NIHR Signal Physical activity in the community improves mobility for cancer survivors

Published on 25 July 2017

Programmes to encourage physical activity for people with cancer at home or in local communities have a positive impact on physical function. The changes were generally small to moderate, for example those receiving rehabilitation could walk on average 28 metres further in six minutes. The studies mostly included older people with breast cancer, in whom these small improvements may be important.

Cancer survivors experience changes to their physical function resulting from cancer and its treatments. Restoring function can help people maintain independence.

This review looked at a range of interventions. Those delivered in people’s homes or nearby community settings may be more convenient for people with reduced physical function, and might enable more people to attend. Further research would help to confirm these findings in the UK and to explore implementation issues.

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Why was this study needed?

As cancer treatments improve, more people are surviving cancer. Recent projections indicate that by 2040, nearly three out of four cancer survivors will be 65 years and older. However, cancer and its treatments affect the body and can impact on people’s ability to carry out everyday activities.

Cancer survivors require support to help them to restore and/or adapt to their new level of physical function, with around 30% of people reporting unmet needs after treatment. Physical rehabilitation to help cancer survivors to increase and improve their physical activity might help in coping with the physical consequences of cancer.

This systematic review focused on physical activity programmes offered to people within their home or community, rather than in a hospital or outpatient centre.

What did this study do?

This systematic review included 14 randomised controlled trials (with 1,768 participants) comparing community-based physical rehabilitation with a control. One study was from the UK, most were from the US.

The interventions were varied, but most included group sessions, workbooks and telephone support. There was a wide variation in the number of sessions (three to 104 sessions) and timeframe (12 to 52 weeks). The controls received standard care, a low-impact intervention or remained on a waiting-list to receive the intervention.

The trials were generally assessed as high quality. However, many relied on participants’ recall and self-reporting of exercise, which might have introduced inaccuracy.

The trials mainly included women with breast cancer. The intervention occurred either during or after treatment, so we cannot be sure if the timing of the start of rehabilitation is important.

What did it find?

  • People who had received a community-based physical activity intervention could walk faster, on average 28 metres further in six minutes, than people in the control groups (95% confidence interval 15.14 metres to 39.86 metres).
  • Community-based physical rehabilitation produced a small, but statistically significant, improvement in physical functioning in four out of the five measures used across the studies. These measurements included how far people could walk in six minutes, self-reported everyday functioning such as climbing stairs, pain and whether physical problems had disrupted everyday social and work activities.
  • There was a 2.1 point increase in scores on the 100-point physical functioning aspect of the SF-36 quality of life scale, amongst people receiving community-based physical activity interventions compared to controls.

What does current guidance say on this issue?

NICE guidelines are not consistent in recommending physical rehabilitation for people receiving treatment for cancer. For example NICE makes no physical rehabilitation-related recommendations for colorectal, prostate cancer or advanced breast cancer. Whereas its 2017 early-stage breast cancer guidelines recommend postoperative arm physiotherapy to ensure future mobility.

In its 2015 to 2020 cancer strategy for England, the Independent Cancer Taskforce recommended that NHS England and Health Education England review the cancer rehabilitation workforce. They advise promoting the role of Allied Health Professionals, who work in cancer rehabilitation, as part of multi-disciplinary cancer teams, not just in palliative care. NHS England’s 2016 Commissioning Guidance recommends rehabilitation for a number of conditions, including cancer.

What are the implications?

Older cancer survivors can find their physical functioning reduced after cancer and treatment, adding to any physical issues they may already have associated with ageing. Home- and community-based physical rehabilitation appears to help to improve these cancer survivors’ physical functioning.

The participants were on average aged 44 to 73 years. So improving physical functioning could help to support older cancer survivors to continue to live independent and active lives as they age.

Home- and community-based programmes may also be more convenient than those based in hospitals and clinics, if people prefer not having to go to hospital and travelling a shorter distance to attend sessions.

Citation and Funding

Swartz MC, Lewis ZH, Lyons EJ, et al. Effect of Home and Community-Based Physical Activity Interventions on Physical Function among Cancer Survivors: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2017. [Epub ahead of print].

