The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial

Jennifer Brunet, Shaunna Burke, Michael P W Grocott, Malcolm A West, Sandy Jack, Jennifer Brunet, Shaunna Burke, Michael P W Grocott, Malcolm A West, Sandy Jack

Abstract

Background: Promoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer.

Methods: In this non-randomized controlled pilot trial, patients in the supervised exercise group (EG; M age = 64 years; 64% male) and in the control group (CG; M age = 72 years; 69% male) completed the European Organization for Research and Treatment of Cancer core Quality of Life questionnaire and the RAND 36-Item Health Survey three times: pre-neoadjuvant chemoradiation therapy (Time 1; n EC = 24; n CG = 11), post-neoadjuvant chemoradiation therapy/pre-exercise intervention (Time 2; n EC = 23; n CG = 10), and post-exercise intervention (Time 3; n EC = 22; n CG = 10). The 6-week exercise intervention was delivered in hospital and comprised of interval aerobic training. Patients trained in pairs three times per week for 30 to 40 min. Data were analyzed by Mann-Whitney tests and by Wilcoxon matched-pairs signed-rank tests.

Results: No significant between-group differences in changes were found for any of the outcomes. In both groups, fatigue levels decreased and physical health perceptions increased from pre- to post-exercise intervention. Pain levels also decreased from pre- to post-exercise intervention, albeit not significantly.

Conclusions: The findings from this study can be used to guide a more definitive trial as they provide preliminary evidence regarding the potential effects of pre-operative exercise on self-reported pain, fatigue, insomnia, and health perceptions in patients with locally advanced rectal cancer.

Trial registration: This study has been registered with clinicaltrials.gov (NCT01325909; March 29, 2011).

Keywords: Advanced stage; Exercise; Experimental study design; Patient-reported outcomes; Quality of life; Rectal cancer.

