Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Palliative Care
Published in: BMC Palliative Care 1/2013

Open Access 01-12-2013 | Research article

Home-based functional walking program for advanced cancer patients receiving palliative care: a case series

Authors: Sonya S Lowe, Sharon M Watanabe, Vickie E Baracos, Kerry S Courneya

Published in: BMC Palliative Care | Issue 1/2013

Login to get access

Abstract

Background

Although meta-analyses have demonstrated that physical activity can positively impact quality of life outcomes in early stage cancer patients, it is not yet known whether these benefits can be extended to patients with advanced cancer. In a previous pilot survey of patients with advanced cancer with a median survival of 104 days, participants felt willing and able to participate in a physical activity intervention, and reported a strong preference for walking and home-based programming. Here, we report on the initial development and feasibility of a home-based functional walking program in patients with advanced cancer receiving palliative care.

Methods

Nine adult patients were recruited from outpatient palliative care clinics and palliative home care. A pilot intervention trial was conducted over a 6-week period. The McGill Quality of Life Questionnaire (MQOL), Late Life Function and Disability Instrument (LLFDI), Edmonton Symptom Assessment System (ESAS), Seniors Fitness Test, four-test balance scale, and grip strength, were performed pre- and post-intervention. Participants wore activPAL™ accelerometers to monitor ambulatory activity levels.

Results

Of the nine recruited participants, three participants dropped out prior to baseline testing due to hospital admission and feeling overwhelmed, and three participants dropped out during the intervention due to severe symptoms. Only three participants completed the intervention program, pre- and post-intervention assessments: two reported improvements in total MQOL scores, yet all three shared an overall trend towards worsening symptom and total fatigue scores post-intervention. Two participants passed away within 90 days of completing the intervention.

Conclusions

This case series demonstrates the challenges of a physical activity intervention in patients with advanced cancer receiving palliative care. Further feasibility research is required in this patient population.

