Date of Award

2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Clinical and Translational Science

First Advisor

Charles MacLean

Abstract

Cancer is pervasive in the United States and worldwide. Early screening, diagnosis and treatment of cancer has led to a significant increase in survivorship over the last three decades. There are currently more than 18 million cancer survivors in the US. Treatment accelerates physiologic aging and functional decline toward frailty. Patients experience high levels of physical needs following medical treatment for cancer. This Ph.D. dissertation examines the role of oncology rehabilitation in cancer care. If implementation of oncology rehabilitation is going to be adopted as a treatment option, it must first be appropriately evaluated. Having agreed-upon outcome measures is important. In a scoping review, we examined the heterogeneity in physical outcome measures used to evaluate the effects of cancer rehabilitation programs. Of the 2,550 abstracts screened, 41 met eligibility criteria and were included in the study. We found significant heterogeneity among the physical function outcome measures utilized to study outcomes among cancer survivors. There were 91 unique measures identified, and 27 unique physical side effects investigated. We examined the impact of a 12-week supervised exercise oncology rehabilitation program on physical function among older breast cancer survivors. Our primary outcome measure was five times sit to stand (5TSTS) which is a validated indicator of fall risk among older individuals. Ninety-two participants met the inclusion criteria for this study. There was a significant difference in mean 5TSTS from baseline to follow-up. All secondary outcome measures also demonstrated significant improvement from baseline. The results of this study support current evidence for oncology rehabilitation as a component of care for older breast cancer patients to improve function and possibly reduce fall risk. Oncology rehabilitation is not widely available. We conducted a survey of oncologists’ knowledge, attitudes, and practices with respect to referrals to oncology rehabilitation. Oncologists were recruited from Florida Society of Clinical Oncology and Northern New England Clinical Oncology Society to complete a 32-question survey. Eighty-two surveys were collected. Oncologists reported referring 23.2% of patients to oncology rehabilitation over the last 12 months. Urban oncologists were less likely to refer to oncology rehabilitation compared to suburban oncologists and reported greater difficulty with the referral process. Our study adds to the limited research available identifying knowledge, attitudes, and practices of oncologists’ use of oncology rehabilitation. Oncology rehabilitation is a safe, feasible, and beneficial intervention for most cancer survivors. If oncology rehabilitation is going to be accepted as the standard of care for survivors of cancer and cancer treatment, we will need to expand the evidence base to more fully understand its benefits and potential risks, determine which patients are most likely to benefit, and improve access and availability.

Language

en

Number of Pages

172 p.

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