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Quality of Life After Self-Management Cancer Rehabilitation: A Randomized Controlled Trial Comparing Physical and Cognitive-Behavioral Training Versus Physical Training

From the Department of Health Education and Promotion (I.K., I.M., B.v.d.B.), School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, Netherlands; Department of Methodology and Statistics (F.T.), School for Public Health and Primary Care (Caphri), Maastricht University, Netherlands; Julius Center for Health Sciences and Primary Care (A.M.M., W.J.G.R.), University Medical Centre Utrecht, Utrecht, Netherlands; Department of Medical Psychology and Psychotherapy (A.M.M., R.W.T.), Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Center for Rehabilitation (E.v.W.), University Medical Centre Groningen, University of Groningen, Groningen, Netherlands; Comprehensive Cancer Centre North-Netherlands (E.v.W., J.E.H.M.H.-W., C.P.v.d.S.), Groningen, Netherlands; Wenckebach Institute (J.E.H.M.H.-W.), University Medical Center Groningen, University of Groningen, Groningen, Netherlands; and University of Applied Sciences (C.P.v.d.S.), Hanze University, Groningen, Netherlands.

Address correspondence and reprint requests to I. Mesters, Department of Health Education and Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands. E-mail: i.mesters{at}gvo.unimaas.nl

Objective: To conduct a randomized controlled trial and compare the effects on cancer survivors’ quality of life in a 12-week group-based multidisciplinary self-management rehabilitation program, combining physical training (twice weekly) and cognitive-behavioral training (once weekly) with those of a 12-week group-based physical training (twice weekly). In addition, both interventions were compared with no intervention.

Methods: Participants (all cancer types, medical treatment completed 3 months ago) were randomly assigned to multidisciplinary rehabilitation (n = 76) or physical training (n = 71). The nonintervention comparison group consisted of 62 patients on a waiting list. Quality of life was measured using the RAND-36. The rehabilitation groups were measured at baseline, after rehabilitation, and 3-month follow-up, and the nonintervention group was measured at baseline and 12 weeks later.

Results: The effects of multidisciplinary rehabilitation did not outperform those of physical training in role limitations due to emotional problem (primary outcome) or any other domains of quality of life (all p > .05). Compared with no intervention, participants in both rehabilitation groups showed significant and clinically relevant improvements in role limitations due to physical problem (primary outcome; effect size (ES) = 0.66), and in physical functioning (ES = 0.48), vitality (ES = 0.54), and health change (ES = 0.76) (all p < .01).

Conclusions: Adding a cognitive-behavioral training to group-based self-management physical training did not have additional beneficial effects on cancer survivors’ quality of life. Compared with the nonintervention group, the group-based self-management rehabilitation improved cancer survivors’ quality of life.

Key Words: cancer • survivors • multidisciplinary • rehabilitation • quality of life • self-management

Abbreviations: PT = physical training; CBT = cognitive-behavioral training; PT+CBT = physical training plus cognitive-behavioral training; WLC = waiting-list comparison; QoL = quality of life; ANOVA = analysis of variance; ES = effect size.