- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04316962
Cancer Rehabilitation in Primary Health Care
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study focuses on piloting a cancer rehabilitation program for cancer survivors (18-70 years of age), conducted in primary health care in a Norwegian municipality. In Norway, more than 70 % of all cancer patients will be long time survivors. However, research documents that cancer survivors are at increased risk for physical and psychosocial late effects with negative consequences for survival, long-time health and quality of life. Still, there is a huge gap between cancer survivors' documented late-effects and unmet needs and cancer rehabilitation interventions.
Background
Current cancer treatment is usually multimodal, hard and long-lasting, whereby many cancer patients experience physical and psychosocial late-effects and challenges. Some late-effects are life threatening, such as cancer relapse, new cancers, or development of chronical diseases. Other late effects influence the individual's health and quality of life negatively, as for example pain, lymphedema, gastrointestinal problems, memory, concentration and cognitive problems, neuropathies, anxiety and depression etc. In addition, cancer survivors report of social, economic and work related challenges. However, fatigue is the most distressing late-effect reported by cancer survivors, as it influences all areas of life, and is regarded as a strong and independent predictor for impaired quality of life.
Even if Norwegians' right to rehabilitation is assigned by law and cancer rehabilitation is a national focus area, cancer rehabilitation is not an integrated part of the cancer trajectory. Research indicate that healthcare providers have limited knowledge of cancer survivors' multidimensional challenges and effective elements in cancer rehabilitation. Consequently, cancer survivors experience lack of information about late-effects, inadequate follow-up and lack of understanding related to their physical and psychosocial challenges, as well as multidimensional rehabilitation interventions. Based on the law, cancer rehabilitation preferably should be conducted in municipalities nearby the patient's home. However, the few existing programs are criticized for being random, fragmented, not research based, only including single elements, and that survivors have to find such offers for themselves. This highlights the need to developed and pilot evidence based cancer rehabilitation programs - especially in primary health care.
Cancer rehabilitation is defined as processes that support cancer survivors to achieve maximal physical, psychological, social and work function within the frames created by cancer and cancer treatment. Consequently, cancer rehabilitation builds on a bio-psychosocial view of health and health promotion.
Even if cancer rehabilitation is a relatively new research field, research shows that effective elements in cancer rehabilitation are based on physical activity and psychosocial interventions. Physical activity is the single element with most evidence, showing positive effects on physical fitness, general health, quality of life, fatigue and return to work for most cancers and ages. Guidelines for cancer survivors recommend moderate physical activity 30 minutes a day, five days a week or more - and physical exercise as a combination of cardiovascular and strength exercise with gradual increase. Different types of psychosocial education have also shown effect on coping and stress reduction in cancer survivors. Such interventions, often called psychoeducation, most often include several elements such as education and illness specific information, emotional support, coping strategies, relaxing technics and discussions. Because cancer survivors challenges are multidimensional and individual, meeting the individual's need are crucial. Consequently, individual follow-up and goal setting are important means in promoting motivation, control and coping expectations that may promote positive physical and psychosocial health.Furthermore, research documents the importance of peer support in cancer rehabilitation, whereby peer support may promote positive changes, psychosocial function, empowerment and quality of life. New research indicates that a multidimensional approach in cancer rehabilitation that combines physical and psychosocial elements are more effective than single interventions related to physical function, quality of life, fatigue and distress. Research also indicate that positive effects of complex interventions are related to group rehabilitation after primary cancer treatment is finished, programs lasting more than three weeks, including several diagnosis and a multidisciplinary approach. Even if most of this research is conducted as in-rehabilitation in the specialist health care level, it seems evident that a complex rehabilitation program in primary healthcare should combine elements of physical activity, psychoeducation, peer support, goal setting and individual follow up for cancer survivors with different types of cancers after completion of primary cancer treatment.
Study goal and research questions
The overall goal of this pilot study is to increase the understanding and knowledge of cancer rehabilitation in primary health care by pilot testing a complex cancer rehabilitation program. Based on this, we have the following research questions:
- What characterize the psychosocial health and what is participants motivation to attend the program?
