Assessment of rehabilitation needs in cancer patients

In Germany and the United States cancer patients are admitted to rehabilitation programmes after anti-cancer treatment. Such programmes do not exist in the Netherlands. This leads to the question of whether in the Dutch health care situation certain problems (impairments-disabilities-handicaps) exist in (ex)cancer patients that can be dealt with by a rehabilitation programme. Using theories on the development of health care needs of chronic patients and the WHO approach of Impairment, Disability and Handicap, a framework for a questionnaire was developed. This questionnaire used quality of life items, functional health items and items mainly from specific cancer-orientated instruments. One hundred and forty seven patients participated in the study. After the results of this phase were clear, a focus group approach combined with in-depth interviews was used to present patients with possible rehabilitation programmes. Questions were formulated verifying the nature of prior results, inquiring about specific elements and desired outcomes and about practical aspects concerning post-cancer rehabilitation. The population consisted mostly of breast cancer (69.4%) and bowel cancer patients (23.8%). Quality of life scored averagely moderate, not indicating large problems. About 26% of all respondents wanted to receive professional help; this was largely determined by perceived quality of life and level of social support. The desire for professional help concentrated significantly on role performance, cognition, control, family relations, psychologic and somatic aspects. The focus group discussion and interviews revealed that patients would prefer a rehabilitation programme focusing on reducing fatigue, reinforcing loadability, coping with social aspects, dietary aspects and finding new life targets. Quality of life seemed to be relatively high and only 26% of post-cancer patients indicated the need of rehabilitation. Related to a significantly lower quality of life score, improved physical loadability and psychosocial functioning (coping) should be the main outcomes of such a programme. Specific elements such as dietary advice and finding new life targets should, from the patients' perspective, be included.