

sessions

at2-wkintervalsover

7wk.

Con

trol

Usualcare.

Process

evaluationqu

estionn

aire

includingprogram

contentand

materials(e.g.,usefulness

ofthe

self-regulationapproach,session

content,andworkboo

k),prog

ram

form

atanddelivery(e.g.,

usefulness

ofgroupsessions

and

telephonesessions),and

sugg

estions

foradditionaltopics.

100%

oftheinterventiongrou

preported

working

onaperson

alprob

lem

ormanagem

ent

concern.

Themostfrequentlyselected

areas

wereph

ysicalactivity

(50%

),stress

(27%

),and

fatigue

(18%

).20

ofthe22

wom

enwho

completed

theprog

ram

developedaspecific

plan

toreachago

alandfeltconfi

dent

that

they

couldreachtheirgo

al;morethan

half(n

513

)werevery

confi

dent.

Craft,D

avis,&

Paulson

(201

3)

https://do

i.org/10.1111

/j.136

5-26

48.201

2.0600

8.x

LevelI

RCT

N5

120early(diagnosis<2

yr)survivorsof

breast

cancer,either

invasive

orno

ninvasive,

who

hadcompleted

defin

itive

treatm

ent

(surgery,chem

otherapy,and/or

radiation

therapy).

Group

1,n5

30.

Group

2,n5

30.

Group

3,n5

30.

Con

trol

grou

p,n5

30.

Intervention

Group

1:Writingabou

tcancer

asa

traumaticeventfor20

min

on4

consecutivedays.

Group

2:Writingaboutaself-selected

traumaticeventfor20

min

on4

consecutivedays.

Group

3:Writingabou

taneutraltopic

(facts,no

feelings)for20

min

on4

consecutivedays.

Con

trol

Nowriting.

FACT–

BGroup

1experiencedsignificantly

improved

QOL.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 7

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entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Dale,

Adair,&Hum

phris

(201

0)

https://doi.org/10.1002

/po

n.15

98

LevelI

Systematic

review

N5

11stud

ies.

N5

1,037men

with

cancer.

Intervention

Posttreatmentpsycho

socialandbehavior

change

interventions.

•Depression

•Anxiety

•Globalhealth

Allstudieshadsomepositiveresults;however,

lack

ofreportingof

interventioncontentand

methodologicalissues

limitthefindings.

Nostudiesintervened

with

singlemen,andnone

provided

comparativeoutcom

esformaritalstatus.

Doorenbos,Given,Given,&

Verbitsky

(200

6)

https://doi.org/10.1097

/00

0061

99-20060

5000

-00002

LevelI

RCT

N5

237participantsnewlydiagnosedwith

solid

tumor

cancersundergoing

chem

otherapy.

Interventiongrou

p,n5

118.

Control

grou

p,n5

119.

Intervention

Cognitive–behavioral

symptom

managem

entinterventiondelivered

in10

contacts.

Control

Usual

care.

SF–36

PhysicalFunctioning

subscale

Wom

enwith

breastcancerhadsignificantlybetter

physicalfunctioning

than

wom

enwith

lung

cancer.Chronichealth

conditions,symptom

limitation,

anddepressive

symptom

sat

baseline

werefoundto

moderatetheeffectof

intervention

onphysicalfunction.Nooverall(director

indirect)

effect

oftheinterventionon

physicalfunctioning

was

detected.

Doo

renbos

etal.(200

5)

https://doi.org/10.1002

/po

n.87

4

LevelI

RCT

N5

237participants

(age

range5

31–87yr)

newlydiagnosedwith

solid

tumor

cancers.

Interventiongrou

p,n5

118.

Control

grou

p,n5

119.

Intervention

Cognitive–behavioralinterventionfocused

oncancer-andchem

otherapy-related

symptom

sin

10contacts

over

18wk.

Control

Usual

care.

•PhysicalSym

ptom

Experience

Tool

•Com

orbidity

Questionn

aire

•CES

–D

Theinterventiongroupsignificantlyreduced

symptom

limitations

comparedwith

thecontrol

grou

pafter10

wkandmaintainedthis

advantageover

thecourse

oftreatm

ent.

Falleret

al.(201

3)

https://doi.org/10.1200

/JCO.2011.40.8922

LevelI

Systematic

review

N5

198stud

ies.

N5

22,238

adults

with

cancer.

Intervention

Psycho-oncologicinterventions

for

emotionaldistress

andQOL.

•Em

otionaldistress

•Anxiety

•Depression

•QOL

Significantsm

allto

medium

effectswere

observed

forindividu

alandgrou

ppsycho

therapyandpsycho

education.

These

effectsweresustained,

inpart,in

themedium

(£6mo)

andlong

term

(>6mo).

Short-term

effectswereob

served

forrelaxation

training

.

Guo

etal.(201

3)

https://doi.org/10.1186

/1477-

7525

-11-121

LevelI

RCT

N5

178patientswith

cancer

undergoing

radiationtherapy.

Interventiongrou

p,n5

89.

Control

grou

p,n5

89.

Intervention

Psychosocialcare

during

radiation

therapy.

