Nearly one in two Canadians will hear the words “you have cancer” in their lifetime.1 These three simple words can strike fear and panic in the hearts of individuals and their family and friends.
Although, cancer remains the leading cause of death in Canada,1 advances in earlier detection and screening, as well as new, more effective treatment, mean that more people are surviving cancer than ever before.2 The five-year cancer survival rate has improved to 60% today with some cancers such as breast (87%) and prostate (95%) having much better five-year survival rates.1
This should be a good news story, but how good this news is depends on what survival looks like. Unfortunately, many survivors are left with lifelong impairments because of their cancer treatment.3 The short- and long-term side effects of treatment commonly experienced by cancer survivors (those who are undergoing treatment and those who have completed treatment) can have a significant impact on their quality of life. Common problems include fatigue, memory problems, pain, muscle wasting, and changes to the heart, lungs and bones.2
One study found that 71% of cancer survivors noted one or more of these problems even 10 years after completing their treatment.2 Research also shows that the distress that cancer survivors experience relates more to their level of disability than to their diagnosis, stage, or treatment for cancer.2 Cancer treatments like chemotherapy, radiation, and surgery often leave the survivor with physical and functional impairments that may significantly affect their lifestyle. As well, “cancer survivors under 65 are three times less likely to return to work”3 than individuals living without cancer or chronic illness.
There is convincing evidence indicating that exercise can have a significant and positive effect on physical function and quality of life for those who are currently undergoing treatment, or who have completed treatment for cancer, regardless of the type of cancer, stage of cancer or prognosis.2 Exercise has also been shown to decrease an individual’s risk of developing cancer.4 Although there may be challenges, many cancer survivors can expect to return to a normal or near normal lifestyle. However, some physicians may be reluctant to recommend cancer survivors start an exercise program because they may be too frail.3
Key facts about cancer and exercise
Some cancer survivors avoid adopting exercise programs due to the inaccurate belief that the effort would be “ludicrous or futile.”5
Many cancer survivors report avoiding exercise due to a fear of increasing their symptoms of fatigue, nausea and shortness of breath, but exercise has been shown to decrease these symptoms,5 particularly symptoms of fatigue.6,7
In addition, exercise has been shown to slow or prevent the functional declines often associated with cancer and cancer treatment,8 and improve both physical abilities and quality of life.2,7,8
Participating in regular exercise also helps to improve self-esteem and self-efficacy,8,9 providing an important sense of control to a difficult and often out-of-control time in one’s life.
Participation with exercise is “associated with improved survival, prevention of new cancers, and earlier detection of some types of cancer.”2
Interestingly, most survivors significantly overestimate the amount of exercise they are getting through routine daily activities. Many indicate that they believe their physician’s generic recommendations to keep active are an indication that they should continue with their daily activities rather than engaging in more formal exercise.4 Physiotherapy Alberta often advocates for active lifestyle adoption rather than formal, prescriptive exercise regimes; however, this is one case where people may benefit from a more formalized, supervised exercise programs, both to ensure safety when exercising5 and to ensure participation.5
How can physiotherapists help?
There is very strong emerging evidence that physical activity and strengthening exercises can significantly reduce cancer-related fatigue, joint pain and increase overall strength and well-being.3,4,5,6,7,8,9 Physiotherapists are able to provide helpful strategies and exercise programs to assist survivors in improving their physical function and strength so that they can return to work and the life they enjoy.
Physiotherapists who have experience working with people with cancer can help cancer survivors by:
Assessing and treating physical impairments and dysfunction caused by cancer and/or its treatment. This may include frozen shoulder, nerve damage, limb amputation, weakness and paralysis, numbness and tingling (peripheral neuropathy), osteoporosis, joint mobility, and balance and coordination problems. Physiotherapists help patients improve movement, strengthen weakened muscles, and learn new ways to move.
Prescribing specific therapeutic exercise programs after surgery/radiation treatment (e.g., supervise resistive strengthening/aerobic exercise to improve strength, activity tolerance and fatigue).
Assessing and treating lymphedema, a common complication of breast cancer surgery. Lymphedema can cause pain, function loss, disfigurement, anxiety, depression, emotional distress, and sometimes infection. Fortunately, lymphedema can be successfully managed with compression therapy and resistive exercises.
Assessing and treating urinary incontinence, a common outcome of prostate removal or radiotherapy. Physiotherapists help men successfully manage incontinence with education, pelvic floor exercises and bladder retraining.
Assessing and treating nerve damage related to head and neck cancer, which is common and can affect arm function and posture. Specific strengthening exercises have been shown to improve both function and quality of life.
Helping survivors return to work. Physiotherapists can assess physical tolerances and any restrictions, then devise a graduated return-to-work plan that allows the transition back into the workplace.
Cancer survivors have unique signs and symptoms and may have other health conditions to factor into their exercise planning; therefore, there are no one-size-fits-all recommendations for what exercises to participate in and which ones to avoid.3,9 Depending on the type of cancer, the presence of metastatic disease and treatment considerations, specific recommendations are most appropriate to ensure safe exercise.
Canadian Cancer Society. (2017) Cancer Statistics at a glance. Available at http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance/?region=ab (accessed Jan 3, 2019).
Cheifetz O, Dorsay JP, Hladysh G, MacDermid J, Serediuk F, Woodhouse LJ. CanWell: Meeting the psychosocial and exercise needs of cancer survivors by translating evidence into practice. Psycho-Oncology 2014; 23:204-215.
Rizzo A. (2016). The Role of Exercise and Rehabilitation in the Cancer Care Plan. Journal of the advanced practitioner in oncology, 7(3), 339-342.
National Cancer Institute. Physical Activity and Cancer. Available at: http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity. Accessed January 2, 2019.
Cheville AL, Dose AM, Basford JR, Rhudy LM. Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function. Journal of Pain and Symptom Management 2012; 44(1): 84-94.
Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews 2012; 11: 1-97.
Kim SH, Shin MS, Lee HS, Lee ES, Ro JS, Kang HS, Kim SW, Lee WH, Kim HS, Kim CJ, Kim J, Yun YH. Randomized pilot test of a simultaneous stage-matched exercise and diet intervention for breast cancer survivors. Oncology Nursing Forum 2011; 38(2): 97-106.
Suh EE, Kim H, Kang J, Kim H, Park KO, Jeong BL, Park SM, Jeong SY, Park KJ, Lee K, Jekal M. Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: A randomized controlled trial. Geriatric Nursing 2013; 34: 445-452.
Drake D, Flazer P, Xistris D, Robinson G, Roberge M. Physical fitness training: Outcomes for adult oncology patients. Clinical Nursing Research 2004; 13(3): 245-264.
Born to Move
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.