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Mihic-Góngora L, Jimenez-Fonseca P, Coca-Membribes S, Cruz-Castellanos P, Galán-Moral R, Asensio-Martínez E, Palacín-Lois M, Carmona-Bayonas A, Caramés-Sánchez C, Calderon C. Physical Activity in Patients with Advanced Cancer: Sociodemographic, Clinical, and Psychological Correlates. Brain Sci 2024; 14:573. [PMID: 38928572 PMCID: PMC11201712 DOI: 10.3390/brainsci14060573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/20/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
As cancer progresses, patients may experience physical decline, which can impair their ability to carry out essential daily tasks. The aim of this study was to analyze the levels of physical activity in patients with advanced cancer undergoing systemic treatment and its relationship with sociodemographic, clinical, and psychological factors. A prospective, cross-sectional, multicenter study was carried out in 15 oncology departments in Spain. Patients with locally advanced, unresectable, or metastatic cancer who were candidates for systemic treatment were included. Participants completed demographic information and psychological scales. In total, 508 patients were included in the study, the majority of whom were male, over the age of 65, and diagnosed with bronchopulmonary tumors (36%) and metastatic disease. Based on their physical activity levels, participants were categorized as sedentary (20%, n = 190), engaging in light physical activity (43%, n = 412), or demonstrating moderate physical activity (37%, n = 351). Patients who were over 65 years old; had a worse baseline status (ECOG ≥ 1); lacked a partner; had a lower educational level; or were retired or unemployed were found to have lower levels of physical activity. Those with sedentary physical activity reported higher levels of psychological distress, anxiety, depression, somatization, and physical symptoms, as well as worse functional status, global health status, and well-being. Understanding the complex interplay between physical activity and sociodemographic, clinical, and psychological factors can help neuroscientists develop tailored exercise interventions that address the unique needs of advanced cancer patients.
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Affiliation(s)
- Luka Mihic-Góngora
- Department of Medical Oncology, Hospital Universitario Central de Asturias, 33007 Oviedo, Spain
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, 33007 Oviedo, Spain
| | - Sara Coca-Membribes
- Department of Medical Oncology, Hospital Universitario de Canarias, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Patricia Cruz-Castellanos
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain
| | - Rocío Galán-Moral
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain
| | - Elena Asensio-Martínez
- Department of Medical Oncology, Hospital General Universitario de Elche, 03203 Alicante, Spain
| | - María Palacín-Lois
- Department of Clinical Psychology and Psychobiology, University of Barcelona, 08007 Barcelona, Spain
| | - Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB, 30008 Murcia, Spain
| | - Cristina Caramés-Sánchez
- Department of Medical Oncology, Hospital Universitario Fundación Jiménez-Diaz, 28040 Madrid, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, University of Barcelona, 08007 Barcelona, Spain
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Shallwani SM, Thomas R, Poitras S, Toupin-April K, Sheill G, King J. Canadian oncology physiotherapists' perspectives of physical activity in people with advanced cancer: a mixed-methods study. Physiother Theory Pract 2024; 40:1281-1299. [PMID: 36305676 DOI: 10.1080/09593985.2022.2138663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Individuals with advanced cancer can benefit from physical activity (PA), but face barriers to PA participation. Physiotherapists can be well-positioned to support this patient population. OBJECTIVE Our objective was to describe the perspectives, practices, knowledge, and skills of oncology physiotherapists related to PA in people with advanced cancer. METHODS In this mixed-methods study, we recruited Canadian physiotherapists with current or recent clinical experience with advanced cancer. Phase I consisted of an online survey about views toward PA in advanced cancer and activity-related recommendations and concerns for two case scenarios. Phase II involved individual, semi-structured interviews about perspectives related to working with advanced cancer. RESULTS Sixty-two physiotherapists participated in the survey, of which 13 participated in interviews. Most respondents (> 85%) agreed or strongly agreed PA is important and safe for individuals with advanced cancer. Case responses highlighted cancer-related considerations (e.g. bone metastases) tailored activity recommendations, and patient-centered, interprofessional care. Interview themes included: 1) situating PA within individually meaningful goals; 2) tailored strategies to promote PA; 3) overarching roles in functional optimization and symptom management; and 4) generalized lack of awareness regarding physiotherapy. CONCLUSION Our findings indicate Canadian oncology physiotherapists describe knowledge of the safety and importance of PA, as well as key considerations in advanced cancer. Moreover, they highlight the importance of a patient-centered approach to support this population, particularly in facilitating safe and meaningful PA, as well as optimizing function and alleviating symptom burden. Further efforts are needed to investigate the development and integration of physiotherapy within cancer care.
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Affiliation(s)
- Shirin M Shallwani
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- McGill Lymphedema Research Program, McGill University Health Centre, Montreal, QC, Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Institut du savoir Montfort, Ottawa, ON, Canada
| | - Grainne Sheill
- Department of Physiotherapy, Trinity College Dublin, University of Dublin, College Green, Ireland
- Department of Physiotherapy, Dublin Trinity Centre for Health Sciences, Dublin, Ireland
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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3
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Presley CJ, Dalal N, Davenport AP, Gounden A, Ramchandran K, Tonorezos E. Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities. Am Soc Clin Oncol Educ Book 2024; 44:e433298. [PMID: 38768420 DOI: 10.1200/edbk_433298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
People with advanced lung cancer represent a distinct group whose needs remain understudied, especially compared with people diagnosed with limited-stage disease. Fortunately, novel treatments such as tyrosine kinase inhibitors and immune checkpoint inhibitors are leading to significant advances in prognosis and survival, even among those with advanced disease at the time of diagnosis. However, there are known gaps in symptom management, psychosocial and nutritional support, complex care coordination, health behavior coaching, and health care delivery efforts among patients living with advanced lung cancer. Many of these patients would benefit from survivorship and palliative care approaches. In particular, survivorship care may include health care maintenance, treatment of immune-related adverse events and late- or long-term effects, frailty assessment and rehabilitation, and care coordination. Palliative care may be best suited to discuss ongoing symptom management, advanced care planning, and end-of-life considerations, as well as psychosocial well-being. To this end, we share a review of the current status of the palliative and survivorship care infrastructure for patients with advanced lung cancer and provide suggestions across the care continuum for this diverse group of patients and families.
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Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ashley P Davenport
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Shallwani SM, Thomas R, King J, Toupin-April K, Poitras S. Perspectives and experiences of leisure-time physical activity in adults with stage 4 cancer: a qualitative interpretive-description study. Disabil Rehabil 2024; 46:1515-1526. [PMID: 37067063 DOI: 10.1080/09638288.2023.2200037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Leisure-time physical activity (LTPA) can be beneficial for individuals with advanced cancer, but little is known on how to tailor rehabilitation strategies targeting LTPA in cancer care. Our objective was to explore perspectives and experiences of LTPA in people with stage 4 cancer. MATERIALS AND METHODS Guided by interpretive-description methodology, our qualitative study consisted of individual, semi-structured interviews with 20 Canadian adults diagnosed with stage 4 cancer. Interviews were transcribed verbatim and analyzed inductively. RESULTS The participants' median age was 51.5 (range, 35-73) years. Cancer types included breast (n = 12), lung (n = 4), and other (n = 4). Participants highlighted their experiences of LTPA as diverse and complex, impacted by individual and cancer-related factors. They emphasized being intentional with LTPA through activity planning and modification. LTPA participation was linked to physical well-being, social connections, and meanings of accomplishment and loss. Many participants desired personalized support related to LTPA, that is integrated, interprofessional, and accessible in cancer care. CONCLUSION The experiences of LTPA for people with stage 4 cancer are personal and connected to health and psychosocial meanings. Further efforts in rehabilitation are needed to address the challenges faced by people with advanced cancer and optimize safe, meaningful participation in LTPA.IMPLICATIONS FOR REHABILITATIONExperiences of leisure-time physical activity in individuals with stage 4 cancer are personal and linked to health benefits and psychosocial meanings.Activity participation frequently involves consideration of cancer-related symptoms, management of risks, and intentional planning and modification of activities.Trained rehabilitation professionals integrated in cancer care may be well suited to support people with stage 4 cancer through personalized activity recommendations.This research can help inform future clinical, research, and educational efforts in rehabilitation aimed at targeting physical activity in individuals with advanced cancer.
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Affiliation(s)
- Shirin M Shallwani
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Lymphedema Research Program, McGill University Health Centre, Montreal, Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Institut du savoir Montfort, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
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Raunkiær M. The Experiences of People With Advanced Cancer and Professionals Participating in a Program With Focus on Rehabilitation and Palliative Care. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1383-1402. [PMID: 35000465 DOI: 10.1177/00302228211058307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study's aim is to explore the experiences of people with advanced cancer and professionals participating in a program with focus on rehabilitation and palliative care. The study is based on two adjusted rehabilitation programs for 33 people with advanced cancer and 12 professionals. An observational study was conducted among the participants and two focus group interviews with 10 professionals. The analytic themes were "Lightness and happiness to gain control in everyday life," "Community and closeness," and "Training as a happiness and changing agent." The activities had to support physical functions and everyday activities promoting body identity and well-being as well as emotions like closeness, lightness, and happiness in groups with like-minded people and at home with a partner and other family members. These activities and theory of emotions and body can expand the understanding of palliative care and rehabilitation as separated or integrated perspectives theoretical and in practice.
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Affiliation(s)
- Mette Raunkiær
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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Bhoyar SS, Sharath HV, Kochar SS, Nerkar S. Importance of Cardiac Rehabilitation and Mouth Opening Exercises in Oral Squamous Cell Carcinoma: A Case Report. Cureus 2023; 15:e50954. [PMID: 38249192 PMCID: PMC10800147 DOI: 10.7759/cureus.50954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The most prevalent malignant tumor in the oral cavity is squamous cell carcinoma (SCC). Social interactions are impeded, including eating, conversing, and practicing basic oral hygiene. A 43-year-old man who had previously suffered pus discharge in the right side of the buccal mucosa complained of dull aching in the lower right back of his jaw. The patient's right buccal mucosa was surgically treated for SCC two years ago. He received 30 cycles of high-dose radiation therapy for SCC of the right buccal mucosa. The right maxilla and mandible had osteoradionecrosis, according to a clinical and radiographic assessment. The aim of emphasizing the importance of cardiac rehabilitation and mouth opening exercises in oral squamous cell carcinoma (OSCC) is to address the multifaceted impact of this type of cancer on a patient's overall health and well-being. OSCC refers to a type of cancer that occurs in the cells lining the oral cavity, including the lips, tongue, gums, and the floor of the mouth. The implications of OSCC go beyond the local effects on the oral region and can have systemic consequences, affecting various aspects of a patient's health.
