REEACaRS version 4
Research type
Research Study
Full title
Realist evaluation and economic analysis of cancer rehabilitation services in South Wales (REEACaRS)
IRAS ID
236999
Contact name
Tessa Watts
Contact email
Duration of Study in the UK
1 years, 6 months, 1 days
Research summary
Research Summary
There is a steady increase in cancer diagnosis every year in Wales. With the help of advanced treatment options more people live with and survive cancer. However, cancer and its treatment can have side effects which can affect people’s health and wellbeing. Cancer rehabilitation is a service which helps with achieving maximal physical functioning, independence and assists people to adapt to a life which has been affected by cancer. In studies from across the world cancer rehabilitation has been found to improve quality of life, although how exactly these services work in South Wales have not been investigated. Based on the findings of a national survey, at least 58% of cancer patients could benefit from rehabilitation, but have not received appropriate help in Wales. Getting access to services, availability of healthcare professionals and what patients think about rehabilitation can all influence how cancer rehabilitation operates. Therefore, it is important to look at the services, how they work and for whom to provide high quality care for everyone.
The main aim of this study is to evaluate cancer rehabilitation services in South Wales. The study will have three phases. During the first phase quality of life data reported by patients, which has been collected for years by a local rehabilitation team, will be examined to investigate how effectively cancer rehabilitation works. In the second phase patients, healthcare professionals and hospital managers will be interviewed to identify what works in cancer rehabilitation and how from their perspective. The third phase will examine two different rehabilitation teams in South Wales to determine how they provide help for patients and how much they cost for the health service and for the patients.
Summary of Results
In Wales, UK, 41.3% of people with cancer responding to a national survey reported receiving limited or no support with their treatment related side effects, even though cancer rehabilitation services are available in the local oncology centres. Two cancer rehabilitation services provide in- and outpatient support, such as a 12-week exercise programme, fatigue management groups etc., in two cancer centres in South Wales, UK. The aim of this study was to investigate how these two Welsh cancer rehabilitation services worked, for whom, and in what circumstances.
This study consisted of statistical analysis of a cancer rehabilitation database, and interviews with twenty rehabilitation professionals and fifteen people with cancer.
The database suggested yearly changes in the number of people accessing cancer rehabilitation, and differences in gender and cancer diagnosis distribution. This was supported by the interview findings indicating delayed and haphazard referrals due to lack of direct information on cancer rehabilitation services from the treatment team. Reasons for the information provision issues included the wider treatment team’s insufficient knowledge on cancer rehabilitation, the prevailing medical model in the healthcare system, and the insufficient integration of rehabilitation in the cancer pathway. On the other hand, data from people who did access cancer rehabilitation showed that the 12-week exercise programme potentially led to improved fatigue and mobility, which was supported by some of the interviews. However, several factors hindered adequate cancer rehabilitation provision. Insufficient needs assessment and care coordination could have led to unmet needs, whilst unmanaged therapeutic relationships might have resulted in people’s dependency on cancer rehabilitation services and a lack of self-management behaviour.
In conclusion, improved coordination of patient support and boundary setting for cancer rehabilitation services is needed. However, some of these issues cannot be resolved until cancer rehabilitation is fully embedded in the cancer pathway. Education of the wider oncology treatment team is needed to incorporate cancer rehabilitation services in the cancer pathway, thus helping to ensure that the rehabilitation needs of people with cancer are met.
REC name
London - South East Research Ethics Committee
REC reference
17/LO/2123
Date of REC Opinion
29 Dec 2017
REC opinion
Favourable Opinion