Evaluation scales and measures in cancer rehabilitation

Introduction. The mean aim of Cancer Rehabilitation is to obtain and save the best Health Related Quality of Life (HRQoL) for each affected person through all different ways which are necessary to restore structures, to improve functioning and to reduce activity limitation and participation restriction like by the biopsychosocial model of ICF. Cancer Rehabilitation assessment needs appropriate and high quality measure instruments and evaluation scales to compare results and guarantee correct clinical data for a better assistance and scientific improvement. The aim of our literature review is to identify a basic rehabilitation scales set for a global evaluation of all aspects regarding cancer patient health including Quality of Life questionnaires, impairments (functions/structures alterations) measures and disability scales. Materials and methods. In May 2012 we performed a literature review using the data base Pubmed and consulting essays and guidelines to identify the most used and well assessed measure instruments and evaluation scales in Cancer Rehabilitation (1,2,3). We developed a list of them and to make their use easier we have distinguished three groups: 1)Impairments scales and outcome measure instruments; 2)Disability scales as generic measures (non specific for disease or population) or specific measure for malignancy 3) Quality of Life scales and questionnaires as generic or specific. Results. Among impairments pain and fatigue is widely assessed using several instruments as intensity rating scales or multidimensional questionnaires; range of motion, muscle strength, dyspnea and others are largely assessed by common instruments. Apart from generic disability scales normally used, cancer specific disability scales Karnofsky Performance Scale Index and Eastern Cooperative Oncology Group (ECOG) Score or Zubrod Score are both suitable to assess prognosis, daily activities, and clinical effectiveness of therapies, but ECOG score, recomned by WHO,is recently larger adopted. About Quality of Life generic scales the SF36 and its shorter form SF12 are the gold standard and widely used also in malignancy; among specific cancer instruments the European Organization for Research and Treatment of Cancer (EORTC) multidimensional 30- item core questionnaire with neoplasms specific modules and the Functional Assessment of Cancer Therapy Scales have been performed worldwide. Furthermore ICF offers a new contribute to evaluation health conditions of people with malignancy and there are already the core sets for breast cancer and head & neck cancer. Conclusions. Hence, in clinical cancer practice for a global evaluation of all aspects regarding patient health we have to consider using a patient-based cancer specific HRQoL questionnaire (like EORTC C30 plus the specific module if there is one suitable) in addition to a set of impairments and disability measures focused to the most relevant patient issues. Over these measures ICF is always necessary to be performed and new cor sets for specific neoplasms are needed. Bibliography 1. Montazeri A. Health –related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008 Aug 29; 27-32 . 2. Blazaby J, Sprangers M, Cull A et al. EORTC quality of life group guidelines for developing questionnaires modules.3rd edition revised. EORTC Quality of Life Group,2002.