Patients with advanced cancer can benefit from a rehabilitation program combining exercise, nutritional counselling and symptom control, according to an evidence review in CMAJ (Canadian Medical Association Journal). Palliative care programs should be expanded to include these elements and should be available to patients from diagnosis.
Programs for people with earlier stage cancer combine diet and exercise, but few programs include patients with advanced cancer.
"Cancer rehabilitation is a process that assists a person with a cancer diagnosis to obtain optimal physical, social, psychological and vocational functioning within the limits created by the disease and its treatment," write Dr. Martin Chasen, Division of Palliative Care, Élisabeth-Bruyère Hospital, Ottawa, Ontario, with coauthors.
Evidence from rehabilitation programs at several Canadian hospitals show improvement in fatigue and physical endurance, symptom alleviation, mood and quality of life after embarking on specialized nutritional and exercise regimens. The Jewish General Hospital and the Royal Victoria Hospital in Montreal, Quebec and Élisabeth-Bruyère Hospital, Ottawa, operate rehabilitation programs and have reported on patient outcomes.
"When caring for patients, we may limit our horizons if we fail to recognize the influence of their psychological state, nutrition, physical activity, symptoms and functional status on their disease and response to therapy," write the authors. "A truly comprehensive care program will incorporate elements that address each of these aspects."
They suggest that cancer centres should add rehabilitation services as part of the ongoing care of patients with advanced cancer.
"We propose that current evidence and community expectations are sufficient to encourage Canadian cancer centres to consider establishing full rehabilitation research models for patients with advanced cancer," the authors conclude.