A Systematic Review of Functional Outcomes in Cancer Rehabilitation Research


Alix G. Sleight, Cedars-Sinai Medical Center, Department of Physical Medicine & Rehabilitation; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai; Samuel Oschin Cancer Center, Cedars-Sinai; National Cancer Institute, Division of Cancer Control and Population Sciences. Electronic address: AlixSleight.Warner@cshs.org.
Lynn H. Gerber, George Mason University, College of Health and Human Services; Inova Health System, Inova Medicine Services.
Timothy F. Marshall, Ivy Rehab Network.
Alicia Livinski, National Institutes of Health Library.
Catherine M. Alfano, Northwell Health Cancer Institute; Center for Personalized Health; Feinstein Institutes for Medical Research; Dept of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Shana Harrington, University of South Carolina, Arnold School of Public Health.
Ann Marie Flores, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University; Robert H. Lurie Comprehensive Cancer center, Cancer Survivorship Institute.
Aneesha Virani, Northside Hospital, Rehabilitation Department.
Xiaorong Hu, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health; Rehabilitation Medicine School, Nanjing Medical University.
Sandra A. Mitchell, Outcomes Research Branch; Division of Cancer Control and Population Sciences; National Cancer Institute.
Mitra Varedi, St. Jude Children's Research Hospital.
Melissa Eden, Mayo Clinic, Department of Physical Medicine and Rehabilitation.
Samah Hayek, Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel.
Beverly Reigle, University of Cincinnati Cancer Institute, Cancer Survivorship Program.
Anya Kerkman, Lincoln Cancer Rehabilitation / CHI Health St. Elizabeth.
Raquel Neves, Czech Rehabilitation Hospital, United Arab Emirates.
Kathleen Jablonoski, George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics.
Eileen Hacker, Indiana University School of Nursing, Science of Nursing Care.
Virginia Sun, Department of Population Sciences and Department of Surgery, City of Hope.
Robin Newman, Boston University College of Health and Rehabilitation Sciences, Department of Occupational Therapy.
Karen Kane McDonnell, University of South Carolina, College of Nursing.
Allison L'Hotta, Washington University in St. Louis, Department of Occupational Therapy.
Alana Schoenhals, University of Southern California, Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy.
Nicole L. Stout, West Virginia University Cancer Institute, West Virginia University School of Public Health; National Institutes of Health, Clinical Center, Rehabilitation Medicine Department.

Document Type

Journal Article

Publication Date



Archives of physical medicine and rehabilitation




functional status; neoplasms; rehabilitation; systematic review


OBJECTIVE: To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer, and describe the breadth of evidence as well as strengths and limitations across a range of functional domains DATA SOURCES: PubMed, CINAHL Plus, Scopus, Web of Science, EMBASE. The time scope was January 2008 - April 2019. STUDY SELECTION: Prospective, controlled trials including single- and multi-arm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full text review identified 362 studies for inclusion. DATA EXTRACTION: Extraction was performed by co-author teams, and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (Class I-IV). DATA SYNTHESIS: Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: 1) quality of life (109 studies); 2) activities of daily living (61 studies); 3) fatigue (59 studies); 4) functional mobility (55 studies); 5) exercise behavior (37 studies); 6) cognition (20 studies); 7) communication (10 studies); 8) sexual function (6 studies); and 9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results following cancer rehabilitation intervention(s) for at least one functional outcome. CONCLUSIONS: These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.


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