Figures

Fig. 1
Fig. 1
Flow chart of recruitment and participation in this study

References

    1. GLOBOCAN 2012 v 1.0. Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. . Accessed 28 Sept 2015.
    1. Foster JD, Jones EL, Falk S, Cooper EJ, Francis NK. Timing of surgery after long-course neoadjuvant chemoradiotherapy for rectal cancer: a systematic review of the literature. Dis Colon Rectum. 2013;56:921–30. doi: 10.1097/DCR.0b013e31828aedcb.
    1. Pucciarelli S, Del Bianco P, Efficace F, Serpentini S, Capirci C, De Paoli A, Amato A, Cuicchi D, Nitti D. Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer: a multicenter prospective observational study. Ann Surg. 2011;253:71–7. doi: 10.1097/SLA.0b013e3181fcb856.
    1. West M, Lythgoe D, Barben C, Noble L, Kemp G, Jack S, Grocott M. Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. Br J Anaesth. 2014;112:665–71. doi: 10.1093/bja/aet408.
    1. Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D. A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. Can Med Assoc J. 2001;165:421–5.
    1. Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA, Hawkins NA, Rowland JH. Mental and physical health–related quality of life among US cancer survivors: population estimates from the 2010 national health interview survey. Cancer Epidemiol Biomarkers Prev. 2012;21:2108–17. doi: 10.1158/1055-9965.EPI-12-0740.
    1. Wong CK, Law W-L, Wan Y-F, Poon JT-C, Lam CL-K. Health-related quality of life and risk of colorectal cancer recurrence and all-cause death among advanced stages of colorectal cancer 1-year after diagnosis. BMC Cancer. 2014;14:337. doi: 10.1186/1471-2407-14-337.
    1. Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA, Fuchs CS. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol. 2006;24:3527–34. doi: 10.1200/JCO.2006.06.0855.
    1. Davies N, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer. 2011;105:S52–S73. doi: 10.1038/bjc.2011.423.
    1. Albrecht TA, Taylor AG. Physical activity in patients with advanced-stage cancer: a systematic review of the literature. Clin J Oncol Nurs. 2012;16:293–300. doi: 10.1188/12.CJON.293-300.
    1. Carli F, Charlebois P, Stein B, Feldman L, Zavorsky G, Kim D, Scott S, Mayo N. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg. 2010;97:1187–97. doi: 10.1002/bjs.7102.
    1. Dronkers J, Lamberts H, Reutelingsperger I, Naber R, Dronkers-Landman C, Veldman A, van Meeteren N. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil. 2010;24:614–22. doi: 10.1177/0269215509358941.
    1. Kim DJ, Mayo NE, Carli F, Montgomery DL, Zavorsky GS. Responsive measures to prehabilitation in patients undergoing bowel resection surgery. Tohoku J Exp Med. 2009;217:109–15. doi: 10.1620/tjem.217.109.
    1. Timmerman H, de Groot J, Hulzebos H, de Knikker R, Kerkkamp H, Van Meeteren N. Feasibility and preliminary effectiveness of preoperative therapeutic exercise in patients with cancer: a pragmatic study. Physiother Theory Pract. 2011;27:117–24. doi: 10.3109/09593981003761509.
    1. Singh F, Newton RU, Galvão DA, Spry N, Baker MK. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol. 2013;22:92–104. doi: 10.1016/j.suronc.2013.01.004.
    1. O’Doherty A, West M, Jack S, Grocott M. Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review. Br J Anaesth. 2013;110:679–89. doi: 10.1093/bja/aes514.
    1. Butt Z, Rosenbloom SK, Abernethy AP, Beaumont JL, Paul D, Hampton D, Jacobsen PB, Syrjala KL, Von Roenn JH, Cella D. Fatigue is the most important symptom for advanced cancer patients who have had chemotherapy. J Natl Compr Canc Netw. 2008;6:448–55.
    1. Osoba D, Hsu M-A, Copley-Merriman C, Coombs J, Johnson FR, Hauber B, Manjunath R, Pyles A. Stated preferences of patients with cancer for health-related quality-of-life (HRQOL) domains during treatment. Qual Life Res. 2006;15:273–83. doi: 10.1007/s11136-005-0580-5.
    1. Burke SM, West MA, Grocott MP, Brunet J, Jack S. Exploring the experience of adhering to a prescribed pre-surgical exercise program for patients with advanced rectal cancer: a phenomenological study. Psychol Sport Exerc. 2015;16:88–95. doi: 10.1016/j.psychsport.2014.09.005.
    1. National Health Institute Symptom management in cancer: pain, depression and fatigue: state-of-the-Science Conference Statement. J Pain Palliat Care Pharmacother. 2003;17:77–97.
    1. Deshpande PR, Rajan S, Sudeepthi BL, Nazir CA. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011;2:137–44. doi: 10.4103/2229-3485.86879.
    1. West M, Loughney L, Lythgoe D, Barben C, Sripadam R, Kemp G, Grocott M, Jack S. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2014;114:244–51. doi: 10.1093/bja/aeu318.
    1. West MA, Loughney L, Barben CP, Sripadam R, Kemp GJ, Grocott MPW, Jack S. The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients. Eur J Surg Oncol. 2014;40:1421–8. doi: 10.1016/j.ejso.2014.03.021.
    1. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 1982;5:649–55. doi: 10.1097/00000421-198212000-00014.
    1. West M, Parry M, Lythgoe D, Barben C, Kemp G, Grocott M, Jack S. Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery. Br J Surg. 2014;101:1166–72. doi: 10.1002/bjs.9551.
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC. The european organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76. doi: 10.1093/jnci/85.5.365.
    1. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health survey 1.0. Health Econ. 1993;2:217–227. doi: 10.1002/hec.4730020305.
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–83. doi: 10.1097/00005650-199206000-00002.
    1. Simes RJ. An improved bonferroni procedure for multiple tests of significance. Biometrika. 1986;73:751–4. doi: 10.1093/biomet/73.3.751.
    1. Scott NW, Fayers PM, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MAG. EORTC QLQ-C30 reference values. Brussels: Quality of Life Department; 2008.
    1. Ware JE, Kosinski M, Dewey JE, Gandek B. SF-36 health survey: manual and interpretation guide. Lincoln: Quality Metric Inc.; 2000.
    1. Windsor PM, Nicol KF, Potter J. A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma. Cancer. 2004;101:550–7. doi: 10.1002/cncr.20378.
    1. Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK. Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist. 2000;5:353–60. doi: 10.1634/theoncologist.5-5-353.
    1. Hawthorn M. Fatigue in patients with advanced cancer. Int J Palliat Nurs. 2010;16:536–41. doi: 10.12968/ijpn.2010.16.11.80023.
    1. Dimeo FC. Effects of exercise on cancer-related fatigue. Cancer. 2001;92:1689–93. doi: 10.1002/1097-0142(20010915)92:6+<1689::AID-CNCR1498>;2-H.
    1. Adamsen L, Quist M, Andersen C, Møller T, Herrstedt J, Kronborg D, Baadsgaard MT, Vistisen K, Midtgaard J, Christiansen B. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ. 2009;339:b3410. doi: 10.1136/bmj.b3410.
    1. McClellan R. Exercise programs for patients with cancer improve physical functioning and quality of life. J Physiother. 2013;59:57. doi: 10.1016/S1836-9553(13)70150-4.
    1. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Libr. 2012;8:CD008465.
    1. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011;25:99–111. doi: 10.1177/0269215510380830.
    1. Shadbolt B, Barresi J, Craft P. Self-rated health as a predictor of survival among patients with advanced cancer. J Clin Oncol. 2002;20:2514–9. doi: 10.1200/JCO.2002.08.060.
    1. Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS. Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med. 2011;41:32–47. doi: 10.1007/s12160-010-9225-1.
    1. Traeger L, Greer JA, Fernandez-Robles C, Temel JS, Pirl WF. Evidence-based treatment of anxiety in patients with cancer. J Clin Oncol. 2012;30:1197–205. doi: 10.1200/JCO.2011.39.5632.

Source: PubMed

3
購読する