Rehabilitation For Cancer Survivors Research Articles

Effectiveness of cardiac rehabilitation in cancer survivors: A meta-analysis of randomized controlled trials

PurposeThis meta-analysis aimed to evaluate available data regarding the potential benefits of cardiac rehabilitation (CR) in cancer survivors. MethodsRelevant studies published from inception to April 2024 were retrieved from PubMed, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, Scopus, CNKI, WanFang, VIP, and CBM databases. Seven randomized controlled trials (RCTs) involving 526 cancer survivors were included in this meta-analysis. ResultsCR increased muscle strength (standardized mean difference (SMD) = 0.39, 95% confidence interval (CI): 0.06 to 0.72, P = 0.020), quality of life (QoL) (SMD = 0.61, 95% CI: 0.40 to 0.82, P < 0.001), and led to a decrease in Body Mass Index (BMI) (mean difference (MD) = −1.11, 95% CI: −2.02 to −0.19, P = 0.020), total cholesterol (TC) (MD = −0.41, 95% CI: −0.69 to −0.14, P = 0.003), triglyceride (TG) (MD = −0.33, 95% CI: −0.63 to −0.03, P = 0.030) and low-density lipoprotein (LDL) (MD = −0.34, 95% CI: −0.57 to −0.12, P = 0.003). The meta-analysis revealed that CR had no statistically significant impact on cardiorespiratory fitness (CRF) and high-density lipoprotein (HDL) levels. ConclusionsCR may represent an effective strategy to evaluate cancer survivors because it improves muscle strength and QoL and reduces BMI, TC, TG and LDL levels. Further RCTs with strict study designs and larger sample sizes are required to determine the effects of CR on cancer survivors.

Exercise training as part of multidisciplinary rehabilitation in cancer survivors: an observational study on changes in physical performance and patient-reported outcomes

PurposeTo describe changes in physical performance and patient-reported outcomes in cancer survivors who participated in an exercise program as part of usual-care multidisciplinary rehabilitation and the influence of training adaptations during the coronavirus-19 (COVID-19) pandemic.MethodsIn an observational cohort study, cancer survivors underwent usual-care multidisciplinary rehabilitation including a 10-week exercise program. During the COVID-19 pandemic, the exercise program was adapted with reduced training time and frequency. Mean changes and 95% confidence intervals in physical performance (peak oxygen uptake (VO2peak), peak work rate during a steep ramp test (SRT-WRpeak), 6-min walking distance, muscle strength) and patient-reported outcomes (health-related quality of life, fatigue, anxiety, and depression) were assessed between the start and the end of the exercise program. Linear regression analysis, adjusting for baseline levels of outcomes, was used to investigate differences in changes in outcomes between participants who underwent the original and the adapted program.ResultsAll outcomes statistically significantly improved over time, regardless of adaptations in the exercise program. VO2peak increased with 9.6% and 7.7% in the original and adapted program, respectively. Significant smaller improvements were observed in SRT-WRpeak (− 3.9%) and upper body muscle strength (− 10.8%) after participation in the adapted compared to the original program. No significant between-group differences were observed for other outcomes.ConclusionPhysical performance and patient-reported outcomes statistically and clinically significantly improved in cancer survivors who participated in an exercise program as part of usual-care multidisciplinary rehabilitation. Improvements of performance outcomes were smaller since the training adaptations, though only significant for SRT-WRpeak and upper body strength.

Research Quality and Impact of Cardiac Rehabilitation in Cancer Survivors: A Systematic Review and Meta-Analysis

BackgroundCardiac rehabilitation (CR) is endorsed to improve cardiovascular outcomes in cancer survivors. The quality of CR-based research in oncology has not been assessed. ObjectivesThe aim of this study was to evaluate the quality of reporting and evidence from CR-based intervention studies in oncology and to explore associations between intervention participation and outcomes. MethodsSystematic searches of 5 databases were conducted (January 2020) and updated (September 2021). Randomized and nonrandomized studies evaluating CR-based interventions in adult cancer survivors during and after treatment were eligible. Independent reviewers extracted data using 2 reporting guidelines (Template for Intervention Description and Replication and Consolidated Standards for Reporting Trials Harms extension), risk of bias (ROB) assessment tools (Cochrane ROB 2.0 and Cochrane Risk of Bias in Non-Randomized Studies of Interventions), and a combined inventory (Tool for the Assessment of Study Quality and reporting in Exercise). A meta-analysis was used to explore pre-intervention/post-intervention differences for commonly assessed outcomes. ResultsTen studies involving data from 685 survivors were included. The mean quality scores for intervention reporting (Template for Intervention Description and Replication) and harms (Consolidated Standards for Reporting Trials Harms extension) were 62% and 17%, respectively. There was moderate-to-high ROB across nonrandomized (Cochrane Risk of Bias in Non-Randomized Studies of Interventions score: 25%) and randomized (ROB 2.0 score: 50%) studies. The mean standardized cardiorespiratory fitness was higher (0.42; 95% CI: 0.27-0.57), fatigue was lower (−0.45; 95% CI: −0.55 to −0.34), and percent body fat (0.07; 95% CI: −0.23 to 0.38) was not different in survivors completing CR compared with those not completing CR. ConclusionsCR-based studies in oncology have low-to-moderate reporting quality and moderate-to-high ROB limiting interpretation, reproducibility, and translation of this evidence into practice.