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Affiliation(s)
- Sarang S Bhoyar
- Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - H V Sharath
- Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shraddha S Kochar
- Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sharvil Nerkar
- Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Nguyen LB, Vu LG, Le TT, Nguyen XT, Dao NG, Nguyen DC, Huyen Thi Dang T, Vu TMT, Boyer L, Fond G, Auquier P, Latkin CA, Zhang MWB, Ho RCM, Ho CSH. Impact of interventions on the quality of life of cancer patients: a systematic review and meta-analysis of longitudinal research. Health Qual Life Outcomes 2023; 21:112. [PMID: 37821985 PMCID: PMC10566122 DOI: 10.1186/s12955-023-02189-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
The impact of cancer interventions has been conducted in several research due to the significant burden of this non-communicable disease. The interventions that played an important role in the improvement of the patient's quality of life (QoL) and health-related quality of life (HRQL) can be classified into two main groups: pharmaceutical and non-pharmacological methods. However, studies so far often analyze a specific group of interventions for specific types of cancer. Thus, in this systematic review and meta-analysis, we synthesized the overall impact of cancer interventions on patients' quality of life in several cancers.In this research, we followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) to search the longitudinal original research on the Web of Science (WOS) database. After that, the Newcastle-Ottawa Scale (NOS) and Jadad Scale were used to assess the quality of non-randomized control trials and randomized control trials, respectively. Then, the characteristics of the included studies were described in the six main fields table and the random effect model with robust estimation was applied to analyze the impact of interventions on the health utility of patients.From the database, 122 longitudinal original research were included in the meta-regression, with most of them having high or fair quality. The European Organization for the research and treatment of cancer scale for quality of life (EORTC-QLQ) was the most used health utility measurement at 65.15%. In the adjusted effect models, the Visual Analogue Scale (VAS) had significant statistics in all models when we compared it with the EQ-5D Scale (p < 0.05) and several types of cancer such as breast, lung, and prostate cancer had significant statistics when comparing with hematological cancer in the model types of cancer (p < 0.01). Moreover, radiotherapy, screening, and a combination of chemotherapy and best supportive care also had significant statistics (p < 0.01) in the model of interventions when compared with radiotherapy applied only. Our research can suggest a vital combination of both pharmaceutical and non-pharmacological interventions to improve the quality of life of some common types of cancer patients.
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Affiliation(s)
- Long Bao Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, 550000, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam
| | - Thanh Thien Le
- Department of Biomedical Engineering, Tufts University, 200 College Avenue, Medford, MA, 02155, USA
| | | | - Nam Gia Dao
- Institute for Global Health Innovations, Duy Tan University, 550000, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam
| | - Duy Cao Nguyen
- Institute for Global Health Innovations, Duy Tan University, 550000, Da Nang, Vietnam.
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam.
| | | | - Thuc Minh Thi Vu
- Institute of Health Economics and Technology (iHEAT), Hanoi, Vietnam
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, CEReSS, Marseille cedex 05, 3279, 13385, France
| | - Guillaume Fond
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, CEReSS, Marseille cedex 05, 3279, 13385, France
| | - Pascal Auquier
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, CEReSS, Marseille cedex 05, 3279, 13385, France
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Melvyn W B Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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Bernabeu-Wittel M, Moreno-Gaviño L, Nieto-Martín D, Lanseros-Tenllado J, Sáenz-Santamaría A, Martínez-Pérez O, Aguilera-Gonzalez C, Pereira-Domínguez M, Ollero-Baturone M. Physiotherapy in palliative medicine: patient and caregiver wellness. BMJ Support Palliat Care 2023; 13:e197-e204. [PMID: 33579794 DOI: 10.1136/bmjspcare-2020-002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Despite the demonstrated efficacy of physiotherapy in palliative care programmes, there are scarce data of its real-life impact on patients' and caregivers' wellness and stress. Our aim was to assess effectiveness of a 30-day physiotherapy programme in psychological wellness and health-related quality of life (HRQoL) of patients with advanced chronic diseases or cancer and in their caregivers' stress. METHODS Quasiexperimental before-after study applying personalised kinesitherapy, exercise with curative effects, respiratory physiotherapy, therapeutic massages and ergotherapy. Psychological wellness, HRQoL and caregiver's strain outcomes were measured. RESULTS 207 patients (60% men, with a mean age of 73.6±12 years) were included; 129 (62.3%) with advanced cancer, and the remaining 78 with advanced chronic diseases. Psychological wellness (Emotional Stress Detection Tool decreased from 12.4±3 to 11±3; p<0.0001), caregiver's strain (Caregiver Strain Index decreased from 8.5±3.2 to 7.9±3.5; p<0.0001) and HRQoL (WHO-BREF physical health domain increased from 8.3±2.6 to 9.4±2.9; p<0.0001) showed a significant improvement after the physiotherapy programme. Global satisfaction with the physiotherapy intervention was also high (Client Satisfaction Questionnaire-8 of 28.3±3.3 points). CONCLUSIONS A personalised physiotherapy programme incorporated to integral palliative care improved psychological wellness, HRQoL and caregivers' strain of patients with advanced chronic diseases and cancer.
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Affiliation(s)
- Máximo Bernabeu-Wittel
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Department of Medicine, University of Seville, Sevilla, Spain
| | - Lourdes Moreno-Gaviño
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Dolores Nieto-Martín
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Ana Sáenz-Santamaría
- Department of Internal Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Olga Martínez-Pérez
- Department of Internal Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Ollero-Baturone
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Joseph A, Vemula B, Smith TJ. Symptom Management in the Older Adult: 2023 Update. Clin Geriatr Med 2023; 39:449-463. [PMID: 37385696 DOI: 10.1016/j.cger.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
In the older adult with a serious illness, the goal of palliative medicine and symptom management is to optimize quality of life. Frailty has become an overarching finding in many older adults with serious illness. Symptom management options need to be considered in the lens of increasing frailty along an illness trajectory. Here, the authors emphasize literature updates and best practices for the most common symptoms experienced by the older adult with a serious illness.
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Affiliation(s)
- Augustin Joseph
- Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA.
| | - Balakrishna Vemula
- Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA; Department of Emergency Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA
| | - Thomas J Smith
- Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA; Department of Oncology, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 359, Baltimore, MD 21287, USA
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Navarro-Meléndez A, Gimenez MJ, Robledo-Donascimento Y, Río-González A, Lendínez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care 2023; 22:99. [PMID: 37474943 PMCID: PMC10357741 DOI: 10.1186/s12904-023-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Over the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence. METHODS An observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05. RESULTS A total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%). CONCLUSIONS Patients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.
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Affiliation(s)
- A Navarro-Meléndez
- Rehabilitation area, Hospital Fundación Instituto San José, Avenida de la Hospitalidad s/n, Madrid, 28054 Spain
- Department of Health Sciences, “San Juan de Dios” School of Nursing and Physical Therapy, Comillas Pontifical University, Avenida San Juan de Dios, 1, Ciempozuelos, 28350 Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - MJ Gimenez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - Y Robledo-Donascimento
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
- Hospital Universitario del Henares and Centro de Investigación Fisioterapia y Dolor, Avenida de Marie Curie 0, Coslada, 28822 Spain
| | - A Río-González
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - A Lendínez-Mesa
- Department of Nursing, Neurology Service. Grupo de Investigación en Cuidados (InveCuid), Hospital 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041 Spain
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11
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Tanriverdi A, Ozcan Kahraman B, Ergin G, Karadibak D, Savci S. Effect of exercise interventions in adults with cancer receiving palliative care: a systematic review and meta-analysis. Support Care Cancer 2023; 31:205. [PMID: 36882538 DOI: 10.1007/s00520-023-07655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Previous publications showed the effectiveness of exercise in adults with cancer receiving palliative care, but evidence for palliative care research on exercise is lacking. The purpose is to examine the effects of an exercise intervention on exercise capacity, physical function, and patient-reported outcome measures in adults with cancer receiving palliative care. METHODS We searched databases including EMBASE, PubMed, and Web of Science from inception until 2021. We used the Cochrane criteria to assess the risk of bias within studies. Using RevMan, mean difference (MD) and 95% confidence intervals or standardized mean difference (SMD) and 95% confidence intervals were calculated. RESULTS A total of 14 studies and 1034 adults with cancer receiving palliative care are included in this systematic review and meta-analysis. Half of the studies were deemed to have high risk of bias. All of the interventions used aerobic and/or resistance exercises. The results indicated that exercise interventions significantly improved exercise capacity (mean difference: 46.89; 95% confidence interval: 4.51 to 89.26; Z = 2.17; P = 0.03), pain (standardized mean difference: - 0.29; 95% confidence interval: - 0.54 to - 0.03; Z = 2.18; P = 0.03), fatigue (standardized mean difference: - 0.48; 95% confidence interval: - 0.83 to - 0.12; Z = 2.66; P = 0.008), and quality of life (standardized mean difference: 0.23; 95% confidence interval: 0.02 to 0.43; Z = 2.12; P = 0.03). CONCLUSION Exercise training, with aerobic exercise, resistance exercise, or combined aerobic and resistance exercise, helps to maintain or improve exercise capacity, pain, fatigue, and quality of life in adults with cancer receiving palliative care.
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Affiliation(s)
- Aylin Tanriverdi
- Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey. .,Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey.
| | - Buse Ozcan Kahraman
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey
| | - Gulbin Ergin
- Department of Physiotherapy and Rehabilitation, İzmir Bakırçay University, İzmir, Turkey
| | - Didem Karadibak
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey
| | - Sema Savci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey
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12
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Giallauria F, Testa C, Cuomo G, Di Lorenzo A, Venturini E, Lauretani F, Maggio MG, Iannuzzo G, Vigorito C. Exercise Training in Elderly Cancer Patients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15061671. [PMID: 36980559 PMCID: PMC10046194 DOI: 10.3390/cancers15061671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Due to the aging of the population, in 70% of cases, a new cancer diagnosis equals a cancer diagnosis in a geriatric patient. In this population, beyond the concept of mortality and morbidity, functional capacity, disability, and quality of life remain crucial. In fact, when the functional status is preserved, the pathogenetic curve towards disability will stop or even regress. The present systematic review investigated the effectiveness of physical exercise, as part of a holistic assessment of the patient, for preventing disability and improving the patient’s quality of life, and partially reducing all-cause mortality. This evidence must point towards decentralization of care by implementing the development of rehabilitation programs for elderly cancer patients either before or after anti-cancer therapy.
