Cheville, A. L., Girardi, J., Clark, M. M., Rummans, T. A., Pittelkow, T., Brown, P., . . . Gamble, G. (2010). Therapeutic exercise during outpatient radiation therapy for advanced cancer: feasibility and impact on physical well-being. American Journal of Physical Medicine & Rehabilitation, 89, 611–619.

To describe the feasibility of delivering a structured physical therapy (PT) program as part of a multidisciplinary intervention to patients undergoing outpatient radiotherapy for advanced cancer.

Patients were randomly assigned to receive the structured intervention or standard care using a stratified approach based on Eastern Cooperative Oncology Group (ECOG) performance status, age, sex, and tumor type. The structured multidisciplinary intervention consisted of eight sessions delivered by a PT and a psychiatrist or a psychologist with facilitation provided by an advanced practice nurse, licensed social worker, or certified hospital chaplain depending on the theme. Cognitive, emotional, social, and spiritual dimensions of the intervention centered on specific topics and coping strategies related to patients' goal setting, challenging negative thoughts, communication, and hope. PT sessions incorporated education and provision of printed material, truncal and upper-limb strengthening exercises, and lower-limb strengthening alternating between standing and seated exercises. These were performed with resistance provided by elastic bands. Aerobic conditioning was not included, although patients were encouraged to engage in regular physical activity. Standard care consisted of regular assessment of treatment toxicities. Patients were not counseled regarding the potential benefits of exercise.

This report focused on the PT and interdisciplinary structured intervention aspects of a previously reported study (Rummans et al. 2006).

• The study was comprised of 103 patients (59%–69% male) receiving radiotherapy for two weeks or longer who received no more than one treatment at the time of study entry.
• Age was 59.4–59.7 years. 
• The highest percentage of patients had gastrointestinal cancer; the sample also included head and neck, lung, brain, and other cancers
• Of the patients, 59%–63% were also receiving chemotherapy, 78%–89% were married, 32% were fully active performance status, and 55% were currently employed.
• Patients were included if they had an ECOG performance status of three or greater and had recurrent disease following a six-month disease-free survival.
• Radiation doses ranged from 3000 to 7200 cGy.

• Single site
• Mayo Clinic

The study was a single-blind, randomized, controlled trial.

• Spitzer Uniscale used for quality of life (QOL) measurement
• Linear analog scales (0–10) for self-assessment of physical well-being and fatigue. These scores were subsequently converted to a 100-point scale.
• Profile of Mood States (POMS) Short Form Vigor and Fatigue subscales
• 30-minute walk

• Six patients were not eligible for analysis due to missing more than four PT sessions.
• Attendance rates for the entire cohort were 89.3%.
• Mean scores after approximately one week of the intervention differed significantly between the intervention and control groups only in overall physical well-being (p = 0.02).
• Changes from baseline were not different between the two groups in any measure at weeks 8 and 27.
• Approximately half of the intervention group declined functionally despite participation in the structured program.

The structured intervention appeared to provide short-term improvement in overall perception of well-being; however, this effect was not sustained over the duration of the trial.

• No commonly used fatigue measures were reported.
• The authors reported improvement in fatigue; however, the measure was actually patient perception of overall well-being.
• There was no attentional control group for comparison.
• The 50% decline in function for patients in the intervention group points to the need to determine which patients might benefit the most from such an intervention and what type of exercise or combined intervention is most effective.
• The study assessed subjective physical well-being rather than objective performance or the specific phenomenon of fatigue.