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Physio findings: lung cancer, rehabilitation, lymphoedema, breast cancer

Janet Wright looks at new research of interest to physiotherapy staff.

Timely treatment speeds recovery

Physiotherapy provides important back-up for lung-cancer patients having surgery. New research shows that timing may be crucial in speeding up recovery after the operation.

Researchers investigating the evidence on different interventions pored through databases and found eight suitable studies including a total of 599 patients.  The studies compared aspects such as improvements in the patient’s functional capacity, post-operative complications and length of hospital stay.

Their most important finding, say the researchers, was that physiotherapy carried out before the operation cut down the length of time patients needed to stay in hospital afterwards.

‘Presurgical interventions based on moderate-intense aerobic exercise, in patients undergoing lung resection for lung cancer, improve functional capacity and reduce postoperative morbidity,’ say Ana Rodriguez-Larrad and colleagues, from the University of the Basque Country in Spain.

When physiotherapy is started after the operation, on the other hand, it doesn’t seem to reduce pulmonary complications or length of hospital stay.

However, the authors add, no firm conclusions can be drawn because the studies were carried out in different ways, so further research is needed. Rodriguez-Larrad A et al. Interactive CardioVascular and Thoracic Surgery 2014 

Economics - Low-cost programme eases post-chemotherapy symptoms

Exercise-based rehabilitation after cancer treatment is cheap and effective, research from Ireland shows.

Patients with cancer are not routinely offered an exercise programme as part of their rehabilitation, despite the growing body of evidence in its favour.  And little research has been done into its cost-effectiveness. So a team from St James’s Hospital and Trinity College Dublin looked into the costs of an earlier trial that had proved successful.

The results, they believe, could prove useful to physiotherapy managers, policymakers and grant-awarding bodies.

The Prescribed Exercise After Chemotherapy (PEACH) trial divided cancer patients into two groups, starting two to six months after chemotherapy.

One group had hour-long exercise classes with a senior physiotherapist and an assistant, twice a week for eight weeks. The other had usual care.  Compared afterwards with those having usual care, the exercisers had increased quality of life, reduced fatigue and improved physical functioning.

Including staff costs, exercise equipment and overheads, the programme cost just £157 per patient.

‘Physiotherapists working in cancer rehabilitation should be more aware of the cost of running rehabilitation programmes such as described in this study,’ say the authors.  Broderick JM et al. Calculating the costs of an eight-week, physiotherapy-led exercise intervention in deconditioned cancer survivors in the early survivorship period (the PEACH trial). Physiotherapy 2014 Broderick JM et al. Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial. Journal of Cancer Survivorship 2013 

Lymphoedema - Poles turn a walk into therapy for arms

Lymphoedema is a common side-effect of breast cancer itself or of its treatment, if lymph nodes in the armpit are damaged by radiotherapy or surgically removed. About one in five patients is left with a painfully swollen arm that may be difficult to move.

Physios’ options for easing the symptoms include exercises. But patients may be daunted by their pain, limitations and fear of getting worse.

Swedish physios have been trying a treatment that turns a walk into a workout for the whole body. Walking with the aid of a pole in each hand exercises upper-body muscles as well as reducing the load on the lower body, making it easy to continue for longer without fatigue.

The physios, from Skåne University Hospital in Lund, got 23 cancer survivors with lymphoedema to try pole walking, also known as Nordic walking. The women exercised three to five times a week for 30 to 60 minutes, at 70 to 80 per cent of their maximum heart rate.

After eight weeks of pole walking, the women had reduced not only the swelling and feelings of tightness in their arms but also their heart rate. Charlotta Jönsson and Karin Johansson. The effects of pole walking on arm lymphedema and cardiovascular fitness in women treated for breast cancer: a pilot and feasibility study. Physiotherapy Theory & Practice 2014  

Breast cancer: Comments & Conclusions

  • Exercise has been proved to aid recovery after breast cancer, but only 35 per cent of patients do the recommended 150 minutes of moderate or 75 minutes of vigorous physical activity each week, say researchers. They call for better strategies to help patients stay active. Hair BY et al. Cancer 2014.

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