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Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
- Faculty of Sciences and Technology, University of New England, Armidale, NSW 2351, Australia
- Correspondence:
| | - Crescenzo Testa
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Elio Venturini
- Cardiac Rehabilitation Unit and Department of Cardiology, Azienda USL Toscana Nord-Ovest, “Cecina Civil Hospital”, 57023 Cecina, Italy
| | - Fulvio Lauretani
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University Hospital of Parma, 43126 Parma, Italy
| | - Marcello Giuseppe Maggio
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University Hospital of Parma, 43126 Parma, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy
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13
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Perez-Concha O, Goldstein D, Harris MF, Laaksonen MA, Hanly M, Suchy S, Vajdic CM. Uptake of Team Care Arrangements for adults newly diagnosed with cancer. Aust J Prim Health 2023; 29:20-29. [PMID: 36076333 DOI: 10.1071/py22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Medicare-subsidised Team Care Arrangements (TCAs) support Australian general practitioners to implement shared care between collaborating health professionals for patients with chronic medical conditions and complex needs. We assessed the prevalence of TCAs, factors associated with TCA uptake and visits to TCA-subsidised allied health practitioners, for adults newly diagnosed with cancer in New South Wales, Australia. METHODS We carried out a retrospective individual patient data linkage study with 13 951 45 and Up Study participants diagnosed with incident cancer during 2006-16. We used a proportional hazards model to estimate the factors associated with receipt of a TCA after cancer diagnosis. RESULTS In total, 6630 patients had a TCA plan initiated (47.5%). A TCA was more likely for patients aged ≥65years, those with higher service utilisation 4-15months prior to cancer diagnosis, a higher number of comorbidities, lower self-rated overall health status, living in areas of greater socio-economic disadvantage, lower educational attainment and those with no private health insurance. A total of 4084 (61.6%) patients with a TCA had at least one TCA-subsidised allied health visit within 24months of the TCA. CONCLUSIONS TCAs appear to be well targeted at cancer patients with chronic health conditions and lower socioeconomic status. Nevertheless, not all patients with a TCA subsequently attended a TCA-subsidised allied healthcare professional. This suggests either a misunderstanding of the plan, the receipt of allied health via other public schemes, a low prioritisation of the plan compared to other health care, or suboptimal availability of these services.
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Affiliation(s)
- Oscar Perez-Concha
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW, Australia
| | - Maarit A Laaksonen
- School of Mathematics and Statistics, UNSW Sydney, Sydney, NSW, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sue Suchy
- Consumer Advisory Panel, Translational Cancer Research Network, Sydney, NSW, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
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14
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Andersen L, Meghani S, Ulrich C, McHugh M, Deng J. Coping Skills Interventions for Fatigue in Adults with Hematologic Malignancies: A Systematic Review. Am J Hosp Palliat Care 2023; 40:183-201. [PMID: 35524400 PMCID: PMC9637237 DOI: 10.1177/10499091221095531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Persons with hematologic malignancies have a high symptom burden throughout the illness journey. Coping skills interventions effectively reduce fatigue for other cancer patients. The purpose of this systematic review is to identify if coping interventions can reduce fatigue in patients with hematologic malignancies. Methods: A search of PubMed, Embase, CINAHL, APA Psych INFO, Scopus, Cochrane, and non-traditional publications was performed in June 2021 for studies introducing coping interventions for adults with hematological cancers within the past 20 years. The Transactional Model of Stress and Coping was used as a framework with fatigue as the primary outcome. The Johns Hopkins Nursing Evidence Based Practice Appraisal tool was used for quality appraisal. Results: Twelve interventional studies met criteria for inclusion. Four studies significantly reduced fatigue, with an additional 3 showing a reduction in fatigue. Interventions that utilized both problem and emotion-focused coping were more effective at reducing fatigue compared to interventions that only used emotion or problem-focused coping. Conclusion: This systematic review found moderate-strength evidence to support that coping interventions can reduce fatigue, with mixed, but mostly beneficial results. Clinicians caring for patients with hematologic malignancies should consider using coping interventions to reduce fatigue.
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Affiliation(s)
- Lucy Andersen
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Salimah Meghani
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Connie Ulrich
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Molly McHugh
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Jie Deng
- University of Pennsylvania, School of Nursing
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15
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Li W, Yang Y, Li Z, Chen W. Effect of malnutrition and nutritional support to reduce infections in elderly hospitalized patients with cancer: A multicenter survey in China. Nutrition 2023; 106:111894. [PMID: 36459844 DOI: 10.1016/j.nut.2022.111894] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Malnutrition is common among elderly patients with cancer, and greatly affects patients' quality of life. Malnutrition is a key factor in the development of systemic, chronic, low-grade inflammation that can exacerbate. METHODS A total of 633 elderly patients with cancer from 29 tertiary public hospitals in 14 cities in China were selected as the research subjects. Physical examination, questionnaire survey, medical history collection, and blood index detection were performed on the research subjects to analyze the relationship between malnutrition, nutritional support, and infection status. RESULTS There was no significant difference in infection rate among elderly hospitalized patients with cancer and different cancer types, cancer stages, or therapy methods (P > 0.05). The proportion of vomiting, loss of appetite, depression, and physical fatigue in patients with good nutritional status were lower than in patients with moderate or severe malnutrition (P < 0.05). Nutritional support is crucial for the nutritional status of elderly patients with cancer, and patients without special nutritional guidance are more likely to develop infection (P < 0.05). After adjusting for confounding variables, the results of the logistic regression analysis showed that oral nutritional supplements (odds ratio [OR]: 0.088; 95% confidence interval [CI], 0.015-0.514), parenteral nutrition (OR: 0.091; 95% CI, 0.011-0.758), and individualized nutritional guidance (OR: 0.026; 95% CI, 0.003-0.202) were all protective factors associated with cancer infection. CONCLUSIONS Many elderly hospitalized patients with cancer have local or systemic infections, and good nutrition is associated with lower rates of infection. Receiving nutritional guidance or support is associated with lower infection rates in elderly patients with cancer.
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Affiliation(s)
- Wanyang Li
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaming Yang
- Department of Nutrition, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zijian Li
- Department of General Surgery, Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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16
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Blumenthaler AN, Bruera E, Badgwell BD. Palliative and Supportive Care Consultation for Patients With Malignant Gastrointestinal Obstruction is Associated With Broad Interdisciplinary Management. Ann Surg 2023; 277:284-290. [PMID: 36745760 PMCID: PMC9902762 DOI: 10.1097/sla.0000000000004974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess rates of palliative care (PC) involvement in the care of patients with malignant gastrointestinal obstruction (GIO) and its influence on interdisciplinary team involvement. BACKGROUND Malignant GIO is an advanced oncologic diagnosis with associated poor prognosis. Data regarding PC and interdisciplinary team involvement in these patients is lacking. METHODS We identified consecutive surgical consultations for GIO in cancer patients at a single institution from August 2017 to July 2019. Clinical characteristics were collected. Rates of PC consultation, ACP discussion, code status change to do not resuscitate, and interdisciplinary service consultation were evaluated. RESULTS We identified 200 patients with consultations for GIO, of whom 114 (57%) had malignant GIO and were included in our study. Of these patients, 95 (83%) had stage IV disease; 68 (60%) had peritoneal metastasis, and 70 (61%) had other intra-abdominal recurrence or metastasis. PC consultation was obtained in 69 patients (61%). PC consultation was associated with higher rates of ACP discussion (64% vs 29%; P < 0.001), code status change to do not resuscitate (30% vs 2%; P < 0.001), nonsurgical procedure (46% vs 11%; P < 0.001), discharge to hospice (30% vs 7%; P < 0.001), and involvement of spiritual care (48% vs 22%; P = 0.01), social work (77% vs 42%, P < 0.001), psychology/psychiatry (42% vs 4%, P < 0.001), nutrition (86% vs 62%, P = 0.006), physical therapy (54% vs 31%, P = 0.02), and occupational therapy (42% vs 16%, P = 0.004). CONCLUSIONS PC consultation benefits patients with malignant GIO by facilitating comprehensive interdisciplinary care, ACP discussions, and transition to hospice care, where appropriate. Diagnosis of malignant GIO should be a trigger for PC consultation or, in facilities with limited PC resources, consideration of deliberately broad interdisciplinary consultation.
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Affiliation(s)
- Alisa N. Blumenthaler
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston,
TX
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative
Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian D. Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston,
TX
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17
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Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment: a systematic review with meta-analysis. Support Care Cancer 2023; 31:129. [PMID: 36683104 DOI: 10.1007/s00520-022-07549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment. METHODS Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review. RESULTS A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD = - 0.69; 95%CI (- 1.15, - 0.22) p < 0.01; I2 = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD = - 0.76; 95%CI (- 1.13, - 0.39) p < 0.01; I2 = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD = - 1.90; 95%CI (- 3.04, - 0.76) p < 0.01; I 2 = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD = - 0.89; 95%CI (- 1.61, - 0.17) p < 0.02; I2 = 90%] and physical fatigue [SMD = - 1.00; 95%CI (- 1.54, - 0.46) p < 0.01; I2 = 92%], while high intensity reduced only general fatigue [SMD = - 0.35; 95%CI (- 0.51, - 0.20) p < 0.01; I2 = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF. CONCLUSION Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue.
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18
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Porzio G, Capela A, Giusti R, Lo Bianco F, Moro M, Ravoni G, Zułtak-Baczkowska K. Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature. Drugs Context 2023; 12:dic-2022-11-7. [PMID: 37077766 PMCID: PMC10108666 DOI: 10.7573/dic.2022-11-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/10/2023] [Indexed: 04/21/2023] Open
Abstract
Underlying cancer pain has heterogenous aetiologies and mechanisms. It requires detailed and comprehensive pain assessment, combined with personalized treatment. A multidisciplinary team is essential to providing the best management of cancer pain at every disease stage, improving the quality of life and outcomes in patients with cancer. This narrative literature review emphasizes the value of providing all patients with multidisciplinary pain management in their preferred care setting. Real-life experiences are also reported to witness the efforts of physicians to properly manage cancer pain. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.
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Affiliation(s)
| | - Andreia Capela
- Centro Hospitalar Vila Nova de Gaia, Espinho; Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Arcozelo – Vila Nova de Gaia, Portugal
| | - Raffaele Giusti
- Medical Oncology Unit, Sant’Andrea Hospital of Rome, Sapienza University of Rome, Rome, Italy
| | - Francesca Lo Bianco
- Medical Oncology Unit, Sant’Andrea Hospital of Rome, Sapienza University of Rome, Rome, Italy
| | - Mirella Moro
- Medical Oncology Unit, Sant’Andrea Hospital of Rome, Sapienza University of Rome, Rome, Italy
| | - Giulio Ravoni
- Tuscany Tumor Association, Home Care Service, Florence, Italy
| | - Katarzyna Zułtak-Baczkowska
- Zakład Zdrowia Publicznego, Wydział Nauk o Zdrowiu, Pomorski Uniwersytet Medyczny w Szczecinie, Stettin, Poland
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19
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Janjua S, Brown M, Parker R, Prue G, Closier P, Cramp F. Physical activity for the management of cancer-related fatigue in adults. Hippokratia 2022. [DOI: 10.1002/14651858.cd015348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Sadia Janjua
- Pain, Palliative and Supportive Care Review Group; Cochrane; Oxford UK
| | - Malcolm Brown
- School of Nursing and Midwifery; Queen's University Belfast; Belfast UK
| | - Roses Parker
- Cochrane MOSS Network; c/o Cochrane Pain Palliative and Supportive Care Group; Oxford UK
| | - Gillian Prue
- School of Nursing and Midwifery; Queen's University Belfast; Belfast UK
| | - Philippa Closier
- University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Fiona Cramp
- Faculty of Health & Applied Sciences; University of the West of England; Bristol UK
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20
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Torregrosa C, Chorin F, Beltran EEM, Neuzillet C, Cardot-Ruffino V. Physical Activity as the Best Supportive Care in Cancer: The Clinician's and the Researcher's Perspectives. Cancers (Basel) 2022; 14:5402. [PMID: 36358820 PMCID: PMC9655932 DOI: 10.3390/cancers14215402] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 08/11/2023] Open
Abstract
Multidisciplinary supportive care, integrating the dimensions of exercise alongside oncological treatments, is now regarded as a new paradigm to improve patient survival and quality of life. Its impact is important on the factors that control tumor development, such as the immune system, inflammation, tissue perfusion, hypoxia, insulin resistance, metabolism, glucocorticoid levels, and cachexia. An increasing amount of research has been published in the last years on the effects of physical activity within the framework of oncology, marking the appearance of a new medical field, commonly known as "exercise oncology". This emerging research field is trying to determine the biological mechanisms by which, aerobic exercise affects the incidence of cancer, the progression and/or the appearance of metastases. We propose an overview of the current state of the art physical exercise interventions in the management of cancer patients, including a pragmatic perspective with tips for routine practice. We then develop the emerging mechanistic views about physical exercise and their potential clinical applications. Moving toward a more personalized, integrated, patient-centered, and multidisciplinary management, by trying to understand the different interactions between the cancer and the host, as well as the impact of the disease and the treatments on the different organs, this seems to be the most promising method to improve the care of cancer patients.