Control

Radiationtherapyon

ly.

•Zu

ngSelf-RatingDepression

Scale

•Zu

ngSelf-RatingAnxiety

Scale

•EO

RTC

QLQ

–C30

Theinterventiongroupshow

edsignificant

improvem

ents

insymptom

sof

depression

(p<

.05),anxiety(p

<.05),and

HRQOL(p

<.05;i.e.,

better

globalhealth

status

andphysicaland

emotionalfunctioning,less

insomnia)

comparedwith

thecontrolgrou

p.

Psychosocialinterventioniscost-effectiveand

canimprovepatients’moo

dandQOLdu

ring

andafterradiationtherapy.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 8

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plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Hayam

a&Inoue(201

2)

https://do

i.org/10.1016

/j.ctcp.2011

.10.001

LevelI

RCT

N5

23Japanese

wom

enwith

gynecological

cancer

undergoing

adjuvant

chem

otherapy.

Interventiongroup,

n5

11.

Con

trol

grou

p,n5

12.

Intervention

10-m

indeep

breathingprog

ram

comprisingabdo

minalbreathing,

thoracic

breathing,

andbreathingwith

arms

raised.

Con

trol

Usualcare.

•Japanese

POMS–S

F•CancerFatigue

Scale

Bothgrou

psshow

edasignificant

redu

ctionin

“tension–anxiety”(p

5.00).

Intheinterventiongrou

p,themedianscorefor

fatigue

decreasedfrom

1.00

to0.00

after

chem

otherapy

(p5

.06);thisscoredidno

tchange

sign

ificantly

inthecontrolgrou

p(p

5.76).

Tension–anxietyandfatigue

weremore

reducedin

theinterventiongroupthan

inthe

controlgrou

p.

Henderson

etal.(201

2)

https://do

i.org/10.1007

/s105

49-011-173

8-1

LevelI

RCT

N5

163wom

en(age

rang

e5

20–65yr)with

Stage

Ior

IIbreast

cancer.

Group

1,n5

53.

Group

2,n5

52.

Con

trol

grou

p,n5

58.

Intervention

Group

1:8-wkMBSRprog

ram

Group

2:Nutritioneducationprogram.

Con

trol

Usualcare.

•BeckDepressionInventory

•BeckAnxiety

Inventory

•Sym

ptom

Checklist–90

–Revised

•Rosenberg

Self-Esteem

Scale

•UCLA

LonelinessScale

•Mini-MAC

•FACT–

B

Group

1experiencedasignificant

improvem

ent

inQOL,

activebehavioralcoping

,andactive

cogn

itive

coping

comparedwith

theother

grou

ps.Significantbetween-grou

psdifferences

favoring

Group

1at4moincluded

measuresof

meaningfulness,

depression,paranoid

ideation,

hostility,anxiety,

unhappiness,

andem

otional

control.

Hop

koet

al.(201

1)

https://do

i.org/10.1037

/a002

5450

LevelI

RCT

N5

80patientswith

breastcancer

andmajor

depression

.

Interventiongroup,

n5

40.

Con

trol

grou

p,n5

40.

Intervention

8sessions

ofbehavioralactivation

treatm

entfordepression

.

Con

trol

Problem

-solving

therapy.

•Depression

•En

vironm

entalreward

•Anxiety

•QOL

•Socialsupp

ort

•Medicalou

tcom

es

Results

revealed

strong

treatm

entintegrity,

excellent

patient

satisfactionwith

treatm

ent

protocols,

andlowpatient

attrition

(19%

).

Acrossboth

treatm

ents,gainswereassociated

with

strong

effect

sizes,

andon

thebasisof

response

andremission

criteria,

areliable

change

index,

andnu

mbers-needed-to-treat

analyses,approximatelythree-qu

arters

ofpatientsexhibitedclinicallysignificant

improvem

ent.

Nosignificant

groupdifferenceswerefoundat

posttreatm

ent.

Jones,

Cheng

,et

al.(201

3)

https://do

i.org/10.1002

/po

n.20

60

LevelI

RCT

N5

442patientswith

breast

cancer

who

werecompletingadjuvant

radiotherapy.

Intervention

Single-sessiongrouppsychoeducational

intervention.

Con

trol

Stand

ardprintmaterial(usualcare).

•Con

tent

questionn

aire

developedby

researchers

•Perceived

Preparedn

essforRe-

entryScale

Theinterventiongroupshow

edsignificant

improvem

entin

know

ledgeregardingthe

reentrytransitionperiod

(d5

0.31)andtheir

feelings

ofpreparedness

forreentry(d

50.37

).

(Con

tinued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 9

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Interventiongrou

p,n5

216.

Control

grou

p,n5

226.

•Self-EfficacyforManaging

ChronicDisease

Scale

•POMS–S

F•MedicalOutcomes

Study

Health

DistressScale

Nodifferencesbetweengroups

over

timewere

foundin

health-related

distress

ormoo

d.

Kangas,

Milross,

Taylor,&

Bryant(201

3)

https://doi.org/10.1002

/po

n.32

08

LevelI

RCT

N5

35patientswith

head

andneck

cancer

andelevated

levels

ofPTS

D,depression,or

anxiety.

