Guest Editorial Does Physical Activity Have Value in End-of-Life Cancer Care?
C
ancer and its treatment are associated with numerous consequential physical and psychological symptoms and adverse effects at the active treatment, survivorship, and end-of-life stages. Oncology nurses play a critical role in assisting cancer patients at different disease stages with managing symptoms and improving quality of life. Physical activity is a potentially effective intervention for promoting health and alleviating physical and psychological symptoms associated with cancer and its treatment. Regular physical activity may provide many health benefits for cancer patients including improving quality of life and cardiopulmonary function and diminishing fatigue.1Y3 The effects of physical activity on cancer during and after medical treatment have been examined in several meta-analyses, with most of them focusing on early-stage breast cancer or colorectal cancer. A recent meta-analysis4 showed that physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancers other than breast cancer were included, physical activity was associated with reduced body mass index and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.4 In a series of studies by our research group on physical activity intervention in lung cancer patients, we determined that 85.2% of the participants preferred to receive physical-activity counseling during their cancer experience.5 Walking was the most preferred form of exercise.5 Exercise adherence is a challenge for lung cancer patients. Participants with higher social support and self-efficacy are more likely to initiate physical activity and participate in a moderate- to vigorous-intensity physical activity program.5 Social support and self-efficacy are the main factors required for maintaining walking exercise for 6 months.6 Moreover, in a randomized controlled trial, lung cancer patients in an exercise group exhibited significantly greater improvements in their anxiety and depression levels in the third and sixth months than did patients in the usual-care group.7 Overall then, the benefit of exercise and physical activity for patients in curative cancer treatment is fairly well established. The benefit during end of life is not yet established. The goals of end-of-life care are to relieve symptoms and to improve quality of life. A decline in physical function, resulting in loss of mobility and independence, has been identified as 1 of the most distressing symptoms negatively affecting quality of life in cancer patients receiving end-of-life care. A systematic review of physical activity in cancer patients receiving palliative care8 showed that none of the patients reported engaging in physical activity with moderate intensity (ie, brisk walking) or strenuous exercise (ie, running, aerobics classes, crosscountry skiing, vigorous swimming, or vigorous cycling). Walking was the most commonly reported physical activity among the patients. A significantly slower rate of decline in total well-being, as well as a significantly slower rate of increase in total fatigue, was observed. In addition, they discovered a trend of improvement in patient-reported quality of life, fatigue, and physical functioning after the exercise intervention. Most importantly, the patients were able to complete physical-activity interventions, with some of the patients reporting improvements. Some of the patients were willing and able to tolerate physical-activity interventions, with some patients demonstrating improvements in some exercises. In conclusion, there is insufficient evidence to evaluate the effectiveness of physical activity in cancer patients receiving end-of-life care; however, a potential role for physical activity as a supportive care intervention seems promising. Nevertheless, physical activity preference, social support, and self-efficacy must be considered when implementing a physical-activity program for cancer patients receiving end-of-life care. Y Chia-Chin Lin, PhD, RN School of Nursing College of Nursing, Taipei Medical University Taipei, Taiwan, Republic of China The author has no funding or conflicts of interest to disclose. DOI: 10.1097/NCC.0000000000000271
References 1. Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc. 2001;33:S379YS399; discussion S320YS419.
Guest Editorial
Cancer NursingTM, Vol. 38, No. 4, 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
n
251
2. Kim CJ, Kang DH, Smith BA, Landers KA. Cardiopulmonary responses and adherence to exercise in women newly diagnosed with breast cancer undergoing adjuvant therapy. Cancer Nurs. 2006;29:156Y165. 3. Stevinson C, Faught W, Steed H, et al. Associations between physical activity and quality of life in ovarian cancer survivors. Gynecol Oncol. 2007;106: 244Y250. 4. Fong DYT, Ho JWC, Hui BPH, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ, 2012;344:e70. 5. Lin YY, Lai YF, Lu HI, Lai YL, Lin CC. Physical activity preferences among patients with lung cancer in Taiwan. Cancer Nurs. 2013;36:155Y162.
6. Lin YY, Liu MF, Tzeng JI, Lin CC. Effects of walking on quality of life among lung cancer patients: a longitudinal study [published online ahead of print August 2, 2014]. Cancer Nurs. 2014. 7. Chen HM, Wu YC, Tsai CM, Tzeng JI, Lin CC. Relationships of circadian rhythms and physical activity with objective sleep parameters in lung cancer patients [published online ahead of print June 18, 2014]. Cancer Nurs. 2014. 8. Lowe SS, Watanabe SM, Courneya KS. Physical activity as a supportive care intervention in palliative cancer patients: a systematic review. J Support Oncol. 2009;7:27Y34.