MicroRNAs as Potential Biomarkers for Exercise-Based Cancer Rehabilitation in Cancer Survivors.

Expression and functions of microRNAs (miRNAs) have been widely investigated in cancer treatment-induced complications and as a response to physical activity, respectively, but few studies focus on the application of miRNAs as biomarkers in exercise-based cancer rehabilitation. Research has shown that certain miRNA expression is altered substantially due to tissue damage caused by cancer treatment and chronic inflammation. MiRNAs are released from the damaged tissue and can be easily detected in blood plasma. Levels of the miRNA present in peripheral circulation can therefore be used to measure the extent of tissue damage. Moreover, damage to tissues such as cardiac and skeletal muscle significantly affects the individual’s health-related fitness, which can be determined using physiologic functional assessments. These physiologic parameters are a measure of tissue health and function and can therefore be correlated with the levels of circulating miRNAs. In this paper, we reviewed miRNAs whose expression is altered during cancer treatment and may correlate to physiological, physical, and psychological changes that significantly impact the quality of life of cancer survivors and their role in response to physical activity. We aim to identify potential miRNAs that can not only be used for monitoring changes that occur in health-related fitness during cancer treatment but can also be used to evaluate response to exercise-based rehabilitation and monitor individual progress through the rehabilitation programme.

Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals\u2019 Perceptions

To explore primary care professionals’ perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals’ knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.

Rehabilitation of Cancer Survivors

Rehabilitation of Cancer Survivors

High Intensity Functional Training in the Rehabilitation of Cancer Survivors

High Intensity Functional Training in the Rehabilitation of Cancer Survivors

Design and application of a standardized communication system for psychological distress of adolescents and young adults with cancer

Objective To set up and apply a standardized communication system of adolescents and young adults (AYAs) cancer patients, in order to improve AYAs cancer patients′ psychological distress and other negative emotions, as well as promote social support and quality of life of patients. Methods A AYAs cancer patients standardized communication system, suitable for China′s national conditions, was preliminarily built. Using randomized controlled trials, a total of 171 subjects, selected from 486 cases of AYAs cancer patients, in the Third Xiangya Hospital of Central South University and Hunan Cancer Hospital from August to September in 2016, were intervened with a set of standardized communication system .The Mental Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Social Support Rating Scale (SSRS) and Concise Health Status Questionnaire (SF-36) were used as evaluation indexes to observe the psychological distress, emotion, social support and quality of life of the three groups of subjects before intervention, immediately after intervention, 1 month after intervention and 3 months after intervention. Results At the follow-up of 3 months after intervention, 38 cases were lost, 14 cases in communication group (final n=43), 11 cases in music therapy group (final n=46), and 13 cases in routine group (final n=44). .There was no significant difference in the evaluation indexes between the communication group, music treatment group and the routine group before intervention (P>0.05). There were statistically significant differences in scores of psychological pain, anxiety and depression, and social support in the 3 groups, before and immediately after intervention, 1 month and 3 months after intervention (P<0.05). The scores of psychological pain, anxiety and depression, social support and quality of life in the communication group 1 month after intervention were statistically significant compared with those in the music group and the routine group (P<0.05). Conclusions Compared to music therapy and regular care, the standardized communication system has significant effect on improving the psychological distress of AYAs with cancer, and can also improve their social support level and quality of life. The clinical validation of the standardized communication system can provide reference for psychological rehabilitation of cancer survivors. Key words: Adolescent; Neoplasms; Psychotherapy; Psychometrics