Interventiongrou

p,n5

18.

Control

grou

p,n5

17.

Intervention

Multim

odal

CBT,

7sessions.

Control

Nondirectivesupportivecounseling.

•PTS

D•Anxiety

•Depressivesymptom

s•Cancer-relatedappraisals

•QOL

Nobetween-groups

differenceswerefoundin

PTS

Dandanxietysymptom

sin

theshortand

long

erterm

.

Upto

67%

oftheinterventiongrou

pno

long

ermet

clinicalor

subclinicalcriteriaforPTS

D,

anxiety,or

depression

by12

moposttreatm

ent,

comparedwith

25%

ofthecontrolgrou

p.

Korstjens

etal.(200

8)

https://doi.org/10.1097

/PSY.0b0

13e31816

e038f

LevelI

RCT

N5

209participants

with

allcancer

types

who

hadcompleted

medicaltreatm

ent³3

mo

previously.

Group

1,n5

76.

Group

2,n5

71.

Control

grou

p,n5

62.

Intervention

Group

1:12

-wkgrou

p-based

multidisciplinaryself-managem

ent

rehabilitationprogram

combining

physical

training

(2·/wk)

andcogn

itive–

behavioral

training

(1·/wk).

Group

2:12

-wkgrou

p-basedph

ysical

training

(2·/wk).

Control

Waitlist.

•QOL(SF–36)

Multidisciplinaryrehabilitationdidnot

outperform

physicaltraining

inrolelim

itations

becauseof

emotionalprob

lems(primary

outcom

e)or

anyotherdo

mains

ofQOL

(p>.05).

Com

paredwith

thecontrolgrou

p,bo

thinterventiongrou

psshow

edsign

ificant

and

clinicallyrelevant

improvem

ents

inrole

limitations

becauseof

physicalproblemsandin

physicalfunctioning,vitality,andhealth

change

(p<.01).

Korstjens,Mesters,vander

Peet,Gijsen,&vandenBorne

(200

6)

https://doi.org/10.1097

/01.

cej.0000220625.77857.95

LevelIII

Pre–post,long

itudinalcoho

rt

N5

658cancer

patients(allcancer

types).

Intervention

12-wkrehabilitationgroupprogram

combining

physical

exercise

and

psycho

education.

Control

Nocontrolgrou

p.

•EO

RTC

QLQ

–C30

Halfway

throughtheintervention,

significant

improvem

ents

werefoundin

alldomains

except

cognitive

functioning.Attheendof

rehabilitation,

participants

hadsignificant

improvem

ents

inglobalQOL,

emotional

functioning,cognitive

functioning,andfatigue

level.

Non–breastcancer

patientsshow

edclinically

relevant

improvem

entin

physicalandsocial

functioning,andno

nworking

patientsshow

eda

clinicallyrelevant

improvem

entin

role

functioning.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 10

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Lapidet

al.(200

7)

https://doi.org/10.1017

/S14

789515

0707

0174

LevelI

RCT

N5

103newlydiagno

sedcancer

patients

with

anestim

ated

5-yr

survivalrate

of0%

–50

%who

requ

ired

radiationtherapy.

Interventiongrou

p,n5

49.

Control

grou

p,n5

54.

Intervention

Structured,

multidisciplinaryprogram

addressing

theQOLdomains

ofcognitive,

physical,em

otional,spiritual,andsocial

functioning,890-m

insessions.

Control

Stand

ardcare.

•QOL(Spitzer

Uniscaleandlinear

analog

self-assessment)

Theinterventiongrouphadconsistentlyhigher

overallQOLscores

throug

hout

thestud

yand

significantly

high

erscores

at4wkthan

the

controlgrou

p(p

5.0461).

Theolderadults

intheinterventiongroup

demonstratedclinically

significant

improvem

entin

QOLscores

at4and8wk

comparedwith

olderadults

inthecontrol

grou

p.

Lloyd-Williams,

Cob

b,O’Con

nor,Dun

n,&Shiels

(201

3)

https://doi.org/10.1016

/j.jad.20

12.11.01

3

LevelI

RCTpilot

N5

100patientswith

advanced

metastatic

cancer.

Interventiongrou

p,n5

49.

Control

grou

p,n5

51.

Intervention

Focusednarrativeinterview

intervention

addressing

patients’senseof

meaning;

psycho

logical,ph

ysical,social,and

spiritualwell-being;

andsenseof

suffering,

with

anem

phasison

allowing

patientsto

telltheirstory.

Control

Usual

care.

•Num

erical

scaleforsuffering

•Brief

Edinbu

rghDepression

Scale

•Ed

mon

tonSym

ptom

Assessm

entScale

•FACIT–S

p

Results

sugg

estthat

thefocusednarrative

interview

canimproveanxietyanddepression

scores.

Theinterventiongroupdemonstrateda

significant

improvem

entin

pain

at8wk(p

<.01)

butno

significant

change

indepression.

Luckett,Britton,Clover,&

Rankin(201

1)

https://doi.org/10.1007

/s005

20-011-111

9-7

LevelI

Systematic

review

N5

9stud

ies.

