Remote, Center-Based Care Improves Function and Pain in Advanced Cancer

Collaborative telerehabilitation could help to improve function and pain in patients with advanced-stage cancer experiencing disability, while also decreasing the length of hospital stays, according to study results from the COllaborative Care to Preserve PErformance in Cancer (COPE) randomized clinical trial.

“Disabling functional losses degrade quality of life and increase health care use among patients with advanced-stage cancer,” the researchers wrote in the study, published in JAMA Oncology. “Hospitalizations, which account for one-third of direct cancer costs, are more frequent, longer and more likely to result in acute hospitalizations, long-term care and inpatient post-acute care among patients with impaired mobility.”

A telecare version of the Collaborative Care Model — designed to deliver supportive care to improve mood, pain and other outcomes — offset patient access barriers to center-based programs and effectively improved depression and pain outcomes. However, the model has not been extended to function-directed care and it is unclear whether the effects achieved would be comparable to those of cancer center-based rehabilitation programs.

Therefore, the researchers aimed to determine whether collaborative telerehabilitation and pharmacological pain management would improve function, lessen pain and reduce requirements for inpatient care.

In total, 516 patients were randomized to three arms: a control arm, telerehabilitation arm and telerehabilitation with pharmacological pain management arm. The control arm was compared with the telerehabilitation arm to assess the effect of a Collaborative Care Model-based, centralized telerehabilitation intervention on function, pain and utilization. It was also compared with the third arm to determine whether the systematic integration of pharmacological pain management had an influence on these effects as well.

All patients underwent automated function and pain monitoring with data reporting to their care teams. Those in the telerehabilitation also received six months of centralized telerehabilitation provided by a physical therapist-physician team, and the third arm had nurse-coordinated pharmacological pain management.

The telerehabilitation only arm experienced improved function and quality of life compared with the control group, while both telerehabilitation arms had reduced pain interference and average intensity.

“Telerehabilitation with pharmacological pain management was less effective in improving function, which was an unexpected finding, as was the equal effectiveness of the rehabilitative and pharmacological) approaches in controlling pain,” the researchers wrote.

In addition, those who received telerehabilitation had a more likely chance of home discharge and fewer days in the hospital compared with the control arm.

“Our finding of reduced hospital use among participants in the telerehabilitation arms adds to growing evidence that proactively addressing functional impairment among vulnerable patients reduces hospital utilization,” they added. “Although strongly associated with health care use, functional impairment has been limitedly targeted in efforts to reduce overall costs of care.”

The researchers emphasized that rehabilitative rather than pharmacological pain management approaches may partially mediate the benefits seen in the study, in turn, warranting further study.