Imagine if there was a cancer therapy that could reduce treatment side effects, improve response, boost mood and energy, and increase survival times, and was indicated for all forms of cancer.
According to a recent position statement from the Clinical Oncology Society of Australia (COSA), there is. The statement says everyone diagnosed with cancer should have exercise added to their management, for the duration of treatment.
Like any treatment, exercise therapy needs to be prescribed, administered, and tailored to each person’s needs.
In the post below, cancer physiotherapist and contributor to the COSA statement, Sharni Patchell, reviews the important role of exercise in cancer treatment and describes how physios can assist.
Sharni Patchell writes:
You could be forgiven for believing that if ever there was a time to take respite, rest and recuperate, it would be upon receiving a cancer diagnosis. Indeed, patients have historically been advised to rest while undergoing treatment.
Underpinning such advice was a lack of clear, substantiated evidence about whether or not exercising while undergoing cancer treatment was safe, so treatment prescription tended to err on the side of caution. This has now changed.
Safety and efficacy of exercise for cancer outcomes
On 7 May, 2018, the Clinical Oncology Society of Australia (COSA) released a set of new recommendations, stating that exercise should be prescribed to all cancer patients, as a standard part of their care.
The COSA statement is based on recent clinical research, which has established exercise as a safe and effective intervention to counteract many of the adverse physical and psychological effects of cancer and its treatment. The quality and quantity of such published evidence has improved significantly over the past five years, and has created momentum for further research in the area.
It is now understood that oncology patients who are prescribed exercise in conjunction with their traditional treatments have a lower relative risk of cancer recurrence, and consequently a lower relative risk of the illness becoming terminal.
Further, exercise for patients—when correctly prescribed and monitored—is now firmly understood to be safe. This knowledge has garnered attention across multiple health professions, and a renewed research focus is now being directed toward illustrating positive effects of exercise on cancer mortality.
Overcoming the barriers
Of course, changing a long-established discourse around cancer care comes with practical barriers to consider. One of the most pressing issues is, quite simply, time. Patients must often dedicate great amounts of time attending medical appointments and treatment sessions; some chemotherapy and radiotherapy regimens involve patients attending daily treatment for up to 6 weeks.
Additionally, these patients often must maintain their work schedules and family commitments, which can make prioritising exercise a difficulty, especially when they are already exhausted and feeling or unwell.
Health professionals experienced in dealing with cancer care, such as physiotherapists, are able to help patients in these circumstances to manoeuvre such roadblocks. Physios have the clinical skills and expertise to provide exercise programs for patients with a cancer diagnosis at all phases of their treatment, tailored to their individual needs.
The role of physiotherapists
The Australian Physiotherapy Association, among a suite of high profile healthcare organisations across Australia, officially endorsed the position statement.
In response to its release, APA National President Phil Calvert said,
“The majority of patients with cancer currently do not meet exercise recommendations despite many expressing a desire to be sufficiently active. They need advice and ongoing support to do this. Increasingly, cancer specialists are recognising that physiotherapists provide a highly beneficial exercise treatment program that ensures the patient is participating in physical activity appropriate to their condition.”
Physiotherapists who work in these areas will work with patients with a range of needs including fatigue, pain, muscle and joint stiffness, shortness of breath, swelling, strength and cardiovascular deconditioning, laryngectomy management, positioning for rest/sleep, mobility and functional assessment, gait and falls risks, as well as the screening, prevention and management of lymphoedema – to name a few.
What form, and how much?
Evidence-based guidelines recommend people with cancer be as physically active as their current ability and conditions allow. For significant health benefits, they should aim for:
- at least 150 minutes of moderate intensity aerobic exercise weekly (such as walking, jogging, cycling, swimming)
- two to three resistance exercise session each week involving moderate to vigorous intensity exercises targeting the major muscle groups (such as weight lifting).
A tailored approach
It is, of course, important to note that exercise for oncology patients must be prescribed on an individual basis. No two oncology patients will ever be the same, and a wide variety of individual situations must be considered.
For example, the physical impacts of the disease, such as location of metastases (particularly bone disease and cardio pulmonary disease) will require consideration prior to exercise prescription. Exercise also enhances quality of life for cancer patients undergoing palliative care. Physios can develop an appropriate exercise plan to help them.
High quality evidence proves that exercise can decrease the negative side effects of intensive cancer treatments such as chemotherapy and radiotherapy, in addition to reducing the frequency and severity of nausea, fatigue and pain, and can help prevent muscle weakness and functional decline. It also helps with promoting positive mental health outcomes and can improve quality of life.
For physio comment on the new recommendations, or how physiotherapy can assist in the care of cancer patients, please contact the Australian Physiotherapy Association, or visit www.choose.physio for further information.
*Sharni Patchell is Clinical Lead Physiotherapist at the Peter MacCallum Cancer Centre and contributor to the COSA position statement. She is a member of the Australian Physiotherapy Association. This article was written with the assistance of the Australian Physiotherapy Association.