N5

630participants

with

head

andneck

cancer.

Intervention

Psycholog

icalinterventions.

•Recruitm

ent

•Anxiety

•Depression

•Distress

Results

sugg

estitis

feasibleto

recruitpeop

lewith

head

andneck

cancer

topsychological

interventions

andto

evaluate

theirprog

ress

throughrepeated-outcomemeasures.

The

evidence

islim

itedby

thesm

allnu

mberof

studies,

metho

dologicalprob

lems,

andpo

orcomparability.

Manos,Sebastian,

Mateos,

&Bueno

(200

9)

https://doi.org/10.1111

/j.136

5-23

54.200

8.0097

8.x

LevelII

Controlledtrial

N5

188wom

en(age

rang

e5

25–7

0yr)who

hadundergonenonm

etastatic

breast

cancer

surgery;

werediagno

sedwith

breast

cancer

forthefirst

time;

andweretreatedwith

chem

otherapy,radiationtherapy,

and/or

horm

onaltherapy.

Interventiongrou

p,n5

94.

Control

grou

p,n5

94.

Intervention

Psychosocialinterventionprog

ram

combining

educationalandcognitive–

behavioral

interventions

andsocial

supportin

14weekly2-hr

sessions.The

sessions

wereorganizedarou

ndpreparationforchem

otherapy,health

education,

body

image,

stress

managem

entandcoping

skills,

communicationskills,

andgoalsetting.

Control

Nointervention(chose

notto

participate).

•EO

RTC

QLQ

–C30

•MAC

Bothgroups

experiencedsignificant

(p5

.000)

improvem

entin

functionallevelover

time,

but

therewas

nosign

ificant

difference

between

grou

psat

anytim

e.

Physicalsymptom

sdiminishedover

timefor

both

grou

ps,bu

tthey

diminishedmoreforthe

interventiongrou

pthan

thecontrolgrou

pfrom

posttreatm

entto

follow-up(p

5.000).

Theinterventiongrouphadsignificantly

less

depression

from

1measure

tothenext

(p5

.005)andsignificantlyless

than

thecontrol

grou

pat

both

posttreatm

entandfollow-up

(p5

.000).

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 11

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Pitceathly

etal.(200

9)

https://doi.org/10.1093

/anno

nc/m

dn708

LevelI

RCT

N5

465cancer

patientsfree

ofanxietyor

depressive

disorder.

Group

1,n5

156.

Group

1,n5

155.

Control

grou

p,n5

154.

Intervention

Group

1:CBTat

thestartof

cancer

treatm

entin

3structured

sessions

over

6wk.

Thefirst

90-m

insessionwas

conductedface-to-face

with

thetherapist;

thesubsequent

sessions,2and6wk

later,lasted

45min

andwerecond

ucted

byteleph

one.

Group

2:CBTbegu

n8wkafterstarting

treatm

entin

3structured

sessions

over

6wk.

Thefirst

90-m

insessionwas

conductedface-to-face

with

thetherapist;

thesubsequent

sessions,2and6wk

later,lasted

45min

andwerecond

ucted

byteleph

one.

Control

Usual

care.

•Standardizedpsychiatric

interviewto

detect

anxietyand

depression

Nobetween-grou

psdifference

was

foun

dat

12mo.

High-risk

patientswho

received

theintervention

wereless

likelyto

developan

anxietyor

depressive

disorder

comparedwith

thosewho

received

usualcare.In

low-riskpatients,

there

was

nodifference.

Poo

l,Nadrian,&

Pasha

(201

2)

https://doi.org/10.1097

/SGA.0b0

13e318

2605f86

LevelI

RCT

N5

105patientswith

esophagealcancer

underchem

otherapy

andwith

ahistoryof

surgery.

Interventiongrou

p,n5

55.

Control

grou

p,n5

50.

Intervention

Group

educationalprog

ram

consistingof

groupdiscussion,lectures,and

pamph

lets.

Control

Pam

phletaboutself-care

before

andafter

surgeryforesop

hagealcancer

anddu

ring

chem

otherapy.

•EO

RTC

QLQ

–C30

•EO

RTC

QLQ

–OES

18Theinterventiongroupexperienced

significantly

improved

QOL(p

5.001),

whereas

QOLdecreasedin

thecontrolgroup.

Theauthorsconcludedthat

self-care

education

programshave

positiveeffectson

theQOLof

patientswith

esop

hagealcancer.

Schofi

eldet

al.(201

3)

https://doi.org/10.1002

/po

n.33

06

LevelI

RCT

N5

108patientswith

inop

erablelung

orpleuralcancer

(including

mesothelioma).

Interventiongrou

p,n5

55.

Control

grou

p,n5

53.

Intervention

Tailoredinterventioncomprising2

sessions,at

treatm

entcommencement

andcompletion,

that

included

aself-

completed

needsassessment,active

listening,self-care

education,

and

communicationof

unmet

psychosocial

andsymptom

needsto

the

multidisciplinaryteam

formanagem

ent

andreferral.

Control

Usual

care.