Trial registration

This study is registered under ClinicalTrials.gov as NCT00438620.
Appendix
Available only for authorised users
Literature
1.
2.
Yennurajalingam S, Bruera E: Palliative management of fatigue at the close of life: “It feels like my body is just worn out”. JAMA. 2007, 297 (3): 295-304. 10.1001/jama.297.3.295.CrossRefPubMed
3.
Chochinov HM, Kristjanson LJ, Hack TF, Hassard T, McClement S, Harlos M: Burden to others and the terminally ill. J Pain Symptom Manage. 2007, 34 (5): 463-471. 10.1016/j.jpainsymman.2006.12.012.CrossRefPubMed
4.
Courneya KS, Friedenreich CM: Physical activity and cancer control. Semin Oncol Nurs. 2007, 23 (4): 242-252. 10.1016/j.soncn.2007.08.002.CrossRefPubMed
5.
Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS: Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med. 2011, 41 (1): 32-47. 10.1007/s12160-010-9225-1.CrossRefPubMedPubMedCentral
6.
Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, Cerin E, Chan WY, Leung IP, Lam SH, Taylor AJ, Cheng KK: Physical activity for cancer survivors: meta-analysis of randomized controlled trials. BMJ. 2012, 344: e70-10.1136/bmj.e70.CrossRefPubMedPubMedCentral
7.
Lowe SS, Watanabe SM, Courneya KS: Physical activity as a supportive care intervention in palliative cancer patients: a systematic review. J Support Oncol. 2009, 7 (1): 27-34.PubMed
8.
Oldervoll LM, Loge JH, Lydersen S, Paltiel H, Asp MB, Nygaard UV, Oredalen E, Frantzen TL, Lesteberg I, Amundsen L, Hjermstad MJ, Haugen DF, Paulsen O, Kaasa S: Physical exercise for cancer patients with advanced disease: a randomized controlled trial. Oncologist. 2011, 16 (11): 1649-1657. 10.1634/theoncologist.2011-0133.CrossRefPubMedPubMedCentral
9.
Oldervoll LM, Loge JH, Paltiel H, Asp MB, Vidvei U, Hjermstad MJ, Kaasa S: Are palliative cancer patients willing and able to participate in a physical exercise program?. Palliat Support Care. 2005, 3: 281-287.CrossRefPubMed
10.
Oldervoll LM, Loge JH, Paltiel H, Asp MB, Vidvei U, Wiken AN, Hjermstad MJ, Kaasa S: The effect of a physical exercise program in palliative care: a phase II study. J Pain Symptom Manage. 2006, 31: 421-430. 10.1016/j.jpainsymman.2005.10.004.CrossRefPubMed
11.
Porock D, Kristjanson LJ, Tinnelly K, Duke T, Blight J: An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study. J Pall Care. 2000, 16 (3): 30-36.
12.
Lowe SS, Watanabe SM, Baracos VE, Courneya KS: Associations between physical activity and quality of life in cancer patients receiving palliative care: a pilot survey. J Pain Symptom Manage. 2009, 38 (5): 785-796. 10.1016/j.jpainsymman.2009.03.006.CrossRefPubMed
13.
Lowe SS, Watanabe SM, Baracos VE, Courneya KS: Physical activity interests and preferences in palliative cancer patients. Support Care Cancer. 2010, 18 (11): 1469-1475. 10.1007/s00520-009-0770-8.CrossRefPubMed
14.
Jones LW, Courneya KS: Exercise counseling and programming preferences of cancer patients. Cancer Pract. 2002, 10 (4): 208-215. 10.1046/j.1523-5394.2002.104003.x.CrossRefPubMed
15.
Mungas D, Marshall SC, Weldon M, Haan M, Reed BR: Age and education correction of mini-mental state examination for English- and Spanish-speaking elderly. Neurology. 1996, 46 (3): 700-706. 10.1212/WNL.46.3.700.CrossRefPubMed
16.
Whaley MH, Brubaker PH, Otto RM: Pre-exercise evaluations. ACSM guidelines for exercise testing and prescription. Edited by: Whaley MH, Brubaker PH, Otto RM. 2006, Baltimore: Lippincott Williams & Wilkins, 39-51. 7
17.
Anderson F, Downing GM, Hill J, Casorso L, Lerch N: Palliative Performance Scale [PPS]: a new tool. J Pall Care. 1996, 12 (1): 5-11.
18.
Gardner MM, Buchner DM, Robertson MC, Campbell AJ: Practical implementation of an exercise-based falls prevention program. Age Ageing. 2001, 30: 77-83. 10.1093/ageing/30.1.77.CrossRefPubMed
19.
Best-Martini E, Botenhagen-DiGenova KA: Exercise for frail elders. 2003, Champaign: Human Kinetics
20.
Rikli R, Jones J: Development and validation of a functional fitness test for community-residing older adults. J Ageing Phys Activity. 1999, 7: 129-161.
21.
Ryan CG, Grant PM, Tigbe WW, Granat MH: The validity and reliability of a novel activity monitor as a measure of walking. Br J Sports Med. 2006, 40: 779-784. 10.1136/bjsm.2006.027276.CrossRefPubMedPubMedCentral
22.
Skipworth RJ, Stene GB, Dahele M, Hendry PO, Small AC, Blum D, Kaasa S, Trottenberg P, Radbruch L, Strasser F, Preston T, Fearon KC, Helbostad , European Palliative Care Research Collaborative (EPCRC): Patient-focused endpoints in advanced cancer: criterion-based validation of accelerometer-based activity monitoring. Clin Nutr. 2011, 30 (6): 812-821. 10.1016/j.clnu.2011.05.010.CrossRefPubMed
23.
Maddocks M, Wilcock A: Exploring physical activity level in patients with thoracic cancer: implications for use as an outcome measure. Support Care Cancer. 2012, 20 (5): 1113-1116. 10.1007/s00520-012-1393-z.CrossRefPubMed