- How are the program's feasibility and adherence?
- In what degree do the participants achieve their goals and do this lead to increased participation?
- What are the participants' outcome on physical fitness?
- What are the participants' short (12 weeks) and long-term outcomes (6 and 12 months) related to quality of life, physical function, fatigue and mental health?
- What are the participants' experience of the rehabilitation process and what are the participants' recommendations for future programs?
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Vestland
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Bergen, Vestland, Norway, 5020
- Center for Crisis Psychology, University of Bergen
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Bergen, Vestland, Norway, 5300
- Askøy Municipality
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Cancer survivors with any type of cancer
- Aged 18- 70 years
- Finished primary cancer treatment within the last three months to five years 4) referred to the study by oncologist or general practitioner assuring the need for, and capability to, to participate in the program
5) Able to speak and read Norwegian
Exclusion Criteria:
- Severe physical and/or mental comorbidity representing a contraindication for rehabilitation
- Insufficient cognitive or Language skills to answer study questionnaires and perform interviews.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Complex rehabilitation
See intervention described elsewhere.
|
The program is conducted as group rehabilitation, organized by four hour weekly over 12 weeks (approximately 50 hours) with 8-10 participants in each group over three years. The program is located in Askøy Municipality's 'Health Central' and conducted by a multidisciplinary team. The content of the program is based on prior research and clinical experience, consisting of five elements:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Quality of life after cancer rehabilitation
Time Frame: Change from baseline (T1) to the end of the program = 12 weeks after baseline (T3)
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Self reported quality of life scale: European Organization for Research and Treatment of Cancer (EORTC QLQ C30), 30 questions, 4-point Likert scale 0-3 for 28 items, 0-6 for two items, total score 0-100 (100=highest Level of function/best score)
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Change from baseline (T1) to the end of the program = 12 weeks after baseline (T3)
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Participation
Time Frame: Change from baseline (T1) to the end of the program=12 weeks after baseline (T3)
|
Participation scale (goal achievement) administrated by professionals: Canadian Occupational Performance Measure (COPM): Participants rate problems in the three areas of self-care, productivity and leisure.
Then they rate the importance of each problem and score performance and satisfaction with performance on a 10-point scale ranging from 1 ('not able to do it' or 'not satisfied at all') to 10 ('able to do it extremely well' or 'extremely satisfied').
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Change from baseline (T1) to the end of the program=12 weeks after baseline (T3)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Long term change in Quality of life
Time Frame: Change from baseline (T1) to 58 weeks (T8= 1 year after end of cancer rehabilitation)
|
Self reported quality of life scale: European Organization for Research and Treatment of Cancer (EORTC QLQ C30), 30 questions, 4-point Likert scale 0-3 for 28 items, 0-6 for two items, total score 0-100 (100=highest Level of function/best score)
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Change from baseline (T1) to 58 weeks (T8= 1 year after end of cancer rehabilitation)
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Physical fitness
Time Frame: Change masured in meters from baseline (T1) to the end of program=12 weeks after baseline (T3)
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6 minutes walking test: Participant walk a predefined route, walk for 6 minutes and number of meter are measured.
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Change masured in meters from baseline (T1) to the end of program=12 weeks after baseline (T3)
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Fatigue
Time Frame: Short and longtime change from baseline (T1) to end of program= 12 weeks after baseline (T3); and to six months and one year after end of program (T4 and T5)
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Self reported fatigue scale: Fatigue Questionnaire (FQ), 13 items, whereby 7 items measure physical fatigue, 4 items measure mental fatigue, and two items are related to timeframe.
4-point Likert scale for all items scored from 0-4.
Sum score > 4 and more than 6 months duration are defined as fatigue.
|
Short and longtime change from baseline (T1) to end of program= 12 weeks after baseline (T3); and to six months and one year after end of program (T4 and T5)
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Mental Health
Time Frame: Short and longtime change from baseline (T1) to the end of program = 12 weeks after baseline (T3); and to six months and one year after program (T4 and T5)
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Self reported mental health scale: Hospital Anxiety and Depression Scale (HADS), including 7 questions of anxiety (HADS -A) and seven question of depression (HADS-B).