•Needs

Assessm

entfor

AdvancedLu

ngCancerPatients

•HADS

•DistressTh

ermom

eter

•EO

RTC

QLQ

–C30

Noneof

theprimarydifferencesof

interestwere

significant

(allps

>.10),althou

ghchange

score

analysis

indicatedarelativebenefit

from

the

interventionforun

metsymptom

needsat8and

12wkpo

stassessment(effectsizes5

.55

and.40,

respectively).

Sem

pleet

al.(201

3)LevelI

Intervention

•Anxiety

•QOL

Noevidence

sugg

ests

that

psycho

social

interventionprom

otes

glob

alQOLor

reduces

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 12

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

https://doi.org/10.1002

/14

6518

58.CD00

9441.pub2

Systematic

review

N5

7stud

ies.

N5

542participants

with

head

andneck

cancer.

Psychosocialinterventions

toimprove

QOLandpsycho

socialwell-being.

•Depression

anxietyor

depression

forpatientswith

head

andneck

cancer.

Atpresent,theevidence

isinsufficientto

refute

orsupporttheeffectivenessof

psychosocial

interventionforpatientswith

head

andneck

cancer.

Sherwoodet

al.(200

5)

https://doi.org/10.1188

/05.

ONF.1190

-119

8

LevelI

RCT

N5

124patientsage³2

1yr

newlydiagno

sed

with

Stage

III,Stage

IV,or

recurrentcancer

(solid

tumor

orno

n-Hod

gkin

lymphom

a)un

dergoing

chem

otherapy.

Interventiongrou

p,n5

62.

Control

grou

p,n5

62.

Intervention

CBTnursinginterventionaimed

atteaching

patientsprob

lem-solving

techniques

toaffect

symptom

severity,5

contacts

over

8wk.

Control

Usual

care.

•Sym

ptom

severity

•CES

–DTheinterventiongroupandparticipants

with

lower

symptom

severity

atbaselinehad

significantlylower

symptom

severity

at10

and

20wk;

thedifference

at20

wkoccurred

primarily

ininterventionparticipants

age

£60yr.

Uitterhoeveet

al.(2004)

https://doi.org/10.1038

/sj.

bjc.66

0210

3

LevelI

Systematic

review

N5

10RCTs

involving13

trials.

N5

812participants

with

advanced

cancer.

Intervention

Psychosocialinterventions

toimprove

QOL.

•QOL

12of

thetrialsevaluatedbehavior

therapyand

foundpo

sitiveeffectson

1or

moreindicators

ofQOL.

Theresults

ofthereview

supp

ortuseof

behavior

therapyin

thecare

ofpatientswith

advanced

cancer.

Returnto

Work

deBoeret

al.(201

1)

https://doi.org/10.1002

/14

6518

58.CD00

7569.pub2

LevelI

Systematic

review

N5

14articlesreporting14

RCTs

and4

controlledpre–po

ststudies.

N5

1,652participants

with

cancer.

Intervention

Interventions

aimed

atenhancingreturn

towork.

Control

Usual

care.

•Return-to-workrate

orsick

leaveduration

•QOL

Moderate-quality

evidence

show

edthat

employed

patientswith

cancer

experienced

return-to-workbenefitsfrom

multidisciplinary

interventions

comparedwith

care

asusual.

Desiron

(201

0)

https://doi.org/10.1179

/otb.20

10.61.1.01

3

LevelIII

One

grou

p,pre–post

N5

13participants

(age

rang

e5

16–6

5yr)

with

breast

cancer

who

wereno

long

erreceivingtreatm

entandwereem

ployed

part

timeor

fulltim

e.

Intervention

3-step

interventionincludingjobanalysis,

establishm

entof

worktolerancebaseline

(WorkerRoleInventory),andindividual

workhardeningplan

(developed

ona

case-by-case

basis).

Control

Nocontrolgrou

p.

•Qualitativequ

estionn

aire

•EO

RTC

QLQ

–C30

Bytheendof

theproject,7participants

had

returned

towork,

1qu

itbecauseof

medical

prob

lems,

3used

OTsupp

ortto

develop

afocusedreturn-to-workprogram

with

theem

ployer

involved,and2used

theresults

ofthefirst

sessionto

evaluate

forthem

selves

whether

return

toworkfit

theirQOL.

Participants

provided

unanimouslypo

sitive

evaluations

oftheprog

ram.

(Continued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 13

Sup

plem

entalTa

ble1.

Eviden

ceTa

bleforOccup

ationa

lTh

erap

yan

dAdu

ltCan

cerReh

abilitation:

Part2.

Multidisciplina

ryReh

abilitationan

dPsychosocial,Sexua

lity,an

dReturnto

Work

Interven

tion

Studies

(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants

InterventionandControl

Groups

OutcomeMeasures

Results

Thijs

etal.(201

2)

https://doi.org/10.1007

/s109

26-011-934

1-1

LevelI

RCT

N5

110cancer

survivorsfrom

1hospital.

Interventiongrou

p,n5

72(64wom

en,M

age5

49yr).

Control

grou

p,n5

38(29wom

en,age

matched).

Intervention

18-wkrehabilitationprogram

including

streng

thandintervaltraining

andho

me-

basedactivities.