This work was supported in part by the Comparative Effectiveness Research on Cancer in Texas grant (RP140020) from the Cancer Prevention and Research Institute of Texas; the Interdisciplinary Rehabilitation Research Training Program (H133P110012) from the National Institute on Disability and Rehabilitation Research.

Bibliography

Independent Cancer Taskforce. Achieving world-class cancer outcomes: a strategy for England 2015-2020. London: Cancer Research; 2015. 

NHS England. Commissioning guidance for rehabilitation. London: NHS England; 2016. 

NICE. Advanced breast cancer: diagnosis and treatment. CG81. London: National Institute for Health and Care Excellence; 2014.

NICE. Colorectal cancer: diagnosis and management. CG131. London: National Institute for Health and Care Excellence; 2014.

NICE. Early and locally advanced breast cancer: diagnosis and treatment. CG80. London: National Institute for Health and Care Excellence; 2017.

NICE. Prostate cancer: diagnosis and management. CG175. London: National Institute for Health and Care Excellence; 2014.

Why was this study needed?

As cancer treatments improve, more people are surviving cancer. Recent projections indicate that by 2040, nearly three out of four cancer survivors will be 65 years and older. However, cancer and its treatments affect the body and can impact on people’s ability to carry out everyday activities.

Cancer survivors require support to help them to restore and/or adapt to their new level of physical function, with around 30% of people reporting unmet needs after treatment. Physical rehabilitation to help cancer survivors to increase and improve their physical activity might help in coping with the physical consequences of cancer.

This systematic review focused on physical activity programmes offered to people within their home or community, rather than in a hospital or outpatient centre.

What did this study do?

This systematic review included 14 randomised controlled trials (with 1,768 participants) comparing community-based physical rehabilitation with a control. One study was from the UK, most were from the US.

The interventions were varied, but most included group sessions, workbooks and telephone support. There was a wide variation in the number of sessions (three to 104 sessions) and timeframe (12 to 52 weeks). The controls received standard care, a low-impact intervention or remained on a waiting-list to receive the intervention.

The trials were generally assessed as high quality. However, many relied on participants’ recall and self-reporting of exercise, which might have introduced inaccuracy.

The trials mainly included women with breast cancer. The intervention occurred either during or after treatment, so we cannot be sure if the timing of the start of rehabilitation is important.

What did it find?

  • People who had received a community-based physical activity intervention could walk faster, on average 28 metres further in six minutes, than people in the control groups (95% confidence interval 15.14 metres to 39.86 metres).
  • Community-based physical rehabilitation produced a small, but statistically significant, improvement in physical functioning in four out of the five measures used across the studies. These measurements included how far people could walk in six minutes, self-reported everyday functioning such as climbing stairs, pain and whether physical problems had disrupted everyday social and work activities.
  • There was a 2.1 point increase in scores on the 100-point physical functioning aspect of the SF-36 quality of life scale, amongst people receiving community-based physical activity interventions compared to controls.

What does current guidance say on this issue?

NICE guidelines are not consistent in recommending physical rehabilitation for people receiving treatment for cancer. For example NICE makes no physical rehabilitation-related recommendations for colorectal, prostate cancer or advanced breast cancer. Whereas its 2017 early-stage breast cancer guidelines recommend postoperative arm physiotherapy to ensure future mobility.

In its 2015 to 2020 cancer strategy for England, the Independent Cancer Taskforce recommended that NHS England and Health Education England review the cancer rehabilitation workforce. They advise promoting the role of Allied Health Professionals, who work in cancer rehabilitation, as part of multi-disciplinary cancer teams, not just in palliative care. NHS England’s 2016 Commissioning Guidance recommends rehabilitation for a number of conditions, including cancer.

What are the implications?

Older cancer survivors can find their physical functioning reduced after cancer and treatment, adding to any physical issues they may already have associated with ageing. Home- and community-based physical rehabilitation appears to help to improve these cancer survivors’ physical functioning.

The participants were on average aged 44 to 73 years. So improving physical functioning could help to support older cancer survivors to continue to live independent and active lives as they age.

Home- and community-based programmes may also be more convenient than those based in hospitals and clinics, if people prefer not having to go to hospital and travelling a shorter distance to attend sessions.

