title: Rehabilitation in advanced, progressive, recurrent cancer: a randomized controlled trial.
abstract: BACKGROUND
  Two million people across the U.K. are living with cancer, often experienced as a long-term condition. They may have unmet needs after active treatment. Rehabilitation aims to address these needs, maximize psychological and physical function, and enable minimum dependency regardless of life expectancy.
  
  
  OBJECTIVE
  We aimed to test, in a randomized controlled trial, the clinical and cost effectiveness of a rehabilitation intervention for patients with advanced, recurrent cancer.
  
  
  METHODS
  We conducted a two-arm, wait-list control, randomized trial of a complex rehabilitation intervention delivered by a hospice-based multidisciplinary team vs. usual care for active, progressive, recurrent hematological and breast malignancies, with a follow-up at three months. The primary outcome was the psychological subscale of the Supportive Care Needs Survey (SCNS). Secondary outcomes were other domains of the SCNS, psychological status, continuity of care, quality of life, and resource use.
  
  
  RESULTS
  Forty-one participants were enrolled and 36 completed the trial. The primary outcome was significantly lower in the intervention arm (adjusted difference -16.8, 95% CI -28.34 to -5.3; P = 0.006). The SCNS physical and patient care subscales (-14.2, 95% CI -26.2 to -2.2; P = 0.02 and -7.4, 95% CI -13.7 to -1.1; P = 0.02, respectively) and self-reported health state (12.8, 95% CI 3.2 to 22.4; P = 0.01) also differed significantly. The incremental cost-effectiveness ratio was £19,390 per quality-adjusted life year.
  
  
  CONCLUSIONS
  This intervention significantly reduced the unmet needs of cancer survivors and it is likely that it is cost-effective. Despite small numbers, the main effect size was robust. We recommend implementation alongside evaluation in wider clinical settings and patient populations.
authors.affiliation: Marie Curie Palliative Care Research Unit, UCL Mental Health Sciences Unit, University College London, London, United Kingdom. caroline.jones@ucl.ac.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
authors.forename: Gail
authors.initials: G
authors.lastname: Fitzgerald
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Round
authors.forename: Jane
authors.initials: J
authors.lastname: Eades
authors.forename: Sarah
authors.initials: S
authors.lastname: Davis
authors.forename: Faye
authors.initials: F
authors.lastname: Gishen
authors.forename: Amanda
authors.initials: A
authors.lastname: Holman
authors.forename: Katherine
authors.initials: K
authors.lastname: Hopkins
authors.forename: Adrian
authors.initials: A
authors.lastname: Tookman
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology