Cross-sectorial Rehabilitation of Patients with Lung Cancer

Cross-sectorial rehabilitation of patients with lung cancer - A cluster randomized controlled trial

Background Currently, approximately 4,700 patients are diagnosed with lung cancer annually in Denmark, with equal distribution between men and women. The average age at the time of diagnosis is 69 years, and the majority of patients are smokers or former smokers, with a high incidence of age- and smoking-related comorbidities. Lung cancer is divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Patients with very small tumors are offered surgery. Otherwise, treatment of localized disease consists of systemic treatment in combination with radiotherapy. Patients with disseminated disease are primarily treated with palliative chemotherapy, targeted treatment or immunotherapy.

The standard program in 2024 for rehabilitation and palliation of patients with cancer in Denmark is a nationwide, multidisciplinary approach defining the roles and the responsibilities of the hospital, municipality and general practice. At the hospital the patients are informed about possible rehabilitation and referred to the municipalities. This is done through a "needs assessment". A needs assessment must be offered at the beginning of treatment, at the end, and during follow-up care, as well as when there are changes in treatment or disease status. This, to ensure that all patients are offered an evaluation of current challenges and needs for support to maintain or restore daily life.

Continuity of care across sectors is a major challenge for healthcare systems. This affects patients with chronic disorders, such as cancer. It is difficult to motivate patients with lung cancer for rehabilitation and exercise, although, they often have many physical challenges, multiple comorbidities and concurrent symptoms. Both patients with lung cancer treated with a curative intent and those with advanced disease can experience fatigue, shortness of breath, pain, cough, depression, weight loss, and decreased muscle strength. Patients often avoid behaviors that produce symptoms and maintain an inactive pattern that exacerbates these symptoms.

A Danish survey, encompassing over 3,000 patients with cancer, reveals that 58% of the patients required support from the municipality. Additionally, 74% of the patients report discomfort that significantly impacts their daily lives due to the cancer and/or treatment. The survey also indicates that many cancer patients are not informed about rehabilitation. Specifically, 52% of patients report that a health professional has not discussed how their general practitioner can assist them with their cancer-related needs, and 40% report that they have not been informed about the support available from the municipality. Thus, data from Department of Oncology, Herlev and Gentofte Hospital's record system shows that only 16% of patients with lung cancer started rehabilitation in 2022. So there seems to be a major communication gap between the sectors in the Danish health care system.