Comprehensive Rehabilitation Programme Benefits Advanced Cancer Patients

A rehabilitation programme that incorporates formal nutrition counselling and exercise with symptom control is recommended for patients with advanced cancer

medwireNews: Palliative care for patients with advanced cancer should combine nutritional components and formal exercise with optimal symptom control, suggests an evidence-based review.

The review’s authors also believe that such comprehensive palliative care should be available to patients with advanced cancer from diagnosis.

“There is clear evidence that certain dietary patterns, exercise and a healthy psychosocial status influence cancer incidence and early progression”, lead author Martin Chasen, from Élisabeth-Bruyère Hospital in Ottawa, Canada, and colleagues note.

“‘Survivorship’ programs that embrace these entities are well accepted. However, few centres provide comprehensive care models that include patients with advanced cancer.”

The review, published in CMAJ, is based on the results of one randomised and five non-randomised trials that looked at the outcomes of combined exercise, nutritional counselling and symptom control programmes. The researchers also reviewed the outcomes of prospective single-institution studies that assessed the outcomes of single-modality programmes, including accounts from participating patients and families regarding the issues they faced.

Evidence from one randomised study showed that a mixed rehabilitation intervention significantly improved patients’ scores on the psychological, physical and patient care subscales of the Supportive Care Needs Survey, as well as self-reported health state. Other benefits of such a programme, as described in a non-randomised trial, included improved endurance and strength and decreased fatigue and reported symptoms.

Recent data from a 2-month comprehensive rehabilitation programme initiated at the Élisabeth-Bruyère Hospital show significant improvements in physiological performance, nutrition, symptoms severity, symptom interference in functioning, fatigue and physical endurance, mobility and balance/function with moderate effect sizes.

Similarly, such a programme at the Royal Victoria Hospital in Montreal, Quebec, Canada, resulted in strong improvements in the physical and activity dimensions of fatigue, moderate reductions in the severity of weakness, depression, nervousness, shortness of breath and distress, and moderate improvements in 6-minute walk distance, maximal gait speed, coping ability and quality of life.

“When caring for patients, we may limit our horizons if we fail to recognize the influence of their psychological state, nutrition, physical activity, symptoms and functional status on their disease and response to therapy”, say Martin Chasen and colleagues.

They also stress the importance of addressing these elements early in the trajectory of advanced cancer.

“The mindset that oncology represents cure whereas palliative care represents care may change if further evidence emerges that not only quality of life but also survival may improve when palliative care and rehabilitation are melded with conventional oncology therapy”, the researchers conclude.


Chasen M, Bhargava R, MacDonald N. Rehabilitation for patients with advanced cancer. CMAJ 2014; First published July 21. doi: 10.1503/cmaj.131402

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