Control

Stand

ardmedicalcare

only.

•Changein

workhr/wk

•Timeun

tilreturn

towork

Theinterventiongroupshow

edsignificantly

less

reductionin

working

hoursperweek.

No

significant

difference

was

foun

din

timeun

tilreturn

towork.

Sexuality

Cormieet

al.(201

3)

https://doi.org/10.1038

/pcan.2012.52

LevelI

RCT

N5

57prostate

cancer

patientsun

dergoing

androg

ensupp

ressiontherapy.

Interventiongrou

p,n5

29.

Control

grou

p,n5

28.

Intervention

Exercise

prog

ram

consistingof

mod

erate-

tohigh-intensity

resistance

andaerobic

exercise

cond

uctedin

smallgrou

psand

supervised

byan

exercise

physiologist,

2·/wkfor12

wk.

Control

Usual

care.

•Sexualactivity

(EORTC

QLQ

–PR25

)Nobaselinedifferencesin

sexual

activity

were

foundbetweengrou

ps.A

sign

ificant

(p5

.045)

adjusted

grou

pdifference

insexualactivity

was

foundafterthe12-wkintervention;

sexual

activity

decreasedinthecontrolgroup

andwas

maintainedin

theinterventiongroup.

Aftertheintervention,

ahigher

percentage

ofthe

interventiongroup(17.2%

)than

thecontrolgroup

(0%)reported

amajor

interestinsex(p

5.024).

Taylor,Harley,Ziegler,Brown,

&Velikova(201

1)

https://doi.org/10.1007

/s105

49-011-172

2-9

LevelI

Systematic

review

N5

21stud

ies.

N5

2,876participantswho

completed

breast

cancer

treatm

ent.

Intervention

Interventions

forsexualprob

lems.

•Sexualfunction

3typesof

interventions

wereidentified:exercise

(n5

2),medical

(n5

2),andpsycho-

educational(n

517).Manyof

theinterventions

used

morethan

1of

thesecomponents.

Methodologicalvariability

prevents

conclusions

aboutwhich

interventions

workforwhom.

Tentativefin

ding

ssugg

estthat

themost

effectiveinterventions

arecouple-based

psycho

educationalinterventions

thatinclud

ean

elem

entof

sexual

counseling.

Note.ADLs

5activities

ofdaily

living;BSI5

BriefS

ymptom

Inventory;CARES

5CancerRehabilitationEvaluationSystem;CARES

–SF5

CancerRehabilitationEvaluationSystem–S

hortForm

;CBT5

cognitive–behavioraltherapy;CES

–D5

CenterforEpidem

iologicStudies

DepressionScale;C

OPD5

chronicobstructivepulmonarydisease;EO

RTC

5European

OrganizationforResearchandTreatm

entofC

ancer;FACIT–S

p5

FunctionalAssessm

entofChronicIllness

Therapy–SpiritualW

ell-B

eing;FACT–B5

FunctionalA

ssessm

entof

CancerTherapy–Breast;FACT–Cog

5FunctionalA

ssessm

entof

CancerTherapy–CognitiveFunction;

FACT–F5

FunctionalA

ssessm

entof

CancerTherapy–Fatigue;

HADS5

HospitalA

nxietyandDepressionScale;H

RQOL5

health-related

quality

oflife;M

5mean;MAC5

MentalA

djustm

entto

CancerScale;M

BSR5

mindfulness-based

stress

reduction;MEP

s5

motor

evoked

potentials;M

ini-

MAC5

Mini–MentalA

djustm

entto

CancerScale;O

T5

occupationaltherapy/occupationaltherapist;P

FS–R

5Piper

Fatigue

Scale–R

evised;P

OMS–S

F5

Profileof

MoodStates–ShortForm

;PT5

physicaltherapy/physicaltherapist;

PTS

D5

posttraumaticstress

disorder;QLQ

–C30

5Qualityof

LifeCore30

Questionnaire;QLQ

–CX24

5Qualityof

LifeCervicalQ

uestionnaire;QLQ

–OES

185

Qualityof

LifeOesophagealQuestionnaire;QLQ

–PR25

5Qualityof

Life

ProstateQuestionnaire;Q

OL5

quality

oflife;RCT5

random

ized

controlledtrial;ROM

5rangeof

motion;SF–36

5MedicalOutcomes

Study

ShortForm

–36;UCLA

5University

ofCalifornia,Los

Angeles;V

AS5

visualanalog

scale.

Thistableis

aprod

uctof

AOTA

’sEvidence-Based

PracticeProject

andAOTA

Press

andis

copyrigh

t©

2017

bytheAmerican

OccupationalTherapyAssociation.

Itmay

befreely

reproduced

forpersonalusein

clinical

oreducationalsettings

aslong

asthesource

iscited.

Allotheruses

requ

irewritten

perm

ission

from

theAmerican

Occup

ationalTh

erapyAssociation.

Toapply,

visithttp://www.copyright.com

.

Suggested

citation:

Hunter,E.

G.,Gibson,

R.W.,Arbesman,M.,&

D’Amico,

M.(2017).Systematic

review

ofoccupationaltherapyandadultcancer

rehabilitation:

Part2.