24.
Cohen SR, Mount BM, Strobel MG, Bui F: The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995, 9: 207-219. 10.1177/026921639500900306.CrossRefPubMed
25.
Cohen SR, Mount BM, Bruera E, Provost M, Rowe J, Tong K: Validity of the McGill Quality of Life Questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliat Med. 1997, 11: 2-30.
26.
Washburn RA, Smith KW, Jette AM, Janney CA: The Physical Activity Scale for the Elderly [PASE]: development and evaluation. J Clin Epidemiol. 1993, 46: 153-162. 10.1016/0895-4356(93)90053-4.CrossRefPubMed
27.
Martin KA, Rejeski WJ, Miller ME, James MK, Ettinger WH, Messier SP: Validation of the PASE in older adults with knee pain and physical disability. Med Sci Sports Exerc. 1999, 31 (5): 627-633. 10.1097/00005768-199905000-00001.CrossRefPubMed
28.
Johansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Da Silva M, Chertow GM: Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int. 2001, 59: 1121-1127. 10.1046/j.1523-1755.2001.0590031121.x.CrossRefPubMed
29.
Bouchard C, Shephard RJ: Physical activity, fitness and health: the model and key concepts. 1994, Champaign: Human Kinetics
30.
McAuley E, Konopack JF, Motl RW, Rosengren K, Morris KS: Measuring disability and function in older women: psychometric properties of the Late-Life Function and Disability Instrument. J Gerontol. 2005, 60A (7): 901-909.CrossRef
31.
Sayers SP, Jette AM, Haley SM, Heeren TC, Guralnik JM, Fielding RA: Validation of the Late-Life Function and Disability Instrument. J Am Geriatr Soc. 2004, 52: 1554-1559. 10.1111/j.1532-5415.2004.52422.x.CrossRefPubMed
32.
Bruera E, Kuehn N, Miller MJ, Selmser P, MacMillan K: The Edmonton Symptom Assessment System [ESAS]: a simple method for the assessment of palliative care patients. J Pall Care. 1991, 7 (2): 6-9.
33.
Chang VT, Hwang SS, Feuerman M: Validation of the Edmonton Symptom Assessment Scale. Cancer. 2000, 88: 2164-2171. 10.1002/(SICI)1097-0142(20000501)88:9<2164::AID-CNCR24>3.0.CO;2-5.CrossRefPubMed
34.
Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL: The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999, 85 (5): 1186-1196. 10.1002/(SICI)1097-0142(19990301)85:5<1186::AID-CNCR24>3.0.CO;2-N.CrossRefPubMed
35.
Nekolaichuk CL, Bruera E: Assessing hope at the end of life: validation of an experience of hope scale in advanced cancer patients. Palliat Support Care. 2004, 2 (4): 243-253.PubMed
36.
Hutton JL, Martin L, Field CJ, Wismer WV, Bruera ED, Watanabe SM, Baracos VE: Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy. Am J Clin Nutr. 2006, 84: 1163-1170.PubMed
37.
Rinck GC, van den Bos GA, Kleijnen J, de Haes HJ, Schade E, Veenhof CH: Methodologic issues in effectiveness research on palliative cancer care: a systematic review. J Clin Oncol. 1997, 15 (4): 1697-1707.PubMed
38.
Mercadante S, Casuccio A, Fulfaro F: The course of symptom frequency and intensity in advanced cancer patients followed at home. J Pain Symptom Manage. 2000, 20 (2): 104-112. 10.1016/S0885-3924(00)00160-3.CrossRefPubMed
39.
WHO: Obesity: preventing and managing the global epidemic. 2000, Geneva: World Health Organization
40.
Tan BHL, Birdsell LA, Martin L, Baracos VE, Fearon KCH: Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009, 15 (22): 6973-6979. 10.1158/1078-0432.CCR-09-1525.CrossRefPubMed
41.
Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T: Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012, 62 (4): 243-274.CrossRefPubMed
42.
Headley JA, Ownby KK, John LD: The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncol Nurs Forum. 2004, 31 (5): 977-983. 10.1188/04.ONF.977-983.CrossRefPubMed
Metadata
Title
Home-based functional walking program for advanced cancer patients receiving palliative care: a case series
Authors
Sonya S Lowe
Sharon M Watanabe
Vickie E Baracos
Kerry S Courneya
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2013
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/1472-684X-12-22

Other articles of this Issue 1/2013

BMC Palliative Care 1/2013 Go to the issue

Research article

Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to death

Study protocol

Towards a standardized method of developing quality indicators for palliative care: protocol of the Quality indicators for Palliative Care (Q-PAC) study

Research article

Is the effect of non-invasive ventilation on survival in amyotrophic lateral sclerosis age-dependent?

Debate

Modelling the landscape of palliative care for people with dementia: a European mixed methods study

Research article

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review

Research article

'My dreams are shuttered down and it hurts lots’–a qualitative study of palliative care needs and their management by HIV outpatient services in Kenya and Uganda