Internet-based WOrk-related Cognitive Rehabilitation for Cancer Survivors: a Randomized Controlled Trial

Internet-based WOrk-related Cognitive Rehabilitation for Cancer Survivors: a Randomized Controlled Trial

Rehabilitation for cancer survivors during treatment

Rehabilitation for cancer survivors during treatment

Moving Research Into Practice: Summary Report of the Ex/Cancer Meeting on Physical Activity, Exercise, and Rehabilitation in Oncology

The development of evidence-based exercise guidelines for people with cancer represents a major achievement in research and provides direction to programming initiatives. The prevalence of sedentary cancer survivors and the risk posed by inactivity suggests a knowledge-to-action gap for which the evidence has not led to increased exercise levels in that population. To address that gap, researchers continue to explore opportunities to improve the understanding of exercise within the oncologic context—from tumour biology to behaviour-change theories—to drive improved access and participation in exercise and rehabilitative activity. In Canada, such efforts have largely been invested by individuals and small teams across the country rather than by unifying stakeholders to drive nationwide impact. Accordingly, a national group of leading researchers, clinicians, and other stakeholders convened a meeting to discuss and strategize initiatives on how to conduct innovative research into the effects of exercise and rehabilitation in cancer survivors, to increase access to exercise and rehabilitation services in cancer survivors, and to reduce sedentary behaviour in cancer survivors. The 2-day meeting, titled Ex/Cancer, was held April 2017 in Toronto, Ontario, and was attended by 83 stakeholders from across Canada, representing knowledge end-users (cancer survivors), clinicians (oncologists, nurses, counsellors), a provincial cancer care agency, community-based exercise and cancer organizations, and researchers. Attendees participated in networking events, roundtable discussions, and breakout sessions to identify, discuss, and develop clinical and research experiences and opportunities. In addition to knowledge exchange between attendees, the meeting set the foundation for the development of a collaborative network to support the development, dissemination, and support of clinical and research activity in exercise and rehabilitation for cancer survivors. With unanimous support from attendees, a major product of the Ex/Cancer meeting was the formation of the Canadian Oncology Rehabilitation and Exercise Network—COREN.

Rehabilitation for Cancer Survivors: How We Can Reduce the Healthcare Service Inequality in Low- and Middle-Income Countries.

Cancer diagnosis often substantially affects patient's physical, psychological, and emotional status. Most patients with cancer experience declining of energy, activity levels, social-cultural participation, and relationships. In addition, cancer progression and adverse effects of aggressive cancer treatment often cause debilitating pain, fatigue, weakness, joint stiffness, depression, emotional instability, limited mobility, poor nutritional status, skin breakdown, bowel dysfunction, swallowing difficulty, and lymphedema leading into functional impairment and disability that can be addressed through rehabilitation care. Comprehensive care models by involving cancer rehabilitation have resulted in significant improvement of patient's quality of life. Although cancer rehabilitation has been implemented in many high-income countries, it is either not yet or suboptimally delivered in most low- and middle-income countries. In this review, we discussed gaps regarding cancer rehabilitation services and identified opportunities to improve quality of cancer care in developing countries. Future collaborations among international organizations and stakeholders of health care delivery systems are required to initiate and improve high-quality cancer rehabilitation in the developing countries.

Guided Imagery and Music (GIM) as therapy and rehabilitation for cancer survivors

Guided Imagery and Music (GIM) as therapy and rehabilitation for cancer survivors

Comparing Indices of Neuromuscular Fatigue with Subjective Fatigue in Cancer Survivors