Impact

ofmultidisciplinaryrehabilitationand

psychosocial,sexuality,andreturn

toworkinterventions

(Suppl.Table1).American

Journalof

Occup

ationalTh

erapy,

71,71

0210

0040

.https://do

i.org/10.5014

/ajot.20

17.02357

2

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 14

Sup

plem

entalTa

ble2.

Risk-of-BiasTa

bleforStudies

Includ

edin

Part2of

theCan

cerReh

abilitationSystematic

Review(Excep

tSystematic

Reviews)

Citation

SelectionBias

Perform

ance

Bias

Blinding

ofOutcome

Assessm

ent(DetectionBias)

IncompleteOutcomeData

(AttritionBias)

ReportingBias

Random

Sequence

Generation

Allocation

Con

cealment

Blinding

ofParticipants

andPersonn

elPatient-Reported

Outcome

All-Cause

Mortality

Sho

rtTerm

(2–6

wk)

Long

Term

(>6wk)

Selective

Reporting

MultidisciplinaryRehabilitation

Ahlberg

etal.(201

1)2

22

22

2NA

1

Benzo

etal.(201

1)1

12

21

11

1

Busset

al.(201

0)1

22

21

1NA

1

Cherrieret

al.(201

3)1

22

?1

1NA

1

Cinar

etal.(200

8)1

1?

21

11

1

Cuesta-Vargas,

Buchan,

&Arroyo-Morales

(201

4)1

12

11

11

1

Gordon,

Battistutta,

Scuffham,Tw

eedd

ale,

&New

man

(200

5)2

22

21

11

1

Hanssenset

al.(201

1)2

22

2?

11

1

Hegelet

al.(201

1)1

22

21

22

1

Jones,

Fitzgerald,et

al.(201

3)1

22

22

11

1

Khan,

Amatya,Pallant,Rajapaksa,&

Brand

(2012)

12

2?

11

11

Lemoignan,Chasen,

&Bhargava(2010)

22

22

11

NA

1

Ruff,Adamson,

Ruff,&Wang(200

7)2

22

21

1NA

1

Schofi

eld&Payne

(200

3)1

22

?1

1NA

1

Stigtet

al.(201

3)1

22

?1

11

1

Yang,

Lim,Rah,&Kim

(201

2)1

22

?1

22

1

PsychosocialInterventions

Allenet

al.(200

2)1

??

21

11

1

And

o,Morita,Akechi,&

Okamoto(201

0)1

?2

21

1NA

1

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al.(200

6)1

12

21

22

1

Carmacket

al.(201

1)1

22

21

11

1

Cimprichet

al.(200

5)1

22

21

1NA

1

Craft,Davis,&Paulson

(2013)

12

22

12

21

Doorenbos,Given,Given,&Verbitsky

(2006)

12

22

22

21

Doo

renbos

etal.(200

5)1

22

22

22

1

Guo

etal.(201

3)1

22

21

11

1

Hayam

a&Inoue(2012)

12

22

11

NA

1

Henderson

etal.(2012)

12/?

22

11

11

Hop

koet

al.(201

1)1

12

21

11

1

Jones,

Cheng,et

al.(201

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22

21

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1

Kangas,

Milross,

Taylor,&

Bryant(201

3)1

12

21

22

1

Korstjens

etal.(200

8)1

22

21

12

1

Korstjens,Mesters,vanderPeet,Gijsen,&vandenBorne

(2006)

22

22

11

11

Lapidet

al.(200

7)1

22

21

1NA

1 (Con

tinued)

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 15

Sup

plem

entalTa

ble2.

Risk-of-BiasTa

bleforStudies

Includ

edin

Part2of

theCan

cerReh

abilitationSystematic

Review(Excep

tSystematic

Reviews)

(con

t.)

Citation

SelectionBias

Perform

ance

Bias

Blinding

ofOutcome

Assessm

ent(DetectionBias)

IncompleteOutcomeData

(AttritionBias)

ReportingBias

Random

Sequence

Generation

Allocation

Con

cealment

Blinding

ofParticipants

andPersonn

elPatient-Reported

Outcome

All-Cause

Mortality

Sho

rtTerm

(2–6

wk)

Long

Term

(>6wk)

Selective

Reporting

Lloyd-Williams,

Cob

b,O’Conno

r,Dun

n,&

Shiels(201

3)1

22

2?

22

1

Manos,Sebastian,

Mateos,

&Bueno

(200

9)1

22

21

??

1

Pitceathly

etal.(200

9)1

22

22

12

1

Poo

l,Nadrian,&Pasha

(201

2)1

22

21

1?

1

Schofi

eldet

al.(201

3)1

22

22

22

1

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al.(200

5)1

22

21

NA

21

Returnto

WorkInterventions

Desiron

(201

0)2

22

2?

11

1

Thijs

etal.(201

2)2

22

2?

