Amanda Montanari, Matthew W. Kirkhart, Ph.D., Martin F. Sherman, Ph.D., Jeffrey M. Lating, Ph.D.

Does Attendance Mediate the Relation Between Cancer Rehabilitation Program Participants’ Anxiety and Depression and Functional Outcomes of Mobility, Applied Cognition and Activities of Daily Living?

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Objective: Cancer is a life altering illness, and it is often difficult for patients to accept the chronicity and life-changing aspects of their diagnosis. For example, it is not uncommon for patients with cancer to suffer from anxiety and depression about both their illness in general, as well as the fears surrounding their future (Burg & Adorno, 2016). Given that there are an estimated 14.5 million cancer survivors currently living in the United States who will live for a significant period of time post diagnosis, cancer rehabilitation programs have been established to help these individuals adjust to their new lives (https://www.cancer.gov/about-cancer/understanding/statistics). Although cancer rehabilitation has been found to be effective (Swenson et al., 2014), and that all types of treatment programs are generally more effective when patients actively engage in them (Glenn et al., 2013), the exact relation between patient engagement and benefits from participating in a cancer rehabilitation program is not known.

The purpose of this study is to examine the relation between psychological functioning and functional outcomes such as mobility, applied cognition and activities of daily living for those participating in a cancer rehabilitation program and how patient engagement partially mediates this relation. Method: The medical records of patients participating in a cancer rehabilitation program at Johns Hopkins Hospital from the previous fiscal year will be reviewed, specifically for Activity Measure for Post Acute Care (AMPAC), Hospital Anxiety and Depression Scale (HADS) and attendance rates.

It is predicted that there will be a negative relation between psychological functioning and patient participation in a cancer rehabilitation program such that higher levels of depression and anxiety will be associated with lower levels of participation in a cancer rehabilitation program. It is also predicted that there will be a positive relation between patient participation in a cancer rehabilitation program and functional outcomes such that higher levels of patient participation in a cancer rehabilitation program will be associated with better functional outcomes of mobility, applied cognition and activities of daily living. It is also predicted that there will be a direct negative relation between psychological functioning and functional outcomes of mobility, applied cognition and activities of daily living such that higher levels of depression and anxiety will be associated with worse functional outcomes of mobility, applied cognition and activities of daily living. This relation will be partially mediated by patient participation in a cancer rehabilitation program such that higher levels of anxiety and depression will be associated with lower levels of patient participation in a cancer rehabilitation program which will be associated with worse functional outcomes of mobility, applied cognition and activities of daily living.