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Physical activity can be a supportive intervention for cancer patients
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As treatment modalities improve, patients are living longer with cancer and its associated symptoms. Cancer patients experience a myriad of distressing symptoms from the disease, the treatments and adverse effects of the treatments. Incorporating attention to symptom relief and quality of life is an integral component of cancer care, both for patients with incurable as well as curable disease. Physical activity as a supportive intervention for cancer patients is proving to be effective in improving quality of life from many different perspectives.
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One of the most prevalent burdensome symptoms for cancer patients is fatigue. Cancer-related fatigue is the constant subjective sensation of exhaustion that impedes normal functioning and is out of proportion to recent activity. The prevalence is estimated to be greater than 50%. Cancer-related fatigue contributes to loss of physical function that leads to a loss of mobility and independence. This loss of independence is distressing for patients and negatively affects their quality of life.
Although there are few universally effective treatments to combat cancer-related fatigue, there is a growing body of evidence on the benefits of physical activity to provide some relief against this distressing symptom. Although most studies have been done in patients with breast cancer, the benefits of physical activity to combat fatigue have also been shown in patients with melanoma, Hodgkin’s lymphoma and multiple myeloma. Laboratory-based exercise studies in patients who had received stem cell transplants demonstrated an improvement in fatigue, emotional distress and hematologic parameters. Low to moderate intensity aerobic exercise has been shown to be the most beneficial, but resistance training can also improve fatigue.
Additional benefits
In addition to the positive effect it has on fatigue, the benefits of physical activity across the continuum of a diagnosis of cancer are many-fold. At diagnosis, the benefits of physical activity include: helping the patient cope with their disease physically and emotionally while awaiting treatment; improving level of fitness to allow difficult treatments to go forward; and delaying the need for treatment by managing the disease and its symptoms.
Once treatment has begun, physical activity can influence treatment effectiveness and coping by managing the treatment’s adverse effects, maintaining physical functioning by preventing muscle loss and fat gain, improving mood and quality of life, facilitating completion of difficult treatment and potentiating the efficacy of cancer treatments. After treatment completion, physical activity can help cancer survivors expedite recovery from the acute effects of treatment. Benefits may include improvement in self-esteem, positive mood states and feelings of well-being, and decreases in pain, fatigue, negative affect and nausea.
Physical activity is also an intervention that may benefit palliative care cancer patients. A recent review by Lowe et al examined this question with a systematic review of the literature. Six studies were identified; there was wide variation in study design, participant characteristics, types of physical activity intervention and outcomes. All six studies reported positive preliminary findings, but due to the overall poor quality of the studies, there was not sufficient evidence to evaluate the efficacy of physical activity as a supportive care intervention for palliative care cancer patients.
Because these were feasibility or pilot studies, the objective was to determine whether or not palliative care cancer patients were interested in and able to tolerate physical activity. The majority of patients in these studies were able to tolerate the various physical activity interventions and some reported an improvement in supportive care outcomes. It is still not certain which patients in this population would benefit most and what differentiates those patients who are interested and able to participate in physical activity from those who are not.
Physical activity as a supportive intervention in cancer patients is beneficial from several perspectives. It improves quality of life by relieving cancer-related fatigue and also has a positive impact on mood and coping. At this time, it is not clear how physical activity should be used for palliative care cancer patients, but preliminary evidence shows that if such a patient is interested in and able to participate in physical activity, they too will have improvement in quality of life.
Christine A. Zawistowski, MD, is an Assistant Professor of Pediatrics at Mount Sinai Medical Center.
For more information:
- Lowe SS. J Support Oncol. 2009; 7: 27-36