Citation and Funding

Swartz MC, Lewis ZH, Lyons EJ, et al. Effect of Home and Community-Based Physical Activity Interventions on Physical Function among Cancer Survivors: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2017. [Epub ahead of print].

This work was supported in part by the Comparative Effectiveness Research on Cancer in Texas grant (RP140020) from the Cancer Prevention and Research Institute of Texas; the Interdisciplinary Rehabilitation Research Training Program (H133P110012) from the National Institute on Disability and Rehabilitation Research.

Bibliography

Independent Cancer Taskforce. Achieving world-class cancer outcomes: a strategy for England 2015-2020. London: Cancer Research; 2015. 

NHS England. Commissioning guidance for rehabilitation. London: NHS England; 2016. 

NICE. Advanced breast cancer: diagnosis and treatment. CG81. London: National Institute for Health and Care Excellence; 2014.

NICE. Colorectal cancer: diagnosis and management. CG131. London: National Institute for Health and Care Excellence; 2014.

NICE. Early and locally advanced breast cancer: diagnosis and treatment. CG80. London: National Institute for Health and Care Excellence; 2017.

NICE. Prostate cancer: diagnosis and management. CG175. London: National Institute for Health and Care Excellence; 2014.

Effect of Home and Community-Based Physical Activity Interventions on Physical Function among Cancer Survivors: A Systematic Review and Meta-analysis

Published on 22 April 2017

Swartz, M. C.,Lewis, Z. H.,Lyons, E. J.,Jennings, K.,Middleton, A.,Deer, R. R.,Arnold, D.,Dresser, K.,Ottenbacher, K. J.,Goodwin, J. S.

Arch Phys Med Rehabil , 2017

OBJECTIVE: We reviewed randomized trials to examine the effect of home and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical function measures. DATA SOURCES: Five electronic databases-Medline Ovid, Pubmed, CINAHL, Web of Science, and PsychINFO-were searched from inception to March 2016 for relevant articles. STUDY SELECTION: Search terms included: community-based interventions, physical functioning, and cancer survivors. A reference librarian trained in systematic reviews conducted the final search. Detail protocol is registered on PROSPERO (www.crd.york.ac.uk/prospero/) CRD42016036730. DATA EXTRACTION: Four reviewers evaluated eligibility and two reviewers evaluated methodological quality. Data were abstracted from studies that used the most prevalent physical function measurement tools-Medical Outcomes Study Short Form-36, Late Life Function and Disability Instrument, European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire, and six minute walk test. Random or fixed effects models were conducted to obtain overall effect size per physical function measure. DATA SYNTHESIS: Fourteen studies met inclusion criteria and were used to compute standardized mean differences using inverse variance statistical method. The median sample size was 83 participants. The majority of the studies were conducted among breast cancer survivors (n = 7). The interventions produced short-term positive effects on physical functioning with overall effect sizes ranging from small (0.17, 95% CI: 0.07, 0.27) to medium (0.45, 95% CI: 0.23, 0.67). Community-based interventions that met in groups and used behavioral change strategies produced the largest effect sizes. CONCLUSIONS: Home and community-based physical activity interventions may be a potential tool to combat functional deterioration among aging cancer survivors. More studies are needed among other cancer types using clinically relevant objective functional measures (e.g., gait speed) to accelerate translation into the community and clinical practice.

Expert commentary

Cancer and its treatment often result in an acceleration of functional decline associated with aging, a consequence that impacts on overall quality of life and the ability to remain independent into older age. A number of randomised controlled trials have demonstrated that physical activity can ameliorate this deterioration, however the key challenge is identifying how best to support engagement in physical activity in a way that is sustainable on a large scale.

This review suggests physical activity interventions delivered in home or community settings may be effective in preventing rapid decline in physical function in cancer survivors. As a research community we must prioritise the development of supportive interventions that have the potential to translate into meaningful change in community and clinical practice.

Dr Chloe Grimmett, NIHR Research Fellow, Macmillan Survivorship Research Group, University of Southampton

Categories

  •   Cancers, Gynaecological disorders, Physical therapy