Cancer-related fatigue (CRF) is the most common patient reported side effect of cancer treatment. There is no universally accepted definition of CRF, thus it is rarely addressed in cancer patients and survivors. Although it is a multi-dimensional concept, including physiological and psychological aspects, it currently is quantified almost exclusively through subjective scales, thereby missing key physiological factors, specifically indicators of neuromuscular (NM) fatigue. Traditional NM fatigue tests are often single-joint isometric contractions and do not reflect activities of daily living (ADL) corresponding to quality of life. Since cycling is a whole-body dynamic exercise and a common exercise in rehabilitation for cancer survivors, we evaluated NM function before, during and after an incremental cycling test in cancer survivors. PURPOSE: To determine if there are differences in knee extensors (KE) NM function at rest and during exercise between subjectively fatigued and non-fatigued cancer survivors. METHODS: Cancer survivors (n=17, age 53 ±12 years) completed the FACIT-F Scale and NM function testing before, during and following an incremental cycling test to task failure consisting of 3-minute stages separated by an isometric maximal voluntary contraction (MVC) and evoked stimulation of the femoral nerve. Pre-testing occurred on a chair with KE force measured isometrically by force transducer. Testing during cycling took place on a recumbent ergometer with instrumented pedals, which were immobilized instantaneously at the end of each stage, to measure isometric force. Unpaired t-tests compared resting twitch and MVC on the ergometer prior to exercise in 6 fatigued (FACIT-F: 25 ± 3) and 11 non-fatigued (FACIT-F: 44 ± 6) subjects based on FACIT-F 34/52 cut off for significant fatigue. RESULTS: KE twitch at rest normalized to body mass was significantly lower in the fatigued group than the non-fatigued group (0.85 ± 0.18 vs 1.05 ± 0.18 N·kg-1, p=0.04). There was no significant difference between groups for MVC (p=0.14) or any fatigue index (i.e. Δ % voluntary activation, peak twitch, MVC). CONCLUSION: Preliminary results show that fatigued cancer survivors may have a deteriorated muscle function at rest but are not more fatigable with an exercise that mimics ADL. Study funded by an anonymous donor.

Effect of the European Organization for Research and Treatment of Cancer (EORTC) on social life for cancer survivors in Europe.

218 Background: Cure is not a dream but a reality for a large group of cancer patients nowadays. In Europe around 4 million patients successfully lived beyond the 5th year after cancer diagnosis. With improved survival rate and an ageing population, there will be more survivors in the near future. They wish to enter or maintain in the job market, and to finance desired house and insurance. However, the lack of sufficient data and knowledge on the ability to perform gets in the way on their path to normal social life. Methods: From 2013 the EORTC set the scene addressing societal issues faced by cancer patients involving key stakeholders including cancer patients themselves, care givers, bankers, insurers, employers and policy makers. These efforts have matured into an innovative research infrastructure in Europe integrating existing patients’ cohorts, including data from clinical trials, (population-based) cancer registries, surveys and social media. The research scope covers from quantifying the magnitude of the problem, assessing the economic burden, to formulating evidence-based EU recommendations for rehabilitation of cancer survivors. Particularly, variation and inequality across member states will be extensively investigated. Results: EORTC has a long tradition of collection data and follow-up patients since 50 years. Currently he is forming a consortium with the European Commission Joint Research Center (EC-JRC), European Network of Cancer Registry (ENCR), and other key experts in EU on the project. Several nation-wide research models are being built to address country-specific questions that cancer survivors face. Conclusions: A sustainable research infrastructure with dedicated partners and network address cancer survivorship is being built in Europe. This joint effort saves repetition in collecting data that already exist, synergizes expertise and methodology in addressing cancer survivorship questions.

Predictors of Rehabilitation in Cancer Survivors

Predictors of Rehabilitation in Cancer Survivors

A randomized trial of cognitive rehabilitation in cancer survivors

AimsThe second most frequently reported post-treatment symptom in cancer survivors are concerns about impaired cognition. Despite numerous studies demonstrating significant impairments in a portion of survivors, information on effective treatments remains an emerging area of research. This study examined the effectiveness of a group-based cognitive rehabilitation intervention in cancer survivors. Main methodsThis study was a randomized, controlled study of a 7-week cognitive rehabilitation intervention delivered in group format. Participants were evaluated with subjective symptom questionnaires and objective neurocognitive tests prior to and following treatment. Key findingsTwenty-eight participants (mean age 58years) with a median of 3years (±6years) post-primary/adjuvant treatment and various cancer sites (breast, bladder, prostate, colon, uterine) completed the study. Compared to baseline, the treatment group demonstrated improvements in symptoms of perceived cognitive impairments (p<.01), cognitive abilities (p<.01) and overall quality of life with regard to cognitive symptoms (p<.01) as measured by the FACT-Cog. The treatment group also improved on objective measures of attention (p<.05) and a trend toward improvement on verbal memory. Significant improvement was not observed on all cognitive tests. SignificanceA group based cognitive rehabilitation intervention in cancer survivors was effective for improving attention abilities and overall quality of life related to cognition. Results suggest that group based cognitive rehabilitation may be an effective intervention for treating cognitive dysfunction in cancer patients and should be further studied in a larger trial with an active control condition.