Scored on a 4-point Likert Scale (0-4) where a sum score of 11 or more are defined as anxiety/depression.
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Short and longtime change from baseline (T1) to the end of program = 12 weeks after baseline (T3); and to six months and one year after program (T4 and T5)
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Work and leisure
Time Frame: Short and longtime change from baseline (T1) to the end of program = 12 weeks after baseline (T3); and to six months and one year after program (T4 and T5)
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Self-reported work/leisure scale: Work and Social Adjustment Scale (WSAS) with five questions, 8- point Likert Scale from 0 (not impaired at all) to 8 (seriously impaired).
Max sum score = 40 (seriously impaired function), where scores > 20 indicates seriously psychopathology and scores 10- 20 is associated with significant impaired function.
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Short and longtime change from baseline (T1) to the end of program = 12 weeks after baseline (T3); and to six months and one year after program (T4 and T5)
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Feasibility/adherence
Time Frame: Through study completion, on average of 1 year
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Registration of study flow during the program: attendance on physical exercise, physical testing, attendance of psychoeducation sessions, dropout (number/reason), adverse events and missing data in questionaires
|
Through study completion, on average of 1 year
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Satisfaction with program
Time Frame: At the end of the program = 12 weeks after baseline (T3)
|
Self-reported satisfaction with program: 7 questions, measured on a 4-point Likert scale measuring satisfaction with the content and structure of the program ranging from 0 (not satisfied at all) to 3 (Very satisfied)
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At the end of the program = 12 weeks after baseline (T3)
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Patients' experiences
Time Frame: At the end of the program = 12 weeks after baseline (T3)
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Focus group interviews with a semi-structured interview guide focusing on motivation for the program, satisfaction with content and structure, importance and experienced outcome.
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At the end of the program = 12 weeks after baseline (T3)
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Posttraumatic Growth
Time Frame: Short and longtime change from baseline (T1) to the end of program= 12 weeks after baseline (T3); and to six months and one year after program (T4 and T5)
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Self-reported scale on posttraumatic growth: The Posttraumatic Growth Inventory Short Form (PTGI-SF) with 10 questions measured on a 6-point Likert scale ranging from 0 (not experienced) to 5 (to a very large extent).
Max sum score = 50 where higher score indicate higher personal growth.
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Short and longtime change from baseline (T1) to the end of program= 12 weeks after baseline (T3); and to six months and one year after program (T4 and T5)
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: May Aa Hauken, Professor, Center for Crisis Psychology, University of Bergen
Publications and helpful links
General Publications
- Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL; American College of Sports Medicine. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010 Jul;42(7):1409-26. doi: 10.1249/MSS.0b013e3181e0c112. Erratum In: Med Sci Sports Exerc. 2011 Jan;43(1):195.
- Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010 Jun;4(2):87-100. doi: 10.1007/s11764-009-0110-5. Epub 2010 Jan 6. Erratum In: J Cancer Surviv. 2011 Mar;5(1):112.
- Spence RR, Heesch KC, Brown WJ. Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev. 2010 Apr;36(2):185-94. doi: 10.1016/j.ctrv.2009.11.003. Epub 2009 Dec 4.
- Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas IK, Oldervoll L, Anker G, Falkmer U, Lundgren S, Leivseth G. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology. 2011 Sep;20(9):909-18. doi: 10.1002/pon.1844. Epub 2010 Sep 6.
- Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, Ozakinci G. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013 Sep;7(3):300-22. doi: 10.1007/s11764-013-0272-z. Epub 2013 Mar 10.
- Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol. 2013 Feb 20;31(6):782-93. doi: 10.1200/JCO.2011.40.8922. Epub 2013 Jan 14.
- Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol. 2011 Feb;50(2):187-93. doi: 10.3109/0284186X.2010.533190.
- Campos MPO, Hassan BJ, Riechelmann R, Del Giglio A. Cancer-related fatigue: a practical review. Ann Oncol. 2011 Jun;22(6):1273-1279. doi: 10.1093/annonc/mdq458. Epub 2011 Feb 16.
