The Development of a Cancer Rehabilitation Exercise Service in a National Cancer Centre

Written by Grainne Sheill, Trinity St James’s Cancer Institute, Dublin

Introduction

Approximately 4,4860 patients are diagnosed and/or treated for cancer in St. James’s Hospital annually. As the number of cancer survivors and the length of their survival continue to increase, the long-term health issues related to cancer and its treatment are becoming more prevalent. Many adverse consequences of cancer treatment are amenable to physiotherapy led interventions; however, the integration of rehabilitation into standard cancer care continues to remain the exception rather than the norm in Ireland. Irish cancer survivors have identified a striking lack of care from healthcare professionals that would be influential in facilitating cancer recovery and rehabilitation.

Evidence Supporting the Role of Exercise in Cancer Rehabilitation

Systematic reviews demonstrate that exercise in cancer survivors improves quality of life, cardiorespiratory fitness, physical functioning, and fatigue. Exercise is an effective non-pharmacologic intervention to ameliorate the impact of cancer-related fatigue and improve patients’ quality of life. Increasing physical activity levels may also decrease the risk of additional late effects of cancer, for example, the cardiac, pulmonary, endocrine, or bone complications of cancer treatment and may even reduce the risk of secondary malignancies. Research on the cost-effectives of individualised cancer rehabilitation interventions also demonstrate positive effects of exercise oncology during cancer care, in terms of reductions in overall cost per patient pre- to post-exercise intervention. Anyone diagnosed with cancer is advised to engage in 150 minutes of aerobic activity and 2 strengthening sessions a week. Despite this, many cancer survivors do not engage in sufficient levels of exercise. Cancer survivors report a need for guidance, education and support when increasing physical activity levels following cancer treatment.

The Cancer Rehabilitation Exercise Service in St James’s Hospital

In October 2021 the Physiotherapy Department in St James’s Hospital started an exercise-based cancer rehabilitation service for patients during and after cancer treatment. The main aims of the service are to:

• Provide individual assessments, treatment programmes and group exercise programmes to approximately 500 patients experiencing cancer-related impairments in St James’s Hospital annually – both on-line and in-person.

• Provide best practice, evidencebased rehabilitation information to patients and carers of those living with, and beyond cancer.

• Develop cancer rehabilitation pathways from acute cancer centers to primary care.

• Act as an educational resource on the role of exercise in the management of the physical side-effects of cancer to healthcare professionals, patients and the public.

Data on 250 patients referred to the service between October 2021 and May 2022 found that 56% of those were male. The mean age of clients was 64±11 years (Range 31-83 years). The main tumour groups presenting were thoracic cancer (n=78), prostate cancer (n=55), breast cancer (n=30), head and neck cancer (n=29), GI cancer (n=25), gynaecological (n=16) and colorectal (n=11). In total 73% of patients were in the first-year post treatment and 18% more than a year post treatment while 9% were on treatment at the time of physiotherapy review. Patient assessment identified physical impairments such as frailty, cancer related fatigue, and decreased strength. Patients attended on average 4 physiotherapy sessions, for input including exercise assessment and advice sessions (24%), 1:1 physiotherapy input (37%), group based supervised exercise programmes (22%) and onward referral (13%). The most common onward referral was to primary care physiotherapy (n=27) for patients to receive physiotherapy input close to their homes.

An online cancer rehabilitation exercise class

The Cancer Rehabilitation Exercise Physiotherapy service in St James’s Hospital provides one of the first dedicated exercise oncology services nationally. Patients presenting to the cancer rehabilitation service attend with a variety of cancer related impairments and cancer rehabilitation needs. Screening to identify rehabilitation needs combined with exercise prescription can effectively improve the quality of survivorship in cancer patients. Referral to cancer rehabilitation is indicated for patients during and after cancer treatment and there is a need to further develop and expand the cancer rehabilitation exercise services available to patients.

References:

Campbell, K.L., Winters-Stone, K., Wiskemann, J., May, A.M., Schwartz, A.L., Courneya, K.S., Zucker, D., Matthews, C., Ligibel, J., Gerber, L. and Morris, S., 2019. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine and science in sports and exercise, 51(11), p.2375.

Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH. Implementing the exercise guidelines for cancer survivors. J Support Oncol. 2012 Sep- Oct;10(5):171-7. doi: 10.1016/j. suponc.2012.02.001. Epub 2012 May 10. PMID: 22579268; PMCID: PMC3543866.

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