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Affiliation(s)
- Cécile Torregrosa
- Oncologie Digestive, Département d’Oncologie Médicale Institut Curie, Université Versailles Saint-Quentin—Université Paris Saclay, 35, rue Dailly, 92210 Saint-Cloud, France
- Département de Chirurgie Digestive et Oncologique, Hôpital Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Frédéric Chorin
- Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS), HEALTHY Graduate School, Université Côte d’Azur, 06205 Nice, France
- Clinique Gériatrique du Cerveau et du Mouvement, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06205 Nice, France
| | - Eva Ester Molina Beltran
- Oncologie Digestive, Département d’Oncologie Médicale Institut Curie, Université Versailles Saint-Quentin—Université Paris Saclay, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Cindy Neuzillet
- Oncologie Digestive, Département d’Oncologie Médicale Institut Curie, Université Versailles Saint-Quentin—Université Paris Saclay, 35, rue Dailly, 92210 Saint-Cloud, France
- GERCOR, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France
| | - Victoire Cardot-Ruffino
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
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21
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De Lazzari N, Wichum F, Götte M, David C, Seid K, Tewes M. Entwicklung einer KI-gestützten Bewegungstherapie bei
onkologischen Palliativpatienten. B&G BEWEGUNGSTHERAPIE UND GESUNDHEITSSPORT 2022. [DOI: 10.1055/a-1909-5766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung
HintergrundDie wechselnde Symptomlast ist eine große Hürde
in der Sporttherapie von onkologischen Palliativpatienten. Die täglich
variierende Symptomstärke erschwert die Einstellung einer optimalen
Trainingsbelastung und stellt neben der Motivation eine große Barriere
für die Teilnahme an bewegungstherapeutischen Interventionen dar. Ein
durch Künstliche Intelligenz (KI) gesteuertes Training könnte
helfen, die Trainingseinheiten individuell anzupassen und die Autonomie von
Palliativpatienten zu erhalten.
Methoden Fünf Patienten mit fortgeschrittener unheilbarer
Krebsdiagnose haben im Rahmen der Routineversorgung eine supervidierte
Bewegungstherapie absolviert. Dabei wurde ein Elektrokardiogramm über
einen Polar H10 Brustgurt aufgezeichnet und daraus kardiale und respiratorische
Vitalparameter extrahiert. Eine Klassifikation in drei Intensitätsstufen
über KI erfolgte anhand von neuronalen Netzen.
Ergebnisse Das KI-gesteuerte Training hat eine sehr hohe
Klassifikationsgüte (F1-Score: 0,95±0,05) durch die Vereinigung
von respiratorischen und kardialen Vitalparametern. Diese Kombination erzielt
genauere Klassifikationsergebnisse als die einzelnen Datensätze
für kardiale Parameter (0,93±0,06) und respiratorische Parameter
(0,72±0,06). Die Berücksichtigung einer Baselinemessung hat eine
positive Wirkung auf die Klassifikationsgenauigkeit.
Diskussion Diese Studie stellt die erste Untersuchung zum Einsatz von KI
zur Klassifizierung von trainingswissenschaftlichen Inhalten bei onkologischen
Palliativpatienten dar. Diese vulnerable Patientengruppe kann von einer
objektiven Erfassung des Belastungsniveaus anhand von Parametern des
kardiovaskulären Systems profitieren. Mit nur fünf Patienten
wird die Aussagekraft dieser explorativen Studie über Kreuzvalidierung
hergestellt. Zukünftig sollen weitere Parameter wie ein subjektives
Empfinden, Alter, Größe und Geschlecht die Klassifikation weiter
verbessern. In einem integrierten System ist eine individuelle
Trainingssteuerung in Echtzeit möglich.
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Affiliation(s)
- Nico De Lazzari
- Westdeutsches Tumorzentrum – Comprehensive Cancer Center,
Innere Klinik (Tumorforschung), Universitätsklinikum Essen, 45122 Essen,
Deutschland
| | - Felix Wichum
- Fraunhofer IMS, Universität Duisburg-Essen, 47057 Duisburg,
Deutschland
| | - Miriam Götte
- Westdeutsches Tumorzentrum – Comprehensive Cancer Center,
Klinik für Kinderheilkunde 3, Universitätsklinikum Essen, 45122
Essen, Deutschland
| | - Corinna David
- Fachhochschule Münster, Fachbereich
Physikingenieurwesen
| | - Karsten Seid
- Fraunhofer-Institut für Mikroelektronische Schaltungen und
Systeme (IMS), 47057 Duisburg und Fachgebiet Elektronische Bauelemente und
Schaltungen (EBS), Universität Duisburg-Essen
| | - Mitra Tewes
- Palliativmedizin der Universitätsmedizin Essen,
Universitätsklinikum Essen, 45122 Essen, Deutschland
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Navigante A, Cresta Morgado P, Daud ML, Dos Santos Regis H, Kolberg M, Marazzi C, Lobbe V, González AA, De Simone G. Physical exercise and fatigue in advanced gastrointestinal cancer during chemotherapy. BMJ Support Palliat Care 2022; 13:218-227. [PMID: 35738869 DOI: 10.1136/bmjspcare-2021-003516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study was aimed to analyse the effect of a patient-oriented modality of physical exercise (programmed and directed physical exercise (PDPE)) on cancer-related fatigue (CRF) and quality of life (QoL). The secondary aim was to evaluate changes in body composition and skeletal muscle function during the study in patients with and without PDPE. METHODS A prospective randomised study was conducted to analyse the impact of PDPE on CRF and QoL. Patients were selected before the development of CRF to set the intervention before its appearance. A high probability CRF population was chosen: patients with advanced gastrointestinal cancer undergoing chemotherapy with weight loss (≥5%) over the last 6 months. PDPE consisted of a programme of exercise delivered weekly and adjusted to patients' medical conditions. Four visits were planned (weeks 0, 4, 8 and 12). QoL, CRF, body composition and skeletal muscle function were evaluated in each visit. RESULTS From 101 patients recruited, 64 were considered evaluable, with three or four visits completed (n=30 control, n=34 PDPE group). Satisfactory compliance of ≥50% to the PDPE programme was seen in 47%. A reduction in the severity of fatigue was detected in the PDPE group (p=0.019), being higher in the subgroup of satisfactory compliance (p<0.001). This latter group showed better results of QoL in comparison with the control group (p=0.0279). A significant increase in endurance was found in the PDPE group (p<0.001). CONCLUSION PDPE reduced the severity of fatigue and improved QoL. The difference in endurance would explain the results seen in the severity of fatigue.
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Affiliation(s)
- Alfredo Navigante
- Pallium Latinoamérica Association, Buenos Aires, Argentina .,Translational Research Unit, Institute of Oncology Angel H Roffo, Buenos Aires, Argentina
| | - Pablo Cresta Morgado
- Translational Research Unit, Institute of Oncology Angel H Roffo, Buenos Aires, Argentina
| | - María Laura Daud
- Pallium Latinoamérica Association Buenos Aires, AR, CABA, Argentina
| | - Helca Dos Santos Regis
- Section of Rehabilitation and Physiotherapist, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Martín Kolberg
- Pallium Latinoamérica Association Buenos Aires, AR, CABA, Argentina
| | - Carla Marazzi
- Section of Rehabilitation and Physiotherapist, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Velia Lobbe
- Nutrition Department, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Andrea Alejandra González
- Section of Palliative Care, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Gustavo De Simone
- Pallium Latinoamérica Association, Buenos Aires, Argentina.,Section of Palliative Care, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
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Santos ATN, Nascimento NDS, Alves PGJM. Efeitos de Abordagens não Farmacológicas nos Sintomas Físicos de Indivíduos com Câncer Avançado: Revisão Sistemática. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introdução: O câncer e um problema de saúde publica que, em estágios avançados, pode ocasionar desconfortos físicos, psicossociais e espirituais. Assim, abordagens fisioterapêuticas e as Práticas Integrativas e Complementares em Saúde (PICS) surgem como ferramentas importantes para o controle e melhora de sintomas físicos nesses indivíduos. Objetivo: Descrever os efeitos de abordagens não farmacológicas, envolvendo técnicas fisioterapêuticas e PICS, nos sintomas físicos de indivíduos com câncer avançado. Método: Revisão sistemática da literatura composta por ensaios clínicos randomizados que abordassem os efeitos de abordagens fisioterapêuticas ou PICS nos sintomas físicos de indivíduos diagnosticados com câncer avançado. Foram selecionadas as bases de dados PubMed, LILACS, PEDro, Cochrane, SciELO, e a última busca ocorreu em abril de 2021. A avaliação da qualidade metodológica dos estudos foi realizada por meio da escala PEDro. Resultados: Vinte e dois estudos foram incluídos, e demonstraram que ambas as abordagens tem efeitos positivos para os sintomas físicos, como fadiga e dor, na população estudada. Conclusão: A fisioterapia e as PICS tem efeitos positivos nos sintomas físicos em indivíduos com diagnostico de câncer avançado. No entanto, existem poucos estudos com qualidade metodológica suficiente para confirmar a eficácia das duas abordagens nos desfechos estudados para essa população.