- Hall AE, Boyes AW, Bowman J, Walsh RA, James EL, Girgis A. Young adult cancer survivors' psychosocial well-being: a cross-sectional study assessing quality of life, unmet needs, and health behaviors. Support Care Cancer. 2012 Jun;20(6):1333-41. doi: 10.1007/s00520-011-1221-x. Epub 2011 Jul 1.
- Buffart LM, Ros WJ, Chinapaw MJ, Brug J, Knol DL, Korstjens I, van Weert E, Mesters I, van den Borne B, Hoekstra-Weebers JE, May AM. Mediators of physical exercise for improvement in cancer survivors' quality of life. Psychooncology. 2014 Mar;23(3):330-8. doi: 10.1002/pon.3428. Epub 2013 Oct 14.
- Cancer Registry of Norway. Cancer in Norway 2018 - Cancer incidence, mortality, survival and prevalence in Norway. Oslo: Cancer Registry of Norway; 2019.
- Bennion AE, Molassiotis A. Qualitative research into the symptom experiences of adult cancer patients after treatments: a systematic review and meta-synthesis. Support Care Cancer. 2013 Jan;21(1):9-25. doi: 10.1007/s00520-012-1573-x. Epub 2012 Sep 13.
- Bibby H, White V, Thompson K, Anazodo A. What Are the Unmet Needs and Care Experiences of Adolescents and Young Adults with Cancer? A Systematic Review. J Adolesc Young Adult Oncol. 2017 Mar;6(1):6-30. doi: 10.1089/jayao.2016.0012. Epub 2016 Jul 25.
- Stricker CT, Jacobs LA. Physical late effects in adult cancer survivors. Oncology (Williston Park). 2008 Jul;22(8 Suppl Nurse Ed):33-41.
- Brearley SG, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N, Richardson A, Scott I, Sharpe M, Stark D, Siller C, Ziegler L, Amir Z. The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs. 2011 Jul;15(3):204-12. doi: 10.1016/j.ejon.2011.02.005. Epub 2011 Apr 13.
- Hewitt M, Greenfield S, Stovall Ee. From cancer patient to cancer survivor. Lost in transition: Institute of Medicine and National Research Council; 2006.
- Hellbom M, Bergelt C, Bergenmar M, Gijsen B, Loge JH, Rautalahti M, Smaradottir A, Johansen C. Cancer rehabilitation: A Nordic and European perspective. Acta Oncol. 2011 Feb;50(2):179-86. doi: 10.3109/0284186X.2010.533194. Erratum In: Acta Oncol. 2011 Apr;50(3):480. Rautalathi, Matti [corrected to Rautalahti, Matti].
- Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors--a systematic review. Int J Psychiatry Med. 2010;40(2):163-81. doi: 10.2190/PM.40.2.c.
- Soon J, Anton A, Torres J, et al. The Spectrum of Late Effects in Survivors of Stage I Seminoma: A Systematic Review. Asia-Pacific Journal of Clinical Oncology. Aug 2017;13:73-73.
- Bifulco G, De Rosa N, Tornesello ML, Piccoli R, Bertrando A, Lavitola G, Morra I, Di Spiezio Sardo A, Buonaguro FM, Nappi C. Quality of life, lifestyle behavior and employment experience: a comparison between young and midlife survivors of gynecology early stage cancers. Gynecol Oncol. 2012 Mar;124(3):444-51. doi: 10.1016/j.ygyno.2011.11.033. Epub 2011 Nov 23.
- Bilodeau K, Tremblay D, Durand MJ. Exploration of return-to-work interventions for breast cancer patients: a scoping review. Support Care Cancer. 2017 Jun;25(6):1993-2007. doi: 10.1007/s00520-016-3526-2. Epub 2017 Jan 4.
- Bevilacqua LA, Dulak D, Schofield E, Starr TD, Nelson CJ, Roth AJ, Holland JC, Alici Y. Prevalence and predictors of depression, pain, and fatigue in older- versus younger-adult cancer survivors. Psychooncology. 2018 Mar;27(3):900-907. doi: 10.1002/pon.4605. Epub 2018 Jan 25.
