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Physiotherapy-led exercise is clinically effective and can help cancer patients improve their quality of life.

Physiotherapy exercise is clinically effective

Cancer and its various treatments are associated with a wide range of distressing physical and psychological symptoms, which can affect patients for many years following the end of treatment. Exercise can improve quality of life for cancer patients, regardless of the type and stage of their disease.1  Inclusion of physiotherapy-led exercise within cancer pathways can reduce and prevent disability.2   Physiotherapy can also alleviate distressing symptoms such as lymphedema and fatigue, which debilitates 75-95% of all cancer patients. 3,4

Evidence shows that exercise reduces the risk of cancer recurrence and mortality.5  Mortality can be reduced by 50%,6  40%7  and 30%8  in bowel, breast and prostate cancer respectively. In addition, the rate of disease progression was reduced by 57% in men with prostate cancer who engaged in moderate intensity exercise three hours a week.9 

Excessive weight gain and loss can be a problem for many patients, depending on their treatment, stage and type of cancer. Physiotherapists are vital for maintaining healthy weight and preventing muscle-wasting in cancer patients.10

Future Health

Physiotherapy reduces future health complications, improves body image11 and can improve an individual’s ability to return to work. Some cancer treatments can reduce bone quality leading to osteoporosis, increased risk of fragility fractures, pain and disability. Physiotherapy exercise can reduce bone loss and the likelihood of falls in patients with poor bone density.12 Patients with cancer may present with problems managing pain–physical, psychological and spiritual in nature.13 Pain can lead to a vicious cycle of fear, inactivity and further disability as a consequence and therefore increase length of hospital stay.13 Physiotherapy has shown to reduce the length of inpatient stays: fewer nights in hospital represents both better quality of life and cost savings.14

By 2030 the number of Albertans with cancer will increase 60%.15

Cancer Rehabilitation

Cancer survivors may experience a wide variety of physical impairments as a result of cancer or cancer treatments. Research suggests physical disability is a leading cause of emotional distress for those who have or have had cancer. CancerControl Alberta’s physiotherapists are skilled in the management of cancer-related impairments, intervening to reduce impact on function and quality of life. Cancer rehabilitation crosses the continuum of care and rehabilitation goals may be preventative, restorative, supportive, or palliative in nature. 

Physiotherapists work with patients and their families to treat and manage a wide breadth of unique and complex conditions specific to a cancer population, including lymphedema, spinal accessory nerve impairments, cancer-related fatigue, chemotherapy-induced peripheral neuropathy and axillary-web syndrome.  

Alberta has four cancer centers with dedicated cancer rehabilitation services, including physiotherapy. Referrals to ambulatory physiotherapy services continue to grow.  In the past five years, the Cross Cancer Institute in Edmonton has seen outpatient physiotherapy referrals increase from 1260 new referrals to more than 1460 annually.  Additionally, in the past two years physiotherapy services have been added to both the Central Alberta Cancer Center in Red Deer and the Jack Ady Cancer Center in Lethbridge.  

Cancer Rehabilitation Research

CancerControl Alberta fosters collaboration and participation in clinical research, including cancer rehabilitation.  Close working relationships between clinicians and researchers facilitates knowledge translation and ensures the most pertinent research questions are being asked.  Alberta research initiatives exploring the benefits of cancer rehabilitation across the continuum of care include:

  • Cancer Rehabilitation Clinic at the University of Alberta, offering a site for clinical research studies in cancer rehabilitation 
  • Alberta Cancer Exercise (ACE) study to support the transition to community based exercise programs as a way to improve health and fitness in cancer survivors
  • Alberta Moving Beyond Breast Cancer (AMBER), a prospective study of the role of physical activity and health related fitness in breast cancer survivors from time of diagnosis onwards
  • Lymphedema Night-time Compression Study (LYNC), examining the effectiveness of lymphedema night compression systems in managing lymphedema
  • Therapeutic & Resistance Group Exercise Training for Survivors of Head and Neck Cancer (Target), measuring the benefits of therapeutic exercise for post-operative shoulder and neck dysfunction in patients recovering from cancers of the head and neck 
  • ULTRA, a pilot study examining the role of therapeutic ultrasound in managing the symptoms of chemo-therapy induced peripheral neuropathy