252 n Cancer NursingTM, Vol. 38, No. 4, 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Lin
C
ancer and its treatment are associated with numerous consequential physical and psychological symptoms and adverse effects at the active treatment, survivorship, and end-of-life stages. Oncology nurses play a critical role in assisting cancer patients at different disease stages with managing symptoms and improving quality of life. Physical activity is a potentially effective intervention for promoting health and alleviating physical and psychological symptoms associated with cancer and its treatment. Regular physical activity may provide many health benefits for cancer patients including improving quality of life and cardiopulmonary function and diminishing fatigue.1Y3 The effects of physical activity on cancer during and after medical treatment have been examined in several meta-analyses, with most of them focusing on early-stage breast cancer or colorectal cancer. A recent meta-analysis4 showed that physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancers other than breast cancer were included, physical activity was associated with reduced body mass index and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.4 In a series of studies by our research group on physical activity intervention in lung cancer patients, we determined that 85.2% of the participants preferred to receive physical-activity counseling during their cancer experience.5 Walking was the most preferred form of exercise.5 Exercise adherence is a challenge for lung cancer patients. Participants with higher social support and self-efficacy are more likely to initiate physical activity and participate in a moderate- to vigorous-intensity physical activity program.5 Social support and self-efficacy are the main factors required for maintaining walking exercise for 6 months.6 Moreover, in a randomized controlled trial, lung cancer patients in an exercise group exhibited significantly greater improvements in their anxiety and depression levels in the third and sixth months than did patients in the usual-care group.7 Overall then, the benefit of exercise and physical activity for patients in curative cancer treatment is fairly well established. The benefit during end of life is not yet established. The goals of end-of-life care are to relieve symptoms and to improve quality of life. A decline in physical function, resulting in loss of mobility and independence, has been identified as 1 of the most distressing symptoms negatively affecting quality of life in cancer patients receiving end-of-life care. A systematic review of physical activity in cancer patients receiving palliative care8 showed that none of the patients reported engaging in physical activity with moderate intensity (ie, brisk walking) or strenuous exercise (ie, running, aerobics classes, crosscountry skiing, vigorous swimming, or vigorous cycling). Walking was the most commonly reported physical activity among the patients. A significantly slower rate of decline in total well-being, as well as a significantly slower rate of increase in total fatigue, was observed. In addition, they discovered a trend of improvement in patient-reported quality of life, fatigue, and physical functioning after the exercise intervention. Most importantly, the patients were able to complete physical-activity interventions, with some of the patients reporting improvements. Some of the patients were willing and able to tolerate physical-activity interventions, with some patients demonstrating improvements in some exercises. In conclusion, there is insufficient evidence to evaluate the effectiveness of physical activity in cancer patients receiving end-of-life care; however, a potential role for physical activity as a supportive care intervention seems promising. Nevertheless, physical activity preference, social support, and self-efficacy must be considered when implementing a physical-activity program for cancer patients receiving end-of-life care. Y Chia-Chin Lin, PhD, RN School of Nursing College of Nursing, Taipei Medical University Taipei, Taiwan, Republic of China The author has no funding or conflicts of interest to disclose. DOI: 10.1097/NCC.0000000000000271
References 1. Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc. 2001;33:S379YS399; discussion S320YS419.
Guest Editorial
Cancer NursingTM, Vol. 38, No. 4, 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
n
251
2. Kim CJ, Kang DH, Smith BA, Landers KA. Cardiopulmonary responses and adherence to exercise in women newly diagnosed with breast cancer undergoing adjuvant therapy. Cancer Nurs. 2006;29:156Y165. 3. Stevinson C, Faught W, Steed H, et al. Associations between physical activity and quality of life in ovarian cancer survivors. Gynecol Oncol. 2007;106: 244Y250. 4. Fong DYT, Ho JWC, Hui BPH, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ, 2012;344:e70. 5. Lin YY, Lai YF, Lu HI, Lai YL, Lin CC. Physical activity preferences among patients with lung cancer in Taiwan. Cancer Nurs. 2013;36:155Y162.
6. Lin YY, Liu MF, Tzeng JI, Lin CC. Effects of walking on quality of life among lung cancer patients: a longitudinal study [published online ahead of print August 2, 2014]. Cancer Nurs. 2014. 7. Chen HM, Wu YC, Tsai CM, Tzeng JI, Lin CC. Relationships of circadian rhythms and physical activity with objective sleep parameters in lung cancer patients [published online ahead of print June 18, 2014]. Cancer Nurs. 2014. 8. Lowe SS, Watanabe SM, Courneya KS. Physical activity as a supportive care intervention in palliative cancer patients: a systematic review. J Support Oncol. 2009;7:27Y34.
252 n Cancer NursingTM, Vol. 38, No. 4, 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Lin