- The Norwegian Department of Health.2018. Living with cancer. National Cancer Strategy 2018-2022. Oslo
- Silver JK. Integrating Rehabilitation Into the Cancer Care Continuum. PM R. 2017 Sep;9(9 Suppl 2):S291-S296. doi: 10.1016/j.pmrj.2017.07.075. No abstract available.
- Dahl L, Wittrup I, Vaeggemose U, Petersen LK, Blaakaer J. Life after gynecologic cancer--a review of patients quality of life, needs, and preferences in regard to follow-up. Int J Gynecol Cancer. 2013 Feb;23(2):227-34. doi: 10.1097/IGC.0b013e31827f37b0.
- Thorsen L, Gjerset GM, Loge JH, Kiserud CE, Skovlund E, Flotten T, Fossa SD. Cancer patients' needs for rehabilitation services. Acta Oncol. 2011 Feb;50(2):212-22. doi: 10.3109/0284186X.2010.531050.
- Stout NL, Silver JK, Raj VS, Rowland J, Gerber L, Cheville A, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Padgett L, Wolf T, Winters-Stone K, Campbell G, Hendricks J, Perkin K, Chan L. Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group. Arch Phys Med Rehabil. 2016 Nov;97(11):2006-2015. doi: 10.1016/j.apmr.2016.05.002. Epub 2016 May 27.
- Brandenbarg D, Korsten JHWM, Berger MY, Berendsen AJ. The effect of physical activity on fatigue among survivors of colorectal cancer: a systematic review and meta-analysis. Support Care Cancer. 2018 Feb;26(2):393-403. doi: 10.1007/s00520-017-3920-4. Epub 2017 Oct 23.
- Burke S, Wurz A, Bradshaw A, Saunders S, West MA, Brunet J. Physical Activity and Quality of Life in Cancer Survivors: A Meta-Synthesis of Qualitative Research. Cancers (Basel). 2017 May 20;9(5):53. doi: 10.3390/cancers9050053.
- Hartmann U, Muche R, Reuss-Borst M. Effects of a step-by-step inpatient rehabilitation programme on quality of life in breast cancer patients. A prospective randomised study. Onkologie. 2007 Apr;30(4):177-82. doi: 10.1159/000099989. Epub 2007 Mar 23.
- Lauver D, Connolly-Nelson K, Vang P. Health-related goals in female cancer survivors after treatment. Cancer Nurs. 2007 Jan-Feb;30(1):9-15. doi: 10.1097/00002820-200701000-00002.
- Scott DA, Mills M, Black A, Cantwell M, Campbell A, Cardwell CR, Porter S, Donnelly M. Multidimensional rehabilitation programmes for adult cancer survivors. Cochrane Database Syst Rev. 2013 Mar 28;2013(3):CD007730. doi: 10.1002/14651858.CD007730.pub2.
- Juvet LK, Elvsaas IKO, Leivseth G, Anker G, Bertheussen GF, Falkmer U, Fors EA, Lundgren S, Oldervoll LM, Thune I, Norderhaug IN. Rehabilitation of Breast Cancer Patients [Internet]. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2009 Mar. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. 02-2009. Available from http://www.ncbi.nlm.nih.gov/books/NBK464742/
- Hauken MA, Larsen TMB, Holsen I. "Back on Track": A Longitudinal Mixed Methods Study on the Rehabilitation of Young Adult Cancer Survivors. Journal of Mixed Methods Research. 2017;13(3):339-360.
- Ahmedzai HH, Oldervoll LM, Sweetmore AH, Hauken MA. Community-Based Multidimensional Cancer Rehabilitation in Norway: A Feasibility Study. Cancer Nurs. 2022 Dec 1. doi: 10.1097/NCC.0000000000001161. Online ahead of print.
- Loken OU, Hauken MA. A Qualitative Study of Cancer Survivors' Experienced Outcomes of a Multidimensional Rehabilitation Program in Primary Healthcare. Cancer Nurs. 2022 May-Jun 01;45(3):E646-E654. doi: 10.1097/NCC.0000000000000989. Epub 2021 Sep 3.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- F322
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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