11

1

SexualityInterventions

Cormieet

al.(201

3)1

22

?1

11

1

Note.Categoriesforrisk

ofbias:1

5lowrisk

ofbias;?5

unclearrisk

ofbias;2

5high

risk

ofbias.NA5

notapplicable.Risk-of-biastableform

atadaptedfrom

“Assessing

Riskof

Biasin

Included

Studies,”by

J.P.T.

Higgins,D.G.Altm

an,andJ.A.C.Sterne,in

CochraneHandbookforSystematicReviewsof

Interventions

(Version

5.1.0),by

J.P.T.

Higgins

andS.Green

(Eds.),20

11,Lo

ndon

:CochraneCollection.

Retrieved

from

http://

hand

book.cochrane.org

Thistableis

aprod

uctof

AOTA

’sEvidence-Based

PracticeProject

andAOTA

Press

andis

copyrigh

t©

2017

bytheAmerican

OccupationalTherapyAssociation.

Itmay

befreely

reproduced

forpersonalusein

clinical

oreducationalsettings

aslong

asthesource

iscited.

Allotheruses

requ

irewritten

perm

ission

from

theAmerican

Occup

ationalTh

erapyAssociation.

Toapply,

visithttp://www.copyright.com

.

Suggested

citation:

Hunter,E.

G.,Gibson,

R.W.,Arbesman,M.,&

D’Amico,

M.(2017).Systematic

review

ofoccupationaltherapyandadultcancer

rehabilitation:

Part2.

Impact

ofmultidisciplinaryrehabilitationand

psychosocial,sexuality,andreturn

toworkinterventions

(Suppl.Table2).American

Journalof

Occup

ationalTh

erapy,

71,71

0210

0040

.https://do

i.org/10.5014

/ajot.20

17.02357

2

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 16

Sup

plem

entalTa

ble3.

Risk-of-BiasTa

bleforSystematic

ReviewsInclud

edin

Part2of

theCan

cerReh

abilitationSystematic

Review

Citation

“APriori

Design”

Included?

DuplicateStudy

Selection/Data

Extraction?

Com

prehensive

Literature

Search

Perform

ed?

Statusof

Publicationas

InclusionCriteria?

List

ofIncluded/Excluded

Studies

Provided?

Characteristicsof

Included

Studies

Provided?

Qualityof

Studies

Assessedand

Docum

ented?

Quality

Assessm

ent

Used

Appropriately?

Methods

Usedto

Com

bine

Results

Appropriate?

Likelihoodof

PublicationBias

Assessed?

Conflict

ofInterest

Stated?

MultidisciplinaryRehabilitation

Scottet

al.(201

3)1

11

11

11

11

11

Smeenk,vanHaastregt,

deWitte,

&Crebolder

(199

8)

11

11

21

11

12

1

PsychosocialOutcomes

Chien,Liu,

Chien,&Liu(201

4)1

11

11

11

11

21

Dale,

Adair,&

Hum

phris(201

0)1

?1

21

12

21

22

Falleret

al.(201

3)1

11

11

11

11

11

Luckett,Britton,

Clover,&Rankin(201

1)1

?1

12

11

11

21

Sem

pleet

al.(201

3)1

11

11

11

11

?1

Uitterhoeveet

al.(2004)

11

11

11

11

11

2

Returnto

Work

deBoeret

al.(201

1)1

11

11

11

12

1?

Sexuality

Taylor,Harley,Ziegler,

Brown,

&Velikova(2011)

1?

11

11

11

12

1

Note.Categoriesforrisk

ofbias:1

5lowrisk

ofbias;?

5un

clearrisk

ofbias;2

5high

risk

ofbias.N

A5

notapplicable.R

isk-of-biastableform

atadaptedfrom

“Developmentof

AMSTA

R:A

MeasurementT

ooltoAssessthe

Metho

dologicalQ

ualityof

SystematicReviews,”by

B.J.S

hea,J.M.G

rimshaw

,G.A

.Wells,M

.Boers,N

.And

ersson

,C.H

amel,.

..L.

M.B

outer,20

07,B

MCMedicalResearchMethodology,7

,p.1

0.http://dx.do

i.org/10.11

86/

1471

-228

8-7-10

Thistableis

aprod

uctof

AOTA

’sEvidence-Based

PracticeProject

andAOTA

Press

andis

copyrigh

t©

2017

bytheAmerican

OccupationalTherapyAssociation.

Itmay

befreely

reproduced

forpersonalusein

clinical

oreducationalsettings

aslong

asthesource

iscited.

Allotheruses

requ

irewritten

perm

ission

from

theAmerican

Occup

ationalTh

erapyAssociation.

Toapply,

visithttp://www.copyright.com

.

Suggested

citation:

Hunter,E.

G.,Gibson,

R.W.,Arbesman,M.,&

D’Amico,

M.(2017).Systematic

review

ofoccupationaltherapyandadultcancer

rehabilitation:

Part2.

Impact

ofmultidisciplinaryrehabilitationand

psychosocial,sexuality,andreturn

toworkinterventions

(Suppl.Table3).American

Journalof

Occup

ationalTh

erapy,

71,71

0210

0040

.https://do

i.org/10.5014

/ajot.20

17.02357

2

The American Journal of Occupational Therapy, March/April 2017, Volume 71, Number 2 17

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