Specialist Rehabilitation of Chronic Late Effects Pain in Cancer Survivors: A Clinical Case Study

Background & Aims

The effects of chronic pain caused by cancer treatment are significant and extensive for patients (1). It is estimated that 34-40% of cancer survivors report persistent pain as a late effect of cancer treatment, with 5-10% experiencing severe pain affecting their function and mood (2). This patient cohort often report unmet needs and encounter challenges when trying to access healthcare services (3). The pain-related Complex Cancer Late Effects Rehabilitation Service (CCLERS) offers a national, highly-specialist, interdisciplinary rehabilitation service for people in the United Kingdom, who experience persistent pain and reduced function caused by cancer treatments. CCLERS programmes are therapy-led and comprise group and one to one sessions. This clinical case study illustrated how tailored rehabilitation techniques are utilised during a CCLERS two-week programme as evaluated by outcome data taken pre/post programme.

Methods

Presentation:
Jo (aged 37; Left Breast Cancer; Mastectomy and Chemo/Radiotherapy; Treatment completed: 2014) presented with a neuropathic pain to her left chest wall and axilla, peripheral neuropathy and widespread joint pain. She was experiencing fatigue and brain fog as she struggled to work, and was highly self-critical with a history of anxiety and depression.

Programme Treatment:
Jo explored the disconnection that she felt in areas of her body and why she often pushed through pain to maximize function (4). She reflected on coping strategies, which were now creating a vicious circle (5), and was encouraged to engage with soothing activities and self-care routines to promote self-compassion (6).

Outcome Measures:
Measures taken pre and 3 months post-programme were: Brief Pain Inventory (BPI), Tampa Scale (fear of movement), PROMIS (fatigue, function, social activity, sleep and self-efficacy domains), GAD7 (anxiety), PHQ9 (depression) and EQ-VAS (health perception).

Results

Three months post-programme, all measures improved.

-BPI severity reduced from 3.75-3/10; BPI interference from 4.7-4.3/10.

-PROMIS results for fatigue reduced by 28-20/30; function increased from 81-83/99; sleep disturbance reduced from 26-22/40; social activity increased from 18-22/40; self-efficacy increased from 14-16/20. -GAD7 reduced from 8-7/21.

-PHQ9 reduced from 16-9/27, indicating a reduction from moderately severe to mild depression.

-Jo perceived her overall health (EQ-VAS) had improved from 60-85/100.

Behavioural Change:
Jo reported that she had made changes to her routines by trying to integrate mindfulness practice and good sleep hygiene. She noticed that she was walking more in nature and doing gentle stretching and yoga. She had rejoined a choir, which had helped her to have a more positive outlook.

Conclusions

This case study illustrates changes in key domains as a consequence of participation in the CCLERS programme. A focus on rehabilitation techniques, comprising sleep hygiene, mindful movement and education on pain and self-compassion, can improve function, fatigue and well-being in people with complex pain resulting from their cancer treatment.

References

References:

1.Armoogum J, Harcourt D, Foster C et al (2020) The experience of persistent pain in adult cancer survivors: a qualitative evidence synthesis. European Journal of cancer care 29, 1, e13192. dob:10.1111/ecc.13192.

2.Bennett MI, Kaasa S, Barke A et al (2019b) The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain. 160, 1, 38-44. doi: 10.1097/j.pain.0000000000001363

3.Armoogum J et al (2023) Cancer survivors experiences of living with chronic pain after curative cancer treatment in England. PLoS ONE 18(9):e0290967

4.Birkholtz M, Aylwin L & Harman R (2004) Activity Pacing in Chronic Pain Management: One Aim But Which Method? Part Two: National Activity Pacing Survey. British Journal of Occupational Therapy. Vol. 67, no. 11, pp. 481- 487.

5.Corkhill B (2019) Going Beyond the BioPsychoSocial: The Complex Person in a Complex Environment and Uncertain World (2019) Pain News. Vol 17 (4) 195-201.

6.Gilbert P (2010) Compassion Focused Therapy: Distinctive Features. Routledge. London and New York.

7.Galligan M, Tanay M, Armoogum J (2023) Exploring the Provision of Services to Support People with Cancer-related Pain. Cancer Nursing Practice. Doi: 10.7748/cnp.2023.e1853

Bibliography: ( to support other CCLERS rehabilitation techniques)

Ho E & Siu A (2018) OT Practice in Sleep Management: A Review of Conceptual Models and Research Evidence; Occupational Therapy International. DOI: https://doi.org/10.1155/2018/8637498.

Legislation.gov.uk (2010) Equality Act 2010. [online] Available at:

Nelson B (2017). Clearing the Fog around Chemobrain. Cancer Cytopathology. Vol125 (7) 517-518. DOI: https://dx.doi.org/10.1002/cncy.21891

Presenting Author

Jane Cook

Poster Authors

Jane Cook

MSc

UWE

Lead Author

E-mail