Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients With Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis

A novel approach to cancer rehabilitation: assessing the influence of exercise intervention on postoperative recovery and survival rates

Cancer rehabilitation is the crucial process by which cancer patients regain their physical abilities and enhance their quality of life through diverse methods following treatment. As the cure rate of cancer continues to rise, the need for postoperative rehabilitation is becoming increasingly evident. This is particularly crucial for enhancing patient survival rates and minimizing the chances of cancer recurrence. Exercise intervention has become increasingly popular and widely used as a proactive rehabilitation therapy in recent years. This article examines the influence of exercise intervention on the recovery and survival rates of cancer patients after surgery. It specifically investigates the effects and mechanisms of various exercise interventions, such as aerobic exercise, strength training, and flexibility training, on patients with lung cancer, gastric cancer, colorectal cancer, and other forms of cancer. Exercise therapies before and after surgery can greatly boost patients' physical abilities, decrease postoperative problems, minimize hospital stays, and improve overall quality of life. In addition, implementing exercise intervention can enhance the long-term survival rates of patients. Future studies should investigate the most effective exercise programs and their suitability for various types of cancer, with the goal of offering better evidence-based clinical advice.

Fatigue Syndrome in Patients with Bone and Soft Tissue Sarcomas: An Observational Study

OBJECTIVES

The aim of the present study is to describe the course of fatigue syndrome in patients with musculoskeletal tumors starting from chemotherapy and to compare it with that of other cancer populations. The second objective is to identify the risk factors for a higher level of fatigue.

METHODS

A prospective prognostic observational cohort study was carried out. All patients diagnosed with musculoskeletal tumors who started chemotherapy treatment over 12 years of age were identified and enrolled consecutively from July 2019 to April 2021 in the osteo-oncology department. Patients' fatigue was measured using the Brief Fatigue Inventory at four different time points: at the beginning of treatment and then subsequently at 6, 12 and 24 months from the time of enrollment.

RESULTS

The mean fatigue value was 3.3 (SD = 2.4) at the start of antiblastic treatment, which progressively decreased over time until it reached a mean score of 2.1 (SD = 1.5). At 24 months; 17% of patients had moderate/severe fatigue. Presence of metastases at the onset of the disease, location of the tumor in the upper limb, a shorter oncological treatment-free gap and surgical treatment were independent predictive factors of BFI score.

CONCLUSION

In patients with musculoskeletal tumors, fatigue is a complication of the disease itself and does not occur only after chemotherapy treatment. In the first two years of treatment, there is a decreasing trend in fatigue syndrome, which remains a significant complication to be monitored over time and to be considered in patient management. Prevention pathways should be implemented.

IMPLICATIONS FOR NURSING PRACTICE

During chemotherapy treatment of patients with bone and soft tissue sarcomas, a fatigue prevention plan should be implemented. Patients with tumor localisation in the upper limb, metastasis at onset and surgical treatment have a higher risk of developing a higher fatigue score.

Effects of an individualised exercise program in hospitalised older adults with cancer: A randomised clinical trial

We aimed to examine the effects of an individualised multicomponent exercise program on functional outcomes in hospitalised older patients with cancer. Patients aged ≥ 65 were recruited upon admission to a Medical Oncology Department and randomly allocated to receive a multicomponent exercise training program twice daily for five days or standard hospital care. The primary outcome measure was the change in functional status using the Short Physical Performance Battery. This study allocated 30 patients in the Control group and 28 in the intervention group. The mean age was 74.4 years. The intervention group (n = 14) showed significant improvements vs the Control group (n = 20) in the Short Physical Performance Battery (SPPB) (between-group difference, 1.92; 95% CI = 0.80,3.07), knee extension strength (between-group difference 7.72; 95% CI = 1.83,13.8), as well as a significant reduction in fatigue (between-group difference -26.5; 95% CI = -38.6,-13.9). This individualised exercise program appears to have contributed to improving functional abilities and reducing fatigue in hospitalised older cancer patients.

The effectiveness of different non-pharmacological therapies on cancer-related fatigue in cancer patients:A network meta-analysis

BACKGROUND

Cancer-related fatigue is the most common symptom of subjective and persistent nature in cancer patients, which almost runs through the whole process of disease and treatment and rehabilitation, seriously affects the effect of anti-tumor treatment and reduces the quality of life of patients. Non-pharmacological management is one of the key links to relieve cancer-related fatigue, however, there are many types of non-pharmacological management and the related guidelines do not recommend the optimal nursing program for cancer-related fatigue. In our study, Network Meta-analysis was used to compare the effectiveness of different non-pharmacological therapies in Cancer-related fatigue to make their treatment and care more clinically valuable.

METHODS

Randomized controlled trials about non-pharmacological therapies for cancer-related fatigue were searched in Chinese and English databases including China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese Scientific Journal database, Chinese Biomedical Database, Google Scholar, Pubmed, Web of science, Cochrane Library, Sci-Hub, ScienceDirect, and other relevant medical websites including Medlive and DingXiangYuan. The search time was from the establishment of the database to December 2023. The quality of the included Randomized controlled trials was evaluated by two trained researchers using the Cochrane Risk of Bias Assessment Tool, and data were independently extracted from the included literature and analyzed by reticulated Meta-analysis using Stata 18.0 statistical software.

