Mesothelioma Symptom Treatment with Physical Therapy
Using Physical Therapy to Alleviate Cancer-Related Fatigue
Everybody experiences fatigue at one time or another; but the type of fatigue
that cancer patients experience is overwhelming and it interferes with
their daily activities. It cannot be alleviated by getting adequate sleep,
which is why physical therapy is a good intervention.
In a study titled Exercise as an Intervention for Cancer-Related Fatigue, published August 2004 in Physical Therapy, researchers examined the Medline and Cumulative Index to Nursing and Allied Health Literature databases to find randomized clinical trials that looked at the effectiveness of physical therapy as an intervention for cancer-related fatigue.
They found eight studies, one of which included participants with non-small cell lung cancer, and after reviewing them, they made the following recommendations for physical therapists creating a program to relieve cancer-related fatigue:
- The program should be started simultaneously with the start of treatment and last throughout the treatment period. Patients should be screened using the NCCN (National Comprehensive Cancer Network) Fatigue Practice Guidelines before beginning the program. These guidelines, which can be accessed from the NCCN Web site (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive – NCCN Guidelines for Supportive Care), ask the patient to rate their fatigue on a 0 to 10 rating scale or as mild, moderate or severe. Symptoms of moderate or severe intensity are referred for primary examinations to identify the cause, with emphasis placed on 7 primary factors: pain, emotional distress, sleep disturbance, anemia, nutritional deficiencies, deconditioning (adapting to a physically less demanding way of living), and other existing medical conditions. If none of these factors are identified, a more comprehensive assessment is performed.
- The activities included in the program should be of low to moderate intensity, meaning 50 percent to 70 percent of maximum heart rate, or a rating of 11–13 on the Borg Scale for Rating of Perceived Exertion http://www.cdc.gov/physicalactivity/everyone/measuring/exertion.htm
- There should be a progressive buildup, based on cardiovascular conditioning, from 15 to 30 minutes of exercise, and from 3 to 5 days per week.
- The emphasis should be on aerobic training, although interval training and resistance exercise have been tested and found to be effective.
- The patient should keep an exercise diary or log to document the type of session, intensity, duration, target heart rate, and symptoms experienced. Use of an exercise diary has been recommended to document the level of exercise participation and to encourage adherence.
The researchers noted that, “Safety is an essential consideration in giving exercise recommendations to individuals who are receiving chemotherapy or other cancer treatment.”
They made the following safety-related recommendation:
- The patient’s oncologist should screen them before they begin any exercise program and give clearance. The oncologist should also give instructions about safeguards related to the specific type of cancer treatment.
- The clinician should monitor the patient’s response to exercise regularly and adjust the program as needed. Because the majority of studies involved patients with breast cancer, there isn’t enough evidence concerning how exercise affects patients with other forms of cancer. That’s why clinicians should use caution when recommending community-based exercise programs.
- Exercise should be done by those with advanced or recurrent cancer under the direct supervision of a physical therapist. A safe and effective exercise program is one that provides guidance as to the type of exercise and its intensity, duration, and frequency. Physical therapists cannot only prescribe exercise, but they can also monitor for adverse changes in cancer patients, in addition to being able to recognize when exercise may be unsafe for them.