Tuesday, May 30, 2006

Exercise programs in palliative care

The currrent Journal of Pain & Symptom Management has an article about the use of an exercise program in palliative care patients.   It involved 34 patients recruited from a Norweigan cancer center/palliative care center with life expectancies between 3 and 12 months.  They were mostly older patients, with relatively high Karnofskys (~80).  The patients received 6 weeks of an exercise program:  twice weekly; 50 minutes at a time; structured group exercises involving stations (combination of stretching, balance, aerobic, strengthening exercises); exercises were tailored somewhat based on the individual patients.  There was no control group.  After 6 weeks there were globally improvement trends on quality of life and functional scales (although these were generally not significant).  Dyspnea, interestingly, did improve significantly, and there was a strong, but non-significant (that is, p= 0.06), trend favoring an improvement in fatigue. 

There has been some study of this in cancer patients, particularly those undergoing chemotherapy (for example here & here), however there's been much less study involving patients with 'more advanced' cancers.  Most studies have been with healthier patients with long life expectancies, so it is good to see this study involving a sicker population (albeit a much healthier one than the average U.S. hospice patient population for example).  For obvious reasons, the sicker/weaker the patient population, the less viable this type of study or therapy becomes (coming to the hospital twice weekly, dying during the study, etc.).  In addition this was a small study, involving a single institution and its physiatrists, with a high chance of interference from selection bias, and the placebo and Hawthorne effects.  (For these reasons, the authors label this study as a "Phase II" one, which seems a little out of place it not being a drug/device trial, but I'll take it to mean a 'proof of principle' trial--that you can do this in a 'palliative' population and that it may work). 

The whole point of me mentioning this article is that our current therapies for cancer-associated fatigue stink, and that's being polite, and so anything that's promising is welcome, even if this may not pan-out in the presumably planned "Phase III" trial. 

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