Impact of two different exercise programs on persistent cancer-related fatigue and physical fitness

Cancer-related fatigue is a common symptom in patients with cancer, which is experienced by 70% to 100% of these patients and brings some impairment of physical and mental performance, hinders their working or carrying out regular daily activities, and hence results in a substantial reduction of the quality of life. Physical exercise has consistently been identified as a central element of rehabilitation for many chronic diseases like cancer, and increasing evidence supports the contention that physical activity is a valuable intervention that can be utilized in conjunction with conventional therapies during CRF treatment. Objective: The aim of this study was to assess the impact of a program of physical exercise on fatigue levels and physical performance of cancer patients. Method: A consecutive series of 44 adult patients with neoplastic disease (solid or hematological), with a medical diagnosis of fatigue, who were enrolled in an oncological treatment, with the ability to walk and willing to enter a rehabilitation program of exercise for at least 4 consecutive months. The exercise program was performed two times per week, each session lasting one hour and consisting of aerobic, resistance, and flexibility exercises. The protocol was divided into aerobic exercise and resistance training combined with aerobic exercise. The patients were evaluated with two assessments: one prior to their beginning the exercise program and other at the end of the four-month program. In both assessments the patients completed the Revised Piper Fatigue Scale and the six-minute walk test. The primary outcome of change over baseline and after 16 weeks in PFS-R score and six-minute walk test were compared using a two sample two-sided t-test for both groups. Alpha level was set at p &lt; 0.05. Results: After 16 weeks, the patients who participated in the aerobic or the combined exercise program reported significantly higher levels of physical functioning (6-minute walking test, p = 0.0009 and p = 0.001, respectively) and significantly lower fatigue (PFS-R, p = 0.003 and p = 0.002, respectively) than at the beginning the exercise program. Conclusion: The results of patients who underwent aerobic or aerobic + anaerobic exercise showed statistically significant improvement of physical performance and of fatigue. Data from this study corroborates with the literature showing that exercise programs with aerobic or resistance exercises are an effective strategy for the treatment of fatigue. The results of this study confirm that physical exercise could be useful in rehabilitation of cancer survivors, especially for fatigued patients.

Cancer rehabilitation from the perspectives of oncology nurses in Korea

The purpose of this study was to understand the perception of oncology nurses and how it is related to cancer rehabilitation in Korea. A qualitative study with three focus groups consisting of 6-8 Korean oncology nurses (n = 21) was conducted. The interviews were thematically analyzed. Two main themes for the attributes of cancer rehabilitation were "comprehensive activities of nurses" and "active involvement of survivors." Six subthemes from the oncology nurses' care experiences were identified: "incorporating partnership and sharing feelings," "fulfilling individualized needs," "providing timely and practical support," "enhancing internal strength with optimistic mindset," "regaining functional independence," and "getting family members in." The findings suggest that oncology nurses can play a key role in rehabilitation for cancer survivors. Nursing interventions focused on comprehensive activities of nurses as well as active involvement of survivors can be effective in enhancing cancer survivors' strength and resilience in order to lead a healthy life. Oncology nurses need to be taught a psychosocial intervention based on individualized assessment and family partnership for cancer survivors.

Quality of life and physical performance and activity of breast cancer patients after adjuvant treatments

The study aimed at investigating the quality of life (QoL) and physical performance and activity, and their interrelations, in Finnish female breast cancer patients shortly after adjuvant treatments. A total of 537 disease-free breast cancer survivors aged 35-68 years were surveyed at the beginning of a one year randomized exercise intervention. The patients were interviewed using EORTC QLQ-C30, FACIT-F, RBDI, and WHQ (for vasomotor symptoms) questionnaires. Physical performance was tested by a 2 km walking test. Physical activity was measured by a questionnaire and a prospective two-week diary. Multivariate analysis was used to study the factors associated with QoL. About 26% of the patients were rated as depressed, 20.4% as fatigued, and 82% suffered from menopausal symptoms. The global QoL was lower than in general population (69.4 vs 74.7, p<0.001). About 62% of the walking test results were below the population average. Fatigue (p<0.001), depression (p<0.001), body mass index (p = 0.016) and comorbidity (p = 0.032) impaired, and physical activity (p = 0.003) improved QoL. Physical activity level correlated positively to physical performance (r = -0.274, p<0.0001). The QoL of the patients shortly after adjuvant treatments was impaired and the physical performance poor as compared to general population. In particular, depression and fatigue were related to impaired QoL. Physical performance and activity level were the only factors that correlated positively to QoL. Thus, physical exercise could be useful in rehabilitation of cancer survivors, especially for depressed and fatigued patients.