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24
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Seo KS. Recent Trends in Rehabilitation for Cancer Patients. Ann Rehabil Med 2022; 46:111-113. [PMID: 35793899 PMCID: PMC9263325 DOI: 10.5535/arm.22072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kwan-Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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25
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Ní Chéileachair FN, Johnston BM, Payne C, Cahill F, Mannion L, McGirr L, Ryan K. Protocol for an exploratory, longitudinal single case study of a novel palliative care rehabilitative service. HRB Open Res 2022; 4:131. [PMID: 35118229 PMCID: PMC8790707 DOI: 10.12688/hrbopenres.13461.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Early access to rehabilitation can improve quality of life for those with life-limiting illnesses and is highlighted as a core component of the Adult Palliative Care Services Model of Care for Ireland. Despite this, palliative rehabilitation remains under-utilised and under-developed. In 2020, the Sláintecare Integration Fund provided opportunity to pilot a novel rehabilitative palliative care service, “Palliat Rehab”. This protocol proposes a case study, which aims to advance understanding of the form, content, and delivery of the pilot service. Methods: A prospective, longitudinal, mixed-methods, case study design will be used to describe the service and to explore the experiences of patients, informal carers and clinicians. Additionally, data collection instruments will be tested and the utility of outcome measures will be examined. Data will be collected from documentary, survey, and interview sources. Quantitative data will be analysed using descriptive statistics, including chi-square tests for categorical variables, Mann-Whitney U tests for ordinal data, and t-tests/ ANOVA for continuous data. Qualitative data will be analysed using thematic analysis. Conclusions: New pathways are required to advance service provision to ensure that patients receive the ‘right care, in the right place, at the right time’. This protocol outlines a case study which will aim to develop current understanding of the implementation and delivery of a novel rehabilitative palliative care service in Ireland and will consider its potential contribution to the achievement of Sláintecare goals. Investigating the service within its environmental context will lead to a better understanding of ‘how’ and ‘why’ things happen. Findings will be used to inform efforts to further develop and tailor the intervention.
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Affiliation(s)
| | - Bridget M. Johnston
- Centre for Health and Policy Management, Trinity College Dublin, Dublin, Ireland
| | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | | | - Lisa Mannion
- Department of Palliative Care, Mater Misericordiae University Hospital, Dublin, Dublin, Ireland
| | | | - Karen Ryan
- Department of Palliative Care, Mater Misericordiae University Hospital, Dublin, Dublin, Ireland
- St. Francis Hospice, Dublin, Ireland
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26
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He F, He RX. Systematic nursing interventions in gastric cancer: A randomized controlled study. World J Clin Cases 2022; 10:1843-1851. [PMID: 35317163 PMCID: PMC8891775 DOI: 10.12998/wjcc.v10.i6.1843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/04/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scientific and effective nursing methods can effectively mitigate negative emotions in patients. Related studies have shown that systematic nursing interventions are beneficial in enhancing the self-efficacy and self-care abilities of patients and improving their physical and mental state, thereby alleviating their fatigue and improving their quality of life.
AIM To explore the effects of systematic nursing intervention on cancer-related fatigue, self-efficacy, self-nursing ability, and quality of life in gastric cancer (GC) patients during the perioperative period.
METHODS In this study, sample size was based on the multivariable scale. The sample size was 10 times the acceptable variable, with an additional 20% added to account for an expected loss of patients in follow-up for a final sample size of 168 patients. Conventional nursing measures were used in the control group, while the systematic nursing intervention Adopted Cancer Fatigue Scale (CFS), General Self-Efficacy Scale-Schwarzer (GSES), Self-Care Agency Scale (ESCA), and simple health scale (SF-36) were used in the observation group. The questionnaires were administered on admission and discharge.
RESULTS At admission, there was no statistically significant difference in the scores on each scale between the groups. At discharge, the CFS and GSES scores in the observation group were 21.56 ± 2.24 and 51.16 ± 11.71, while those in the control group were 29.61 ± 3.48 and 41.58 ± 8.54, respectively, with statistically significant differences. The ESCA score in the observation and control groups was 112.09 ± 11.72 and 97.87 ± 9.26, respectively. Moreover, the scores in all dimensions (self-concept, self-responsibility, health knowledge level, and self-care skills) in the observation group were higher than those in the control group, with statistically significant differences. The SF-36 score in the observation and control groups was 75.51 ± 3.63 and 63.24 ± 3.41, respectively, with statistically significant differences. The scores in all dimensions (mental health, vitality, physical function, physical pain, social function, emotional function, and overall health level) in the observation group were higher than those in the control group, with statistically significant differences.
CONCLUSION Systemic nursing intervention for GC patients during the perioperative period could alleviate cancer-related fatigue, improve self-efficacy and self-nursing ability, and improve quality of life, which all have clinical value.
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Affiliation(s)
- Fang He
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rui-Xian He
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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27
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Fan R, Yang S, Bu X, Chen Y, Wang Y, Shen B, Qiu C, Li X. Symptomatic Features and Factors Associated With Do-Not-Resuscitate Consent in Advanced Cancer Patients Admitted to Palliative Care Ward. Am J Hosp Palliat Care 2022; 39:1312-1324. [PMID: 35041534 DOI: 10.1177/10499091211068824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to conduct a retrospective cross-sectional study to investigate the prevalence of symptoms and symptom clusters on sociodemographic and disease characteristics, as well as factors associated with Do-Not-Resuscitate (DNR) consent. Advanced cancer patients were enrolled between 2018 and 2020 with available data. Demographic and clinical data were obtained for analysis from Hospital Information System (HIS) in China. Symptom clusters were extracted by hierarchical cluster analysis. Chi-square test and multiple logistic regression were conducted to investigate the prevalence characteristics of symptoms and influencing factors of DNR consent, respectively. 798 advanced cancer patients were enrolled. The most prevalent symptoms were pain (93%), anorexia (36.5%), and sleep disorders (34.2%). High heart rate was associated with poor performance status and more symptoms. Three clusters were extracted: fatigue-related, respiratory-circulatory system, and digestive system symptom clusters. The incidence of symptoms was statistically significant in age, gender, education level, residence, BMI, performance status, distress score, ADL, and primary pain level. The DNR signature rate was 15.5%. Female, distant metastasis, in-ward rescue, and appearance of dyspnea were independent influencing factors of DNR signature.Chinese hospitalized cancer patients had more symptoms burden that were influenced by various demographic characteristics, especially pain and fatigue-related symptoms. Concerning the trajectory of vital signs is important among advanced cancer patients. The DNR signature rate was lower and our finding indicating an urgency to accurately assess the prognosis and give more palliative care education to enhance DNR rates and early signing in Chinese context.
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Affiliation(s)
- Rongrong Fan
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Siyu Yang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaofan Bu
- 12570Xiangya Nursing School of Central South University, Changsha, China
| | - Yongyi Chen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Ying Wang
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Boyong Shen
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Cuiling Qiu
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
| | - Xuying Li
- 117924Hunan Cancer Hospital/Affiliated Cancer Hospital of Xiangya Nursing School of Central South University, Changsha, China
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28
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Functional Improvement During Prolonged Hospitalization in a Patient With Acute Myeloid Leukemia Utilizing Physical and Occupational Therapy Comanagement. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Ní Chéileachair F, Johnston BM, Payne C, Cahill F, Mannion L, McGirr L, Ryan K. Protocol for an exploratory, longitudinal single case study of a novel palliative care rehabilitative service. HRB Open Res 2021; 4:131. [DOI: 10.12688/hrbopenres.13461.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Early access to rehabilitation can improve quality of life for those with life-limiting illnesses and is highlighted as a core component of the Adult Palliative Care Services Model of Care for Ireland. Despite this, palliative rehabilitation remains under-utilised and under-developed. In 2020, the Sláintecare Integration Fund provided opportunity to pilot a novel rehabilitative palliative care service, “Palliat Rehab”. This protocol proposes a case study, which aims to advance understanding of the form, content, and delivery of the pilot service. Methods: A prospective, longitudinal, mixed-methods, case study design will be used to describe the service and to explore the experiences of patients, informal carers and clinicians. Additionally, data collection instruments will be tested and the utility of outcome measures will be examined. Data will be collected from documentary, survey, and interview sources. Quantitative data will be analysed using descriptive statistics, including chi-square tests for categorical variables, Mann-Whitney U tests for ordinal data, and t-tests/ ANOVA for continuous data. Qualitative data will be analysed using thematic analysis. Conclusions: New pathways are required to advance service provision to ensure that patients receive the ‘right care, in the right place, at the right time’. The development of ‘‘Palliat Rehab’’ offers opportunity to study an innovative service and consider its potential contribution to the achievement of Sláintecare goals. Investigating the service within its environmental context will lead to a better understanding of ‘how’ and ‘why’ things happen. Findings will be of value in assessing whether there is evidence that supports the service, and will be used to inform efforts to further develop and tailor the intervention.
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30
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Brooks FA, Keeney T, Ritchie C, Tolchin DW. Rehabilitation for Symptom Management for Patients with Cancer at the End of Life: Current Evidence and Barriers to Care. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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31
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Jensen RK, Jakobsen S, Gundersen SV, Andersen MF, Kongsgaard M, Thomsen JL, Riis A. Patients' Expectations of Physiotherapeutic Treatment for Long-Term Side Effects After Cancer: A Qualitative Study. Cancer Control 2021; 28:10732748211047091. [PMID: 34582740 PMCID: PMC8485255 DOI: 10.1177/10732748211047091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aims to explore the expectations of physiotherapeutic treatment of long-term side effects (LTSEs) after cancer among patients treated in physiotherapy clinics. Methods This a qualitative interview study based on a phenomenological approach. Adult patients with LTSEs after cancer were recruited through The Danish Cancer Society and a private physiotherapy clinic in Denmark. Individual semi-structured interviews were carried out using Microsoft Teams based on an interview guide piloted before the interviews. Interviews were audiotaped and transcribed verbatim. Sampling was conducted with a focus on variation in LTSE. The data were analyzed using Malterud’s principles of systematic text condensation and coded in NVivo 12. Results 2 males and 8 females with an average age of 55.8 years were interviewed for between 40 and 60 minutes from October to November 2020. Four main themes emerged from the interviews1: The importance of the physiotherapist’s approach,2 the benefits of meeting patients with similar symptoms,3 the importance of receiving knowledge, and4 patients seeking to maintain their current state more often than aiming to improve their condition. Conclusions Patients consulting a physiotherapy clinic with LTSE after cancer prefer the physiotherapist to have knowledge about cancer and to be emphatic. Furthermore, patients prefer to meet like-minded people and expect support to maintain their current condition rather than improve their condition.