Survivorship and work

  • The loss of economic resources and reduced productivity due to occupational cancer costs the Alberta economy an estimated $64.1 million per year.16 Physiotherapy exercise is significant in managing the longer term side effects, helping people return to work, reducing recurrence following remission and increasing survival and quality of life.14
  • Over 17,500 new cases of cancer were diagnosed in Alberta in 2012. 43% were of working age.17 Cancer survivors are 1.4 times more likely to be unemployed than matched controls.18 
  •  Cochrane review reported evidence that multidisciplinary interventions involving physical, psycho-educational and vocational components led to higher return-to-work rates than usual care.19 

Size of the problem

  • In 2012, approximately 131,550 Albertans were living with or after cancer.20 
  • 60% have unmet physical or psychological needs following treatment.21 
  • 54% of Canadian cancer survivors are physically inactive.22 

References

  1. McLellan, R. Exercise programs for patients with cancer improve physical functioning and quality of life. J Physiother 2013 Mar;59(1):57. doi: 10.1016/S1836-9553(13)70150-4
  2. Broderick JM et al. Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial. J Cancer Surviv (2013) 7:551–562 DOI 10.1007/s11764-013-0294-6
  3. Bergmann et al. Physiotherapy in upper limb lymphedema after breast cancer treatment: a randomized study. Lymphology 2014 Jun; Vol. 47 (2), pp. 82-91
  4. McNeely ML, Courneya KS. Exercise programs for cancer-related fatigue: evidence and clinical guidelines. JNatl Compr Canc Netw 2010 Aug;8(8):945-53
  5. Ballard- Barbash et al. Physical Activity, Biomarkers, and Disease Outcomes in Cancer. PMC3465697
  6. Myerhard JA  et al. Physical activity and survival in male colorectal cancer survivors. Arch Intern Med. 2009 December 14; 169(22): 2102–2108. doi:10.1001/archinternmed.2009.412
  7. Ibrahim EM and Al-Homaidh. A Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol 2011 Sep;28(3):753-65. doi: 10.1007/s12032-010-9536-x. Epub 2010 Apr 22
  8. Kenfield SA, et al. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of clinical oncology. 2011;29(6):726-32
  9. Richman EL, et al. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Cancer research. 2011;71(11):3889
  10. Ingram C, et al. The effects of exercise on body weight and composition in breast cancer survivors: an integrative systematic review 2006: OncNurs Society
  11. Rankin J. RK, Murtagh N. Rehabilitation in Cancer Care. Chichester: Wiley Blackman; 2009
  12. Waltman et al. The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial. Osteoporosis Int 2010 Aug;21(8):1361-9 doi: 10.1007/s00198-009-1083-y
  13. Silver JK, Baima J, RS. Impairment-Driven Cancer Rehabilitation: An Essential Component of Quality Care and Survivorship. CA CANCER J CLIN 2013;63:295–317
  14. Support MC. The importance of physical activity for people living with and beyond 
  15. Cancer: a concise evidence review. Macmillan Cancer Support; 2011
  16. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2015. Toronto, ON: Canadian Cancer Society; 2015
  17. Orenstein, M. R., Dall, T., Curley, P., Chen, J., Tamburrini, A. L., & Petersen, J. (2010). The economic burden of occupational cancers in Alberta. Calgary, AB: Alberta Health Services.© AHS
  18. Statistics Canada. Table 103-0550. New cases of primary cancer (based on the May 2015 CCR tabulation file), by cancer type, age group and sex, Canada, provinces and territories, annual.  CANSIM (accessed: 2015 24 12)
  19. de Boer AG. et al. Cancer Survivors and Unemployment: A Meta-analysis and Meta-regression. JAMA. 2009;301(7):753-762. doi:10.1001/jama.2009.187
  20. de Boer AG et al. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev. 2015; 9:CD007569 DOI: 10.1002/14651858.CD007569.pub3
  21. Surveillance & Reporting: 2012 Report on Cancer Statistics in Alberta. Edmonton: CancerControl AB, Alberta Health Services, 2015
  22. Initiative NCS. Consequences of cancer treatment: the challenge. MacMillan Cancer Support; 2012 [cited 2012 28th August]; Available from http://www.ncsi.org.uk/what-we-are-doing/consequences-of-cancer-treatment/
  23. Courneya, K. S., Katzmarzyk, P. T. and Bacon, E. (2008). Physical activity and obesity in Canadian cancer survivors. Cancer, 112: 2475–2482. doi: 10.1002/cncr.23455

Acknowledgement

Adapted and used with permission of the Chartered Society of Physiotherapy