Early rehab makes a difference for children with cancer

Participating in an individualized rehabilitation program is beneficial to children with cancer, yielding significant gains in function without any adverse consequences, as reported in a study from Singapore.

Over 12 months, the program was associated with progressive linear improvements in three out of four domains of the Functional Independence Measure for Children: self-care (p<0.01), mobility (p<0.01), and overall function (p<0.01), but not cognition (p=0.18). [Ann Acad Med Singap 2022;51:736-738]

Of note, the improvements in mobility scores were significantly greater in boys than in girls (p=0.03)—a trend that has been seen in a systematic review in which boys tended to perform better in activities involving gross motor skills, whereas girls did better in activities involving fine motor skills. [Rev Int de Cienc Deporte 2019;15:72-87]

Meanwhile, the lack of effect of rehabilitation on cognition “is not surprising as the majority [of the cancer cases] were not brain tumours,” the investigators pointed out.

“Our study did not uncover any adverse events and supports the safety and efficacy of rehabilitation in the acute phase of cancer,” they said.

One-size program doesn’t fit all

“The aim of therapy was to return children to their premorbid status and address any developmental delay or impairment,” according to the investigators, who acknowledged that a rehabilitation program has a better chance of succeeding if tailored according to the needs of each child.

In the study, the rehabilitation program was individualized based on the children’s assessed needs at baseline. Depending on their needs, the children participated in one or combinations of the following: music, occupational, physio-, and speech therapy.

The rehabilitation interventions were conducted by the respective disciplines either in the inpatient or outpatient setting. Each session lasted about 45 minutes, conducted daily or weekly. Functional impairments were evaluated at the follow-up time points (3, 6, 9, and 12 months), and therapy was adjusted as required.

“In children assessed to have no deficits, and rehabilitation deemed unnecessary, caregivers were advised to monitor their functional ability and self-refer for rehabilitation if required later,” the investigators noted.

Individual goals were also set for each child, and the extent of progress toward these goals throughout the course of the rehabilitation program was measured using the Goal Attainment Scale. A total of 155 goals were formulated, with 56 (36.1 percent) were under the domain of Body Functions and Impairments, 98 (63.2 percent) under the domain of Activity and Participation, and one (0.6 percent) under the Environmental domain.

Most of the goals (91.6 percent) were met or exceeded. Eleven of the 13 (8.4 percent) goals that were missed were under the Activity and Participation domain. The main reason for failing to achieve these goals, according to the investigators, was due to complications during cancer treatment, such as stroke.

Further research needed

A total of 34 children were included in the study and underwent the rehabilitation program. Their mean age was 9.13 years, and 21 were boys. In terms of cancer diagnoses, 14 children had solid tumour, 11 had blood cancer, and nine had brain tumour.

The findings of the study may have important clinical implications, as “[i]mproving functional ability in children translates to an increase in physical activity, participation, and quality of life,” the investigators pointed out. [Qual Life Res 2006;15:1023-1031]

However, they advised careful interpretation of the findings, since the study had no control group and had limited sample size due to the rare nature of childhood cancer.

“Future multicentre studies will hopefully strengthen the evidence base and expand the body of literature regarding paediatric oncologic rehabilitation,” they said.