Prediction of long-term psychosocial burden and relevant participation restrictions among breast cancer patients undergoing rehabilitation: Development of a prediction model

As a result of breast cancer and its treatment, many patients report physical limitations, functional impairments and psychosocial distress. These are often accompanied by a reduced quality of life and restricted social participation.
Following the completion of acute cancer treatment, there is the option in Germany to undergo oncological rehabilitation. The aim is to reduce functional impairments, overcome barriers to participation and impart health-promoting strategies.
A previous project investigated whether distinct symptom profiles could be identified among breast cancer rehabilitation patients. For this purpose, a cluster analysis was conducted based on secondary data from the ReNaApp study (DRKS00019017).
A total of N = 437 participants aged between 18 and 60 were surveyed at the beginning and end of their follow-up rehabilitation, as well as one year later, using standardised patient-reported outcome measures. The analysis included longitudinal data on participation restrictions (IMET), quality of life (EORTC QLQ-C30), physical fatigue (EORTC QLQ-FA12) and depression (CES-D).
The analysis identified three clusters with low, moderate and high symptom profiles. Patients in the high-burden cluster showed the most severe limitations in terms of participation, fatigue, depression and quality of life across all measurement points.
Significant differences were also evident with regard to employment: One year after rehabilitation 90 % of women in both the low- and moderate-burden clusters were employed, compared to only 61 % in the high-burdened cluster. The analysis therefore identified a particularly vulnerable subgroup with persistently high health limitations, reduced rehabilitation success, and a limited reintegration into working life.
Based on this, the early identification of rehabilitation patients experiencing particular psychological distress is of great relevance. Although established tools for assessing psychological distress do exist, these are primarily designed describe current symptoms. A predictive instrument for early risk identification could enable the needs-based allocation of intensified interventions.
The aim of this project is to develop and test a predictive screening tool to identify rehabilitation participants who are at increased risk of persistent psychosocial distress and restricted occupational participation.
The testing will evaluate the tools comprehensibility and practicality in daily rehabilitation practice.