Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis
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Physical exercise (PE) and/or therapy (PT) shows beneficial effects in advanced cancer patients and is increasingly implemented in hospice and palliative care, although systematic data are rare. This retrospective study systematically evaluated the feasibility of PE/PT in terminally ill cancer patients and of different modalities in correspondence to socio-demographic and disease- and care-related aspects.
All consecutive terminally ill cancer patients treated in a palliative care inpatient ward during a 3.5-year period were included. The modalities were chosen according to the therapists' and patients' appraisal of current performance status and symptoms.
PE/PT were offered to 572 terminally ill cancer patients, whereof 528 patients (92 %) were able to perform at least one PE/PT unit (average 4.2 units/patient). The most frequently feasible modalities were physical exercises in 50 %, relaxation therapy in 22 %, breathing training in 10 %, and positioning and lymph edema treatment in 6 % each. Physical exercise and positioning treatment were performed significantly more often in older patients (p = 0.009 and p = 0.022, respectively), while relaxation (p = 0.05) and lymph edema treatment (p = 0.001) were used more frequently in younger. Breathing training was most frequently performed in head and neck cancer (p = 0.002) and lung cancer (p = 0.026), positioning treatment in brain tumor patients (p = 0.021), and lymph edema treatment in sarcoma patients (p = 0.012).
PE/PT were feasible in >90 % of terminally ill cancer patients to whom PE/PT had been offered. Physical exercises, relaxation therapy, and breathing training were the most frequently applicable methods. Prospective trials are needed to evaluate the efficacy of specific PE/PT programs in terminally ill cancer patients.
KeywordsPalliative care Physical exercise Physical therapy Terminally ill cancer patients
Conflict of interest
None of the authors have any conflict of interest. This study was performed without any external funding or financial sponsoring.
- 4.Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302:741–749. doi: 10.1001/jama.2009.1198 PubMedCentralPubMedCrossRefGoogle Scholar
- 5.Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 29:2319–2326. doi: 10.1200/JCO.2010.32.4459 PubMedCrossRefGoogle Scholar
- 6.Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742. doi: 10.1056/NEJMoa1000678 PubMedCrossRefGoogle Scholar
- 7.Bandieri E, Sichetti D, Romero M, Fanizza C, Belfiglio M, Buonaccorso L, Artioli F, Campione F, Tognoni G, Luppi M (2012) Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol 23:2016–2020. doi: 10.1093/annonc/mds103 PubMedCrossRefGoogle Scholar
- 8.Maloney C, Lyons K, Li Z, Hegel M, Ahles TA, Bakitas M (2013) Patient perspectives on participation in the ENABLE II randomized controlled trial of a concurrent oncology palliative care intervention: benefits and burdens. Palliat Med 27:375–383. doi: 10.1177/0269216312445188 PubMedCentralPubMedCrossRefGoogle Scholar
- 13.Oechsle K, Jensen W, Schmidt T, Reer R, Braumann KM, de Wit M, Bokemeyer C (2011) Physical activity, quality of life, and the interest in physical exercise programs in patients undergoing palliative chemotherapy. Support Care Cancer 19:613–619. doi: 10.1007/s00520-010-0862-5 PubMedCrossRefGoogle Scholar
- 15.Oldervoll LM, Loge JH, Lydersen S, Paltiel H, Asp MB, Nygaard UV, Oredalen E, Frantzen TL, Lesteberg I, Amundsen L, Hjermstad MJ, Haugen DF, Paulsen Ø, Kaasa S (2011) Physical exercise for cancer patients with advanced disease: a randomized controlled trial. The Oncologist 16:1649–1657. doi: 10.1634/theoncologist.2011-0133 PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Jones L, Fitzgerald G, Leurent B, Round J, Eades J, Davis S, Gishen F, Holman A, Hopkins K, Tookman A (2012) Rehabilitation in advanced, progressive, recurrent cancer: a randomized controlled trial. J Pain Symptom Manage 46(3):315–325. doi: 10.1016/j.jpainsymman.2012.08.017 PubMedCrossRefGoogle Scholar
- 20.Laakso EL, McAuliffe AJ, Cantlay A (2003) The impact of physiotherapy intervention functional independence and quality of life in palliative patients. Cancer Forum 27:15–20Google Scholar
- 22.Ebel S, Langer K (1993) The role of the physical therapist in hospital care. Am J Hosp Palliat Care 2:393–398Google Scholar
- 24.Association of Chartered Physiotherapist in Palliative Oncology (1993) Guidelines for good practice. Chartered Society of Physiotherapy, LondonGoogle Scholar
- 25.Chartered Society of Physiotherapy (2003) The role of physiotherapy for people with cancer- CSP position statement. Chartered Society of Physiotherapy, LondonGoogle Scholar
- 29.Villanueva R, Ajmani C (1977) The role of rehabilitation medicine in physical restoration of patients with head and neck cancer. Cancer Bull 29:46–54Google Scholar
- 30.Van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ (2011) A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 26:155–170. doi: 10.1007/s00455-010-9288-y PubMedCentralPubMedCrossRefGoogle Scholar