Rehabilitation and exercise oncology program: translating research into a model of care

INTRODUCTION

The Rehabilitation and Exercise Oncology model of care (ActivOnco) was established to optimize cancer survivorship through exercise prescription and active lifestyle promotion, providing a transition of care from hospital to community. Patients having any cancer diagnosis, stage of disease, and treatment were eligible for evaluation and exercise prescription upon deterioration of performance status. The team of professionals included hospital-based physiotherapists proactively screening for rehabilitation needs, loss of functional independence, and exercise eligibility, plus exercise specialists in a community-based Wellness Centre to provide follow-up or direct access for post-treatment or non-complex patients.

METHODS

From January 2011 to December 2015, the hospital team assessed 1635 patients representing all major cancer sites, and the Wellness Centre team evaluated and prescribed exercise for 1066 participants. Primary interventions provided were education about fatigue management, physical activity promotion, exercise prescription, fracture risk reduction, referral to specialized follow-up services (for example, occupational therapy, lymphedema clinic), and coordination for mobility aids and paratransit services.

RESULTS AND CONCLUSIONS

Implementation of the ActivOnco model of care showed that exercise alone is not a panacea for all functional deterioration associated with the cancer trajectory and its treatment. However, screening to identify rehabilitation needs combined with exercise prescription can effectively improve the quality of survivorship in cancer patients. Program developments are limited by the cost of human resources, lack of hospital-based physical resources, and lack of public funding, all of which significantly limit the scope and development of appropriate services.

Physiological correlates of cancer-related fatigue in advanced non-small cell lung cancer (NSCLC) patients

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Background: Fatigue is a debilitating consequence of lung cancer and its treatments. The etiology of fatigue is unclear, and our current knowledge does not point to logical interventions. In this study, global fatigue score was assessed using the Brief Fatigue Inventory (BFI). A symptom questionnaire, as well as muscular and cardiorespiratory function, were assessed as potential contributors to the global fatigue score. Methods: Participants were evaluated by a physical therapist within the McGill Cancer Nutrition and Rehabilitation Program. Performance-based measures of physical function [upper limb strength and endurance (Jamar dynamometry), lower limb strength (30sec chair rise), cardiorespiratory function (2 minute walk -2MW)] and a symptom questionnaire [Edmonton Symptom Assessment Scale (ESAS)] were conducted at one point in time. Results: Eighty patients (43M:37F, mean age 68 ± 12 ) participated in the study. Forty-seven percent were actively receiving treatment at the time of assessment. On the BFI, 56% had moderate or severe fatigue and 88% indicated fatigue had interfered with their functioning during the past 24 hours. Global fatigue scores were unrelated to hand grip strength or endurance measurements but were significantly correlated with chair rise performance (R= -0.31, p<0.05), 2MW (R= -0.31, p<0.05), ESAS rating of pain (R=0.47, p<0.01), overall ESAS rating of breathlessness (R= 0.59, p<0.01), and ESAS rating of strength (R=0.58, p<0.01). Multivariate regression analysis suggested the best model for global fatigue scores incorporates chair rise performance, 2MW performance, ESAS rating of strength and ESAS rating of shortness of breath (adjusted R sq = 0.68, p<0.01). Conclusions: Fatigue is prevalent and impacts on the function of advanced NSCLC patients. Several key factors contribute to this fatigue, with muscular and cardiorespiratory restrictions playing an important role. Such findings may have clinical implications in the recommendations of rest and exercise to best manage fatigue.

No significant financial relationships to disclose.

