Clinical Oncology Society of Australia position statement on exercise in cancer care

Introduction: Clinical research has established exercise as a safe and effective intervention to counteract the adverse physical and psychological effects of cancer and its treatment. This article summarises the position of the Clinical Oncology Society of Australia (COSA) on the role of exercise in cancer care, taking into account the strengths and limitations of the evidence base. It provides guidance for all health professionals involved in the care of people with cancer about integrating exercise into routine cancer care. Main recommendations: COSA calls for: - exercise to be embedded as part of standard practice in cancer care and to be viewed as an adjunct therapy that helps counteract the adverse effects of cancer and its treatment; - all members of the multidisciplinary cancer team to promote physical activity and recommend that people with cancer adhere to exercise guidelines; and - best practice cancer care to include referral to an accredited exercise physiologist or physiotherapist with experience in cancer care. Changes in management as a result of the guideline: COSA encourages all health professionals involved in the care of people with cancer to: - discuss the role of exercise in cancer recovery; - recommend their patients adhere to exercise guidelines (avoid inactivity and progress towards at least 150 minutes of moderate intensity aerobic exercise and two to three moderate intensity resistance exercise sessions each week); and - refer their patients to a health professional who specialises in the prescription and delivery of exercise (ie, accredited exercise physiologist or physiotherapist with experience in cancer care)

The impact of an inpatient hospital admission on patients’ physical functioning and quality of life in the oncology setting

Objective: Cancer can affect an individual’s level of physical function and health related quality of life (HRQoL). Those requiring hospital admission may be at risk of further decline during hospitalisation. The aim of this study was to investigate physical functioning and HRQoL of cancer patients on admission and over the course of their hospital admission. Methods: A prospective observational study was undertaken on the inpatient wards of a specialist oncology hospital. Assessment measures were taken bi-weekly until discharge from hospital or if they became too unwell to continue. Functional outcome measures included timed-up and go test (TUG), 30 second sit to stand test (30SST), 30 second arm curl test and isometric muscle strength (30ACT). HRQoL was assessed via the EORTC-C30 and SF-8 and distress was measured using the Distress Thermometer. Results: Fifty-five patients (28 males), mean age 64 years ±10.8, with an average length of stay of 19 days participated in the study. Primary reasons for hospital admission included; symptom management (36%) or delivery of cancer treatment (35%). On hospital admission, the majority of patients scored worse than normative levels on the EORTC-C30 and SF-8. Similarly, 65%, 69% and 35% recorded below age norms for TUG, 30SST and 30ACT. Most measures showed a trend towards worsening during hospitalisation with up to 59% of patients experiencing 10% worsening over time. However, only role and social functioning (p < .05), as well as financial difficulty showed statistically significant worsening (p < .05) during hospitalisation. Conclusions: Participants demonstrated substantially reduced HRQoL and physical functioning at time of hospital admission which tended to worsen during hospitalisation. Despite this low level of function, very few received rehabilitation followup. Screening programs using HRQoL and functional assessment measures could be useful in identifying patients who are deconditioned or at risk of deconditioning and require specialised therapy to prevent declines in function and hospital readmissions