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Affiliation(s)
- Rikke Klitlund Jensen
- Department of Physiotherapy, 86942University College Northern Denmark, Aalborg, Denmark
| | - Sarah Jakobsen
- Department of Physiotherapy, 86942University College Northern Denmark, Aalborg, Denmark
| | | | | | - Marianne Kongsgaard
- 91688Quality Unit for General Practice in the North Denmark Region, Aalborg, Denmark
| | - Janus Laust Thomsen
- 1004Research Unit for General Practice in Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Allan Riis
- Department of Physiotherapy, 86942University College Northern Denmark, Aalborg, Denmark.,1004Research Unit for General Practice in Aalborg, Denmark
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32
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De Lazzari N, Niels T, Tewes M, Götte M. A Systematic Review of the Safety, Feasibility and Benefits of Exercise for Patients with Advanced Cancer. Cancers (Basel) 2021; 13:cancers13174478. [PMID: 34503288 PMCID: PMC8430671 DOI: 10.3390/cancers13174478] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Most advanced cancer patients suffer from severe symptoms due to cancer and medical treatment. Common symptoms are physical weakness, mental problems, and tiredness. Research has shown that exercise positively influences cancer-related side effects during and after treatment and longevity in cancer survivorship. However, exercise as a supportive therapy in advanced cancer patients is still not recommended in oncological guidelines. Therefore, the aim of this systematic review was to assess the safety, feasibility, and benefits of exercise for patients with advanced cancer. Based on the results of 14 included exercise intervention studies, we conclude that exercise is safe and feasible, seems to improve physical performance, and may lower symptoms like chronic tiredness. Early integration of exercise for advanced cancer patients should be considered as usual care as a supportive strategy. Abstract Exercise therapy is a common supportive strategy in curative cancer treatment with strong evidence regarding its positive effects on, for example, cancer-related fatigue, health- related quality of life, and physical function. In the field of advanced cancer patients, knowledge about exercise as a useful supportive strategy is missing. The aim of this systematic review was to evaluate the feasibility and safety of exercise interventions as well as its effects on lowering the symptom burden. We included randomized controlled trials and nonrandomized controlled trials with advanced cancer patients receiving any type of exercise intervention. After an extensive literature search (in accordance to PRIMSA guidelines) in PubMed, Cochrane Library, and SPORTDiscus, 14 studies including 940 participants with different cancer entities were eligible. The results indicated the safety of exercise. In total, 493 participants received exercise interventions, with nine adverse events and no severe adverse events. The median recruitment rate was 68.33%, and adherence to exercise intervention was 86%. Further research with a high-quality and larger sample size is needed to clarify the potential of exercise with advanced cancer patients. Different advanced cancer entities have distinguished symptoms, and future research should construct entities-specific trial populations to figure out the best supportive exercise interventions.
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Affiliation(s)
- Nico De Lazzari
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
- Correspondence:
| | - Timo Niels
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Mitra Tewes
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
| | - Miriam Götte
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics 3, Center for Child and Adolescent Medicine, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
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Mack A, Arrigo M, Fink T, Garrity K, Cox D, Kwasnowski L, Wong J. Fatigue and functional outcomes in cancer rehabilitation. Support Care Cancer 2021; 29:8069-8076. [PMID: 34231039 DOI: 10.1007/s00520-021-06405-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is one of the most common symptoms experienced by oncology patients, though its impact on functional outcomes during inpatient rehabilitation is relatively unknown. The purpose of this study is to determine whether CRF severity on admission is related to functional gains following standard rehabilitation care in an inpatient oncology rehabilitation population. METHODS A retrospective cohort study was conducted within an inpatient oncology unit at a long-term acute care hospital. Seventy-six patients admitted to the hospital between April and December 2015 with an oncology diagnosis, planned discharge, and completed standardized assessments of CRF and functional ability were included in this study. Patients received standard interdisciplinary rehabilitation services including physical and occupational therapy. CRF was assessed on admission using the Brief Fatigue Inventory, and functional abilities were assessed on admission and discharge using the basic mobility and daily activity domains of the Activity Measure for Post-Acute Care inpatient short forms (AM-PAC). RESULTS Ninety-seven percent of patients reported CRF, and 57% reported severe CRF upon admission. Patients demonstrated on average a 30% and 14% reduction in functional impairment in basic mobility and daily activity respectively during their admission. There was no significant correlation found between CRF on admission and change in functional impairment. CONCLUSION This study contributes to existing literature in that it found patients who received inpatient rehabilitation services demonstrate significant improvement in their functional status despite reporting CRF upon admission to a long-term acute care hospital oncology unit.
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Affiliation(s)
- Amanda Mack
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA. .,MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA.
| | - Monica Arrigo
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA.,MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
| | - Twyla Fink
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA.,Salem State University, 352 Lafayette St, Salem, MA, 01970, USA
| | - Karla Garrity
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA
| | - David Cox
- MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
| | - Lauren Kwasnowski
- Spaulding Hospital for Continuing Medical Care Cambridge, 1575 Cambridge St, Cambridge, MA, 02138, USA.,MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
| | - John Wong
- MGH Institute of Health Professions, 36 1st Avenue, Charlestown, MA, 02129, USA
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Molecular and Neural Mechanism of Dysphagia Due to Cancer. Int J Mol Sci 2021; 22:ijms22137033. [PMID: 34210012 PMCID: PMC8269194 DOI: 10.3390/ijms22137033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Cancer is one of the most common causes of death worldwide. Along with the advances in diagnostic technology achieved through industry–academia partnerships, the survival rate of cancer patients has improved dramatically through treatments that include surgery, radiation therapy, and pharmacotherapy. This has increased the population of cancer “survivors” and made cancer survivorship an important part of life for patients. The senses of taste and smell during swallowing and cachexia play important roles in dysphagia associated with nutritional disorders in cancer patients. Cancerous lesions in the brain can cause dysphagia. Taste and smell disorders that contribute to swallowing can worsen or develop because of pharmacotherapy or radiation therapy; metabolic or central nervous system damage due to cachexia, sarcopenia, or inflammation can also cause dysphagia. As the causes of eating disorders in cancer patients are complex and involve multiple factors, cancer patients require a multifaceted and long-term approach by the medical care team.
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35
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Mochamat, Cuhls H, Sellin J, Conrad R, Radbruch L, Mücke M. Fatigue in advanced disease associated with palliative care: A systematic review of non-pharmacological treatments. Palliat Med 2021; 35:697-709. [PMID: 33765888 DOI: 10.1177/02692163211000628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fatigue is a common complaint reported by patients with advanced disease, impacting their daily activities and quality of life. The pathophysiology is incompletely understood, and evidence-based treatment approaches are needed. AIM This systematic review aims to evaluate the efficacy of non-pharmacological interventions as treatment for fatigue in advanced disease. DESIGN The review design follows the Cochrane guidelines for systematic reviews of interventions. DATA SOURCES We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PubMed, ClinicalTrials.gov and a selection of journals up to February 28th 2019, for randomised controlled trials (RCTs) investigating the effect of non-pharmacological treatments for fatigue in advanced disease associated with palliative care. Further potentially relevant studies were identified from the reference lists in relevant reviews, and in studies considered for this review. RESULTS We screened 579 publications; 15 met the inclusion criteria, with data from 1179 participants: 815 were treated with physical exercise, 309 with psycho-educational therapy and 55 with an energy restoration approach. Sources of potential bias included lack of description of blinding and allocation concealment methods, and small study sizes. Physical exercise as treatment for fatigue in patients with advanced cancer was supported by moderate-quality evidence. CONCLUSION Physical exercise should be considered as a measure to reduce fatigue in patients with advanced cancer, but data on other advanced diseases is lacking. Due to the differences between studies, no clear recommendations can be made with respect to the best type of physical therapy. Restoration exercise and psycho-educational therapy are promising treatment options, although further research is needed.
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Affiliation(s)
- Mochamat
- Department of Anesthesiology and Intensive Therapy, University of Diponegoro/Kariadi Hospital, Semarang, Indonesia.,Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Henning Cuhls
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Julia Sellin
- Centre for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.,Center for Palliative Care, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Martin Mücke
- Centre for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
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Myrcik D, Statowski W, Trzepizur M, Paladini A, Corli O, Varrassi G. Influence of Physical Activity on Pain, Depression and Quality of Life of Patients in Palliative Care: A Proof-of-Concept Study. J Clin Med 2021; 10:jcm10051012. [PMID: 33801357 PMCID: PMC7958598 DOI: 10.3390/jcm10051012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction: Palliative care not only focuses on physical ailments associated with the disease, but also considers the psychological, social and spiritual needs of the patients. The aim of this study is to assess the impact of physical activity on palliative care patients, with special regard to the subjective assessment of severity of total pain and quality of life. Materials and methods: The study was conducted on 92 palliative care patients either in a hospice or at home. The tool used to assess the patients was an original questionnaire focusing on the area of their independence and motor abilities. The study attempted to understand whether an appropriate physical activity and the instruction of palliative care patients and their families in the field of independence would improve the quality of life and reduce the intensity of total pain in the patients. Results: All of the patients were at an advanced stage of cancer. The survey at time “0”, conducted before the start of the instructions for patients and their relatives, showed that a majority of patients (47, 51.09%) often experienced limitations during the performance of daily activities. In the fourth visit, conducted one week after the fourth educational session, there was a significant increase in patients who did not experience any limitations in performing their daily activities or experienced them just sometimes. Conclusions: The ultimate effect of the proposed educational program on physical activity was an increase in the quality of life, a reduction in pain and a mood improvement. These results would need confirmation with more extensive studies.
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Affiliation(s)
- Dariusz Myrcik
- Emergency Medicine, Department of Internal Medicine, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 42-600 Bytom, Poland; (D.M.); (M.T.)
| | - Wojciech Statowski
- Chair and Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland;
- Faculty of Health Sciences, Jan Długosz University in Częstochowa, Armii Krajowej 13/15, 42-200 Częstochowa, Poland
| | - Magdalena Trzepizur
- Emergency Medicine, Department of Internal Medicine, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Piekarska 18, 42-600 Bytom, Poland; (D.M.); (M.T.)
| | | | - Oscar Corli
- Mario Negri Institute for Pharmacological Research IRCCS, 20156 Milano, Italy;
| | - Giustino Varrassi
- Paolo Procacci Foundation, Via Tacito 7, 00193 Roma, Italy
- Correspondence: ; Tel.: +39-3486068472
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Frikkel J, Beckmann M, De Lazzari N, Götte M, Kasper S, Hense J, Schuler M, Teufel M, Tewes M. Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months-a comparative study. Support Care Cancer 2021; 29:5127-5137. [PMID: 33608761 PMCID: PMC8295138 DOI: 10.1007/s00520-021-06020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/21/2021] [Indexed: 01/28/2023]
Abstract
Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017
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Affiliation(s)
- J Frikkel
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - N De Lazzari
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Götte
- Department of Pediatric Hematology/Oncology, Center for Child and Adolescent Medicine, University Hospital Essen, Essen, Germany
| | - S Kasper
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - J Hense
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Schuler
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147, Essen, Germany
| | - M Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - M Tewes
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.
