Friday, December 12, 2008

Exercise for cancer fatigue review

Cochrane has published a meta-analysis on exercise for cancer-related fatigue in adults. Unlike our previous complaints about Cochrane reviews this one had a good number of trials (28, with 2000 patients), but like my most recent griping includes an astonishing variety of patients and treatments (graded exercise training, tai chi, yoga, home-based and supervised aerobic exercise programs, strenghtening programs; patients range from youngish breast cancer patients having received curative therapy to stem-cell transplant patients to a variety of 'stage IV' patients). Of course there's also the variety of fatigue measures used.... I'm going to leave all that behind however.

The authors conclude that the evidence supports exercise for cancer-related fatigue (which is fair, and if you look at the forest-plots in the review the vast majority of trials tilted towards there being a positive treatment effect). However most of the patients had breast cancer, and while it's impossible to tell, one suspects a large number of these were receiving/had received curative therapy (e.g. surgery plus adjuvant chemo/radiation). That is, these findings don't apply to patients frequently encountered in 'palliative care' settings, which makes me wonder - what do readers recommend regarding exercise for advanced cancer patients with moderate to severe fatigue? I personally don't actively recommend it, outside of general advice to keep active as much as people feel able without over-doing it (vague I know - I usually recommend walking). I know this is a controversial area (largely because there's a void of studied, successful interventions) - what do others say? Should I be doing better?

(Thanks to Dr. Bob Arnold for this.)

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