Exercise in patients with advanced non-small cell lung cancer (NSCLC): Compliance and population characteristics of patients referred to the McGill Cancer Nutrition-Rehabilitation Program (CNRP)

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Background: Few studies focus on exercise in advanced NSCLC. We evaluated compliance with exercise prescription in stages 3/4 NSCLC. Methods: Patients (pts) referred to the CNRP, a multidisciplinary clinic, for weight/functional loss were evaluated for participation in a supervised exercise program. Compliance with exercise was scored as 0 (refused/home exercise), 1 (<6 sessions in 2 mo), and 2 (≥ 6 sessions in 2 mo). Gender, age, PS, stage, CRP, weight loss, and quality of life [Edmonton Syptom Assessment Scale (ESAS)] were assessed by univariate and multivariate analyses. Survival from the time of exercise prescription was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: 168 pts were referred to the CNRP from April 2002 to September 2005. 92/168 (54%) were prescribed exercise. Of the 76 remaining pts, 3 (4%) refused, and 6 (8%) were on an exercise trial. Others were excluded due to bone metastasis/severe pain (50 pts, 66%), cardiovascular instability (13 pts, 17%) or poor PS (4 pts, 5%). Of the 92 who were prescribed exercise, the compliance score was 0 in 38 (41%), 1 in 37 (40%) and 2 in 17(19%). There were no significant differences in gender, age, PS, stage, ESAS, and weight loss at the time of referral among the three compliance groups. Most pts (15/17) with a compliance score of 2 were referred prior to or during initial treatment, whereas those with compliance scores of 0 and 1 were referred later in the course of treatment. Compliance with exercise correlated with survival (p<0.001). The median survival from time of exercise prescription for pts with a compliance score of 2 was 22 mo (95%CI 13.4,30.2); compared with 5 mo (95%CI 3.7,5.6) and 7 mo (95%CI 2.5,11.5) for those with compliance scores of 0 and 1 respectively. No serious adverse events occurred. Conclusion: A select group of advanced NSCLC pts can exercise safely at a moderate-high level. Those referred earlier tended to be more compliant, and their longer survival may reflect a lead time bias. Clinical trials are needed to evaluate efficacy of exercise in newly diagnosed NSCLC.

No significant financial relationships to disclose.

Participation in workplace design with reference to low back pain: a case for the improvement of the police patrol car

Thirty Canadian police officers, divided into six groups, participated in the redesign of the interior of the patrol car. Three of the groups consisted of individuals having a history of low back disease. The effect of participating in a design process on the characteristics of the final design and on the perception of the low back pain was studied in a semi-experimental setting. The participants developed a strong commitment to the participatory design process, which was reflected in their productions. The differences between participants with and without a history of a low back disease was not marked. The former tended to stress posture-related elements in their analysis and design.

Isokinetic rehabilitation after arthroscopic meniscectomy

The aim of this study was to assess the effects in humans of early (2 weeks) and delayed (6 weeks) isokinetic strength training in the recovery of muscle strength following an arthroscopic partial meniscectomy. The peak torque developed in the quadriceps and hamstrings and the torque developed at a knee angle of 1.05 rad were evaluated in 16 subjects, pre-operatively (pre-op), and 2, 6, and 10 weeks post-operatively (post-op), on an isokinetic device at four different velocities (1.05, 2.09, 3.14, and 4.19 rad.s-1). The fatigue characteristics of the muscles were evaluated by having the subject perform 15 maximal contractions at 3.14 rad.s-1. Training was done on the same device (three times a week for 1-2 months), beginning either 2 or 6 weeks post-op. A repeated measures analysis of variance demonstrated a time effect but no differences between groups and no interactions. Torques developed by the knee flexors and extensors were significantly smaller 2 weeks post-op than pre-op, at all velocities tested. Torques developed in the quadriceps recovered to their pre-op values by 6 weeks, and further gained significantly in strength from 6 to 10 weeks. Quadriceps torques remained weaker than the contralateral side at 10 weeks. Hamstrings torques were either higher or similar to pre-op values by 6 weeks, and demonstrated increases from 6 to 10 weeks post-op at 1.05 and 4.19 rad.s-1 only. Total work and average power developed by the quadriceps and hamstrings during the fatigue protocol changed with time in a similar manner to torque.(ABSTRACT TRUNCATED AT 250 WORDS)