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Yao C, Cheng Y, Zhu Q, Lv Z, Kong L, Fang M. Clinical Evidence for the Effects of Manual Therapy on Cancer Pain: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6678184. [PMID: 33628310 PMCID: PMC7881934 DOI: 10.1155/2021/6678184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate the effects of manual therapy (MT) on cancer pain, so as to provide clinical evidence for application. METHODS Five English and Chinese databases were searched until February 29, 2020, for randomized controlled trials (RCTs) of MT for cancer pain. Articles published in the English or Chinese language were included. Two authors independently reviewed all articles and extracted the data, and any disagreements in the above process were discussed with other reviewers until the authors reached consensus. Review Manager 5.3 was used to calculate the effect size and 95% confidence intervals. This review was registered in PROSPERO, number CRD42020172053. RESULTS The intensity of cancer pain is our primary outcome measure, and compared with standard care, MT can significantly relieve the pain of patients with cancer (SMD, 0.63; 95% CI [0.18, 1.08]; P=0.006 < 0.01); the effects of MT plus active activity were significantly different from AT alone (SMD, 0.79; 95% CI [0.28, 1.30]; P=0.002 < 0.01); there was no statistical difference in the efficacy of MT and AT alone (SMD, -0.24; 95% CI [-1.09, 0.62]; P=0.53 > 0.05). In other related symptoms, the above evidence cannot support that MT had a good effect on fatigue (SMD, 0.77; 95% CI [-0.09, 1.63]; P=0.08 > 0.05), nausea (SMD, 0.24; 95% CI [-0.00, 0.48]; P=0.05), anxiety (SMD, 0.76; 95 % CI [-0.32, 1.84]; P=0.17 > 0.05), and depression (SMD, 0.67; 95 % CI [-0.28, 1.62]; P=0.17 > 0.05); however, MT intervention can improve physical function (n = 271; SMD, 0.35; 95 % CI [-0.04, 0.74]; P=0.04 < 0.05) and global well-being (SMD, 0.50; 95 % CI [0.02, 0.98]; P=0.04 < 0.05). In addition, MT had a significant effect on pain relief (SMD, 0.52; 95% CI [0.03, 1.01]; P=0.04 < 0.05) and improvement of physical function (SMD, 0.28; 95% CI [0.02, 0.53]; P=0.03 < 0.05) even after a period of time after treatment. CONCLUSION MT was an effective intervention, which may have immediate effect on cancer pain and may improve physical function and global well-being. In the view of follow-up effects, MT had good effects for the reduction of pain and the recovery of physical function. However, because of limitations, the seemingly promising results should be interpreted with caution.
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Affiliation(s)
- Chongjie Yao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanbin Cheng
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Qingguang Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Zhizhen Lv
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingjun Kong
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- College of Acupuncture and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Machado MO, Kang NYC, Tai F, Sambhi RDS, Berk M, Carvalho AF, Chada LP, Merola JF, Piguet V, Alavi A. Measuring fatigue: a meta-review. Int J Dermatol 2020; 60:1053-1069. [PMID: 33301180 DOI: 10.1111/ijd.15341] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
There is a lack of validated tools to measure fatigue in patients with inflammatory skin, neuropsychiatric, and medical disorders. The use of nonvalidated tools may compromise the quality of data. The purpose of this meta-review was to evaluate existing fatigue scales commonly used to assess fatigue in other inflammatory conditions and to identify if there are scales that have been validated in dermatologic conditions. The PubMed/MEDLINE and SCOPUS databases were systematically searched from inception through March 10, 2020, in accordance with the PRISMA statement. Validated tools were identified and assessed according to their main measurement properties. The literature search identified 403 references, and eight studies were eligible and assessed in this review. The unidimensional fatigue scales included were the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F), Brief Fatigue Inventory, Fatigue Severity Scale, Numerical Rating Scale - Fatigue, and Visual Analog Scale - Fatigue. The multidimensional fatigue scales found were the Checklist Individual Strength, Chalder Fatigue Scale, Multidimensional Assessment of Fatigue, Multidimensional Fatigue Inventory Scale, and Piper Fatigue Scale. To measure fatigue, a brief scale with the ability to detect change is needed as there is a growing interest in evaluating this dimension of treatment response. In addition, a good content validity is also needed. From this systematic review, none of the selected scales have had content validation, even though the FACIT was validated in patients with psoriatic arthritis. Validation studies in specific disorders are urgently warranted.
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Affiliation(s)
- Myrela O Machado
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Felicia Tai
- BMSc Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raman D S Sambhi
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andre F Carvalho
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada and Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Lourdes P Chada
- International Dermatology Outcome Measures, Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Divison of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent Piguet
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Chowdhury RA, Brennan FP, Gardiner MD. Cancer Rehabilitation and Palliative Care-Exploring the Synergies. J Pain Symptom Manage 2020; 60:1239-1252. [PMID: 32768554 PMCID: PMC7406418 DOI: 10.1016/j.jpainsymman.2020.07.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
With perpetual research, management refinement, and increasing survivorship, cancer care is steadily evolving into a chronic disease model. Rehabilitation physicians are quite accustomed to managing chronic conditions, yet, cancer rehabilitation remains unexplored. Palliative care physicians, along with rehabilitationists, are true generalists, who focus on the whole patient and their social context, in addition to the diseased organ system. This, together with palliative care's expertise in managing the panoply of troubling symptoms that beset patients with malignancy, makes them natural allies in the comprehensive management of this patient group from the moment of diagnosis. This article will explore the under-recognized and underused parallels and synergies between the two specialties as well as identifying potential challenges and areas for future growth.
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Affiliation(s)
| | - Frank P Brennan
- Calvary Health Care, Kogarah, New South Wales, Australia; The St George Hospital, Kogarah, New South Wales, Australia; The University of NSW, Sydney, New South Wales, Australia
| | - Matthew D Gardiner
- Calvary Health Care, Kogarah, New South Wales, Australia; The St George Hospital, Kogarah, New South Wales, Australia; The University of NSW, Sydney, New South Wales, Australia.
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41
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Hasegawa T, Sekine R, Akechi T, Osaga S, Tsuji T, Okuyama T, Sakurai H, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members. J Pain Symptom Manage 2020; 60:1163-1169. [PMID: 32615299 DOI: 10.1016/j.jpainsymman.2020.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT In end-of-life care, rehabilitation for patients with cancer is considered to be an important means for improving patients' quality of death and dying. OBJECTIVES To determine whether the provision of rehabilitation for patients with cancer in palliative care units is associated with the achievement of a good death. METHODS This study involved a cross-sectional, anonymous, and self-report questionnaire survey of families of patients with cancer who died in palliative care units in Japan. We evaluated the short version of Good Death Inventory (GDI) on a seven-point scale. A logistic regression model was used to calculate the propensity score. Covariates included in this model were survey year, patients' characteristics, and families' characteristics. The associations between rehabilitation and GDI were tested using trend tests after propensity score matching adjustment. RESULTS Of the 1965 family caregivers who received the questionnaires, available data were obtained from 1008 respondents (51.2%). Among them, 285 (28.2%) cases received rehabilitation in palliative care units. There was no difference in total GDI score between the groups with and without rehabilitation. In exploratory analyses, patients receiving rehabilitation were significantly more likely to feel maintaining hope and pleasure (mean 4.50 [SE 0.10] vs. 4.05 [0.11], respectively; effect size [ES] 0.31; P = 0.003), good relationships with medical staff (mean 5.67 [SE 0.07] vs. 5.43 [0.09], respectively; ES 0.22; P = 0.035), and being respected as an individual (mean 6.08 [SE 0.06] vs. 5.90 [0.07], respectively; ES 0.19; P = 0.049) compared with patients not receiving rehabilitation. CONCLUSION Rehabilitation in palliative care units may contribute to several domains of quality of death and dying, particularly maintaining hope and pleasure. Further research is needed to investigate whether palliative rehabilitation contributes to the achievement of a good death.
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Affiliation(s)
- Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan.
| | - Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Tatsuo Akechi
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan; Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toru Okuyama
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan; Department of Pain and Palliative Care, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Haruka Sakurai
- Division of Rehabilitation Medicine, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamtsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Saikyo-ku, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Wilk M, Kepski J, Kepska J, Casselli S, Szmit S. Exercise interventions in metastatic cancer disease: a literature review and a brief discussion on current and future perspectives. BMJ Support Palliat Care 2020; 10:404-410. [PMID: 32943468 DOI: 10.1136/bmjspcare-2020-002487] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/04/2022]
Abstract
Exercise is a well-established factor which improves outcomes of oncological patients during curative treatment as well as in cancer survivors. However, the role of physical activity in metastatic disease, due to the deficiency of high-level evidence from prospective clinical trials, remains a partially unexplored field of research. Additionally, no specific guidelines related to exercise for persons with advanced cancer have been developed so far. Unfortunately, this research deficit may effectively prevent physicians from prescribing adequate and safe recommendations on physical activity to their patients. In an attempt to fill this gap in clinical practice, we present here an up-to-date review of potential benefits of exercise interventions in relation to the survival, quality of life and supportive care for patients with metastatic cancer. We also review the data on the safety of physical activity with special emphasis on elderly populations or individuals with bone metastases. Finally, we discuss the most relevant clinical factors that should be considered during exercise qualification. In conclusion, physical activity is an important tool for improving the outcomes of people undergoing anticancer therapy for metastatic disease. However, the training should be tailored individually to the patient's functional status, comorbidities and preferences. Physical activity should become a standard component of every metastatic cancer care plan.
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Affiliation(s)
- Michal Wilk
- Department of Oncology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Jaroslaw Kepski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Justyna Kepska
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | | | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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García-Soidán JL, Pérez-Ribao I, Leirós-Rodríguez R, Soto-Rodríguez A. Long-Term Influence of the Practice of Physical Activity on the Self-Perceived Quality of Life of Women with Breast Cancer: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144986. [PMID: 32664375 PMCID: PMC7400245 DOI: 10.3390/ijerph17144986] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Abstract
Background: There is still no consensus on the most suitable interventions for exercise practice in breast cancer survivors. Therefore, the aim of this study was to evaluate the effect of a two-year physical activity intervention (strength, aqua fitness and aerobic exercise programs) on the self-perceived quality of life and physical functionality of female breast cancer survivors. Methods: A randomized, controlled, experimental trial with a sample of 316 women (63 ± 7 years), who had been diagnosed with breast cancer. The evaluations were performed using the Rikli & Jones Senior Fitness Test, and the Short Form 12 Health Survey (SF-12). Results: The participants in the strength program showed statistically significant improvements in all the items of the SF-12. The aqua fitness program obtained significant improvements in Physical Functioning and Limitations, Pain and Emotional Limitations, General Health, Vitality, Social Functioning and the physical and mental components of the SF-12. The participants in the aerobic program showed a progressive deterioration of Vitality and Mental Health. Conclusion: When assigning breast cancer survivors to an exercise program, the preferential or predominant activity should include strength exercises. On the other hand, as the second choice, those patients with particularly low levels of Vitality or Physical Limitations will show greater improvement with an aqua fitness program.