RESULTS

A total of 49 studies with 24 non-drug management methods, and 3887 patients were included. The results of network meta-analysis showed that the use of massage therapy to improve cancer-related fatigue had a more significant advantage over conventional nursing measures and other non-pharmacological therapies in cancer patients, followed by infrared laser moxibustion and ginger-isolated moxibustion with traditional Chinese medicine characteristics, while the worst effect was strengthening excise.

CONCLUSIONS

The existing evidence shows that massage therapy has the best effect in the intervention of cancer-related fatigue. However, due to the diversity of non-pharmacological therapies and the small number of studies included in each therapy, the coverage of this study is insufficient, and more large-sample, multi-center and high-quality randomized controlled trials are needed for further verification in the future.

The combined effect of physical exercise, pranayama, and diet on fatigue in adult cancer patients undergoing chemotherapy: a randomized controlled trial

PURPOSE

Cancer patients undergoing chemotherapy continue to experience significant fatigue, which affects their quality of life. The present study aims to evaluate the combined effect of comprehensive physical exercise, pranayama (regulated breathing practices of yoga), and dietary support intervention on fatigue in cancer patients undergoing chemotherapy.

METHODS

Non-advanced adult cancer patients undergoing chemotherapy (N = 52) were randomized into the intervention group (N = 26) or control group (N = 26). Fatigue assessment was done using the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale (version 4) at baseline and after 3 months. The intervention group participants practiced physical exercise, slow-paced pranayama and supplemented their diet with an intake of 100 g of millet protein powder (MPP), commonly known as "Sattu" in India. The control group received standard medical care.

RESULTS

A total of 39 patients (N = 13 in the intervention and N = 26 in the control group) were included in the statistical analysis. Within the intervention group, a statistically significant reduction in fatigue (p = 0.002) with a large effect size (d = 2.1) was observed. There was no statistically significant reduction in fatigue within the control group (p = 0.36). The group comparison showed a statistically significant reduction in post-scores of fatigue (p < 0.0001) in the intervention group as compared to the control group with a moderate effect size (R = 0.1). No unintended adverse effects related to the intervention were observed.

CONCLUSION

The results suggest the potential role of integrated physical exercise, pranayama, and dietary support in reducing fatigue in cancer patients undergoing chemotherapy. Further validation with a larger sample size is required.

TRIAL REGISTRATION

CTRI/2022/04/041717 [Registered prospectively on 07/04/2022].

Effects of Physical Activity on Cardiotoxicity and Cardio respiratory Function in Cancer Survivors Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

Introduction: Physical activity, as a promising complementary therapy, has shown considerable potential for reducing chemotherapy-related cardiotoxicity (CTRCT) and enhancing cardiorespiratory function (CRF). This study aimed to systematically assess the effects of physical activity on CTRCT and CRF in various cancer survivors receiving chemotherapy. Methods: A systematic review and meta-analysis was conducted. A literature search was conducted across 8 databases from inception to January 2024 and was limited to the English and Chinese languages. Statistical analysis was conducted using RevMan 5.3 and Stata 17.0 software. Results: Sixteen randomized controlled trials (RCTs) were included in the systematic review and 15 RCTs were included in the meta-analysis. Among various cancer survivors undergoing chemotherapy, physical activity markedly increased absolute oxygen uptake (VO2peak or VO2max; WMD = 292.99, 95% confidence interval [CI]:87.87 to 498.12, P = .005), with significant effects of subgroup analysis at 4 to 10 weeks (P = .02) or over 16 weeks (P < .01), moderate-to-high or high intensity training (both P < .0001), patients with breast cancer (P = .009) and reported CTRCT (P = .007); relative VO2peak or VO2max(WMD = 3.30, 95%CI: 2.02 to 4.58, P < .00001), with significant effects of subgroup analysis at 10 to 16 weeks or over 16 weeks, moderate-to-high or high intensity training, patients with breast cancer, with or without reported CTRCT and exercise during chemotherapy (all P < .01); E/A values (WMD = 0.11, 95%CI:0.03 to 0.18, P = .007) and flow-mediated dilatation (WMD = 2.71, 95%CI:1.49 to 3.94, P < .0001). Compared to the control group, physical activity had no significant improvement in E/e' values (P = .50), NT-proBNP (P = .12), hs-cTn (P = 3.83), left ventricular ejection fraction (WMD = 2.89, 95%CI: -3.28 to 9.06, P = .36) with non-significant effects being independent of exercise intensity or duration, with or without CTRCT and cancer types (all P > .05), and global longitudinal strain (WMD = 0.37, 95%CI: -0.20 to 0.94, P = .20) with non-significant effects being independent of exercise duration and cancer types(both P > .05). Conclusions: Physical activity may be an effective complementary therapy to improve CRF and CTRCT in various cancer survivors, particularly during medium to long duration and moderate-to-high and high intensity exercise with concurrent chemotherapy.

Exercise Training in Elderly Cancer Patients: A Systematic Review

Due to the aging of the population, in 70% of cases, a new cancer diagnosis equals a cancer diagnosis in a geriatric patient. In this population, beyond the concept of mortality and morbidity, functional capacity, disability, and quality of life remain crucial. In fact, when the functional status is preserved, the pathogenetic curve towards disability will stop or even regress. The present systematic review investigated the effectiveness of physical exercise, as part of a holistic assessment of the patient, for preventing disability and improving the patient’s quality of life, and partially reducing all-cause mortality. This evidence must point towards decentralization of care by implementing the development of rehabilitation programs for elderly cancer patients either before or after anti-cancer therapy.