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Affiliation(s)
- Jose L. García-Soidán
- Faculty of Education and Sport Sciences, University of Vigo, Campus a Xunqueira, s/n. 36005 Pontevedra, Spain; (J.L.G.-S.); (I.P.-R.)
| | - Ignacio Pérez-Ribao
- Faculty of Education and Sport Sciences, University of Vigo, Campus a Xunqueira, s/n. 36005 Pontevedra, Spain; (J.L.G.-S.); (I.P.-R.)
| | - Raquel Leirós-Rodríguez
- Faculty of Physical Therapy, University of Vigo, Campus a Xunqueira, s/n. 36005 Pontevedra, Spain
- Correspondence: ; Tel.: +34-986-801-750
| | - Anxela Soto-Rodríguez
- Health Service from Galicia (SERGAS), Galician Health Services—Ourense Hospital, 32005 Ourense, Spain;
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Ćwirlej-Sozańska A, Wójcicka A, Kluska E, Stachoń A, Żmuda A. Assessment of the effects of a multi-component, individualized physiotherapy program in patients receiving hospice services in the home. BMC Palliat Care 2020; 19:101. [PMID: 32646517 PMCID: PMC7350635 DOI: 10.1186/s12904-020-00600-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/22/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The interest in physiotherapy programs for individuals in hospice is increasing. The aim of our study was to assess the impact of a multi-component, individualized physiotherapy program on the functional and emotional conditions and quality of life of patients receiving hospice services in the home. METHODS The study included 60 patients (mean 66.3 years) receiving hospice services in the home. A model of a physiotherapy program was designed, including breathing, strengthening, transfer, gait, balance, functional, and ergonomic exercises, as well as an adaptation of the patient's living environment to functional needs. The tests were performed before and after the intervention. The study used the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, the World Health Organization Quality of Life - Bref (WHOQOL-BREF), the Visual Analogue Scale (VAS) pain scale, the Tinetti POMA Scale, and the Geriatric Depression Scale (GDS). To enable comparison of our results worldwide, a set of International Classification of Functioning, Disability and Health (ICF) categories was used. RESULTS The average functional level of the ADL (mean 2.9) and the IADL (mean 11.9), as well as the WHOQOL-BREF (mean 46.4) of the patients before the intervention were low, whereas the intensity of pain (VAS mean 5.8), the risk of falling (Tinetti mean 8.2), and depression (GDS mean 16.7) were recorded as high. After the completion of the intervention program, a significant improvement was found in the ADL (mean 4.0), IADL (mean 13.9), WHOQOL-BREF (mean 52.6), VAS (mean 5.1), risk of falling (Tinetti mean 12.3), and GDS (mean 15.7) scores. CONCLUSIONS The physiotherapeutic intervention had a significant impact on improving the performance of ADL, as well as the emotional state and quality of life of patients receiving hospice services in the home. The results of our research provide evidence of the growing need for physiotherapy in individuals in hospice and for comprehensive assessment by means of ICF. Registered 02.12.2009 in the Research Registry ( https://www.researchregistry.com/why-register ) under the number research registry 5264.
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Affiliation(s)
| | - Agnieszka Wójcicka
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Edyta Kluska
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Anna Stachoń
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Anna Żmuda
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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Anandarajah G, Mennillo HA, Rachu G, Harder T, Ghosh J. Lifestyle Medicine Interventions in Patients With Advanced Disease Receiving Palliative or Hospice Care. Am J Lifestyle Med 2020; 14:243-257. [PMID: 32477022 PMCID: PMC7232901 DOI: 10.1177/1559827619830049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Lifestyle medicine interventions have the potential to improve symptom management, daily function, and quality of life (QOL) in patients with advanced or terminal disease receiving palliative or hospice care. The goal of this review is to summarize the current state of the literature on this subject. Methods: The authors used a broad search strategy to identify relevant studies, reviews, and expert opinions, followed by narrative summary of available information. Results: Four main categories of lifestyle interventions feature prominently in the palliative care literature: exercise, nutrition, stress management, and substance use. High-quality studies in this vulnerable population are relatively sparse. Some interventions show promise. However, most show mixed results or inadequate evidence. For some interventions, risks in this generally frail population outweigh the benefits. Clinical decision making involves balancing research findings, including the risks and benefits of interventions, with a clear understanding of patients' prognosis, goals of care, and current physical, emotional, and spiritual state. Achieving optimum QOL, safety, and ethical care are emphasized. Conclusions: The use of lifestyle interventions in patients receiving palliative or hospice care is a complex undertaking, requiring tailoring recommendations to individual patients. There is potential for considerable benefits; however, more research is needed.
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Affiliation(s)
- Gowri Anandarajah
- Gowri Anandarajah, MD, Office of Medical Education, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912; e-mail:
| | - Haran Asher Mennillo
- Warren Alpert Medical School of Brown University, Providence, Rhode Island (GA, HAM, JG)
- Hope Hospice and Palliative Care Rhode Island, Providence, Rhode Island (GA, GR)
- Brown University, Providence, Rhode Island (TH)
| | - Gregory Rachu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island (GA, HAM, JG)
- Hope Hospice and Palliative Care Rhode Island, Providence, Rhode Island (GA, GR)
- Brown University, Providence, Rhode Island (TH)
| | - Tyler Harder
- Warren Alpert Medical School of Brown University, Providence, Rhode Island (GA, HAM, JG)
- Hope Hospice and Palliative Care Rhode Island, Providence, Rhode Island (GA, GR)
- Brown University, Providence, Rhode Island (TH)
| | - Jyotsna Ghosh
- Warren Alpert Medical School of Brown University, Providence, Rhode Island (GA, HAM, JG)
- Hope Hospice and Palliative Care Rhode Island, Providence, Rhode Island (GA, GR)
- Brown University, Providence, Rhode Island (TH)
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Chapman EJ, Edwards Z, Boland JW, Maddocks M, Fettes L, Malia C, Mulvey MR, Bennett MI. Practice review: Evidence-based and effective management of pain in patients with advanced cancer. Palliat Med 2020; 34:444-453. [PMID: 31980005 DOI: 10.1177/0269216319896955] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pain of a moderate or severe intensity affects over half of patients with advanced cancer and remains undertreated in at least one-third of these patients. AIM The aim of this study was to provide a pragmatic overview of the evidence supporting the use of interventions in pain management in advanced cancer and to identify where encouraging preliminary results are demonstrated but further research is required. DESIGN A scoping review approach was used to examine the evidence supporting the use of guideline-recommended interventions in pain management practice. DATA SOURCES National or international guidelines were selected if they described pain management in adult cancer patients and were written within the last 5 years in English. The Cochrane Database of Systematic Reviews (January 2014 to January 2019) was searched for 'cancer' AND 'pain' in the title, abstract or keywords. A MEDLINE search was also made. RESULTS A strong opioid remains the drug of choice for treating moderate or severe pain. Bisphosphonates and radiotherapy are also effective for cancer-related bone pain. Optimal management requires a tailored approach, support for self-management and review of treatment outcomes. There is likely a role for non-pharmacological approaches. Paracetamol should not be used in patients taking a strong opioid to treat pain. Cannabis-based medicines are not recommended. Weak opioids, ketamine and lidocaine are indicated in specific situations only. CONCLUSION Interventions commonly recommended by guidelines are not always supported by a robust evidence base. Research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies and transcutaneous electrical nerve stimulation.
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Affiliation(s)
- Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
| | - Zoe Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, Leeds, UK
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Chen YJ, Li XX, Ma HK, Zhang X, Wang BW, Guo TT, Xiao Y, Bing ZT, Ge L, Yang KH, Han XM. Exercise Training for Improving Patient-Reported Outcomes in Patients With Advanced-Stage Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2020; 59:734-749.e10. [PMID: 31546002 DOI: 10.1016/j.jpainsymman.2019.09.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Patients with advanced-stage cancer often suffer many physical and psychological symptoms. Exercise has been shown to improve quality of life (QoL), decrease cancer-related symptoms, and maintain or improve functional status in cancer survivors or patients with early stage cancer. However, the effect of exercise on these outcomes in patients with advanced-stage cancer is unclear. OBJECTIVES This meta-analysis aimed to assess the effectiveness of exercise interventions for patients with advanced-stage cancer in improving cancer-related symptoms and functional status outcomes. METHODS We conducted a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science from their inception to February 3, 2019, to include randomized controlled trials (RCTs) comparing exercise and usual care for improving outcomes in patients with advanced-stage cancer. Two reviewers independently screened the studies, extracted data of interest, and assessed the risk of bias of individual RCTs using the Cochrane Handbook, Version 5.1.0. RESULTS About 15 RCTs enrolling 1208 patients were included. Compared with usual care, exercise showed a significant improvement in QoL (standardized mean difference [SMD] 0.22; 95% CI 0.06-0.38; P = 0.009), fatigue (SMD -0.25; 95% CI -0.45 to -0.04; P = 0.02), insomnia (SMD -0.36; 95% CI -0.56 to -0.17; P = 0.0002), physical function (SMD 0.22; 95% CI 0.05-0.38; P = 0.009), social function (SMD 0.18; 95% CI 0.02-0.34; P = 0.03), and dyspnea reduction (SMD -0.18; 95% CI -0.34 to -0.01; P = 0.03). CONCLUSION Exercise serves as an effective intervention to improve QoL and alleviate fatigue, insomnia, dyspnea, and physical and social functions for patients with advanced-stage cancer.
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Affiliation(s)
- Ya-Jing Chen
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiu-Xia Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Hai-Kun Ma
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xu Zhang
- General Department 2, Second Hospital, Lanzhou University, Lanzhou, Gansu, China
| | - Bang-Wei Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Tao-Tao Guo
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ya Xiao
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Zhi-Tong Bing
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
| | - Long Ge
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ke-Hu Yang
- Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
| | - Xue-Mei Han
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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Dun L, Xian-Yi W, Xiao-Ying J. Effects of Moderate-To-Vigorous Physical Activity on Cancer-Related Fatigue in Patients with Colorectal Cancer: A Systematic Review and Meta-Analysis. Arch Med Res 2020; 51:173-179. [DOI: 10.1016/j.arcmed.2019.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022]
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The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review. PLoS One 2019; 14:e0226227. [PMID: 31834898 PMCID: PMC6910682 DOI: 10.1371/journal.pone.0226227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background Persistent post-surgical pain (PPSP) is a common condition following surgery, resulting in persistent pain and reduced quality of life (QoL). While pharmacological management is common, its effectiveness remains equivocal. This systematic review investigated the effectiveness of physiotherapy management in adults with PPSP in comparison to usual care. Methods A systematic search of six electronic databases was conducted. Studies of human adults (>18 years) with PPSP localised or directly referred from the surgical site, pain persisting for at least two months post-surgery and with physiotherapy as the intervention were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The McMaster critical review form for quantitative studies was utilised to assess the methodological quality. A descriptive synthesis was undertaken due to the heterogeneity of the included studies. Results Of the 1395 articles that were screened, eight studies met the inclusion criteria. A diverse range of physiotherapy interventions were utilised, and effectiveness was measured through diverse outcomes and measures. Summarised findings from the heterogenous evidence base indicated that physiotherapy interventions for PPSP has a positive impact across a range of outcomes, including pain, quality of life (QoL), physical function and depression. While these are encouraging findings, the current evidence base lacks uniformity with regards to participant characteristics, time periods since diagnosis, interventions delivered, and its parameters, and outcomes measured. Conclusion Due to ongoing challenges in the management of PPSP, alternate treatment strategies such as physiotherapy are being trialled. Despite a number of methodological constraints, current evidence indicates that physiotherapy could play a role in the management of PPSP. PROSPERO registration CRD42019129580
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