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Cancer-related fatigue (CRF) is a common side effect and remains under-diagnosed. Screening of CRF by physical therapists (PTs) and patient perspectives of their experiences has not been comprehensively examined. To survey PTs to understand the frequency of CRF screening, and to assess the knowledge and experiences of survivors as it relates to CRF. Two separate electronic surveys developed by the authors were distributed. One targeted oncology PTs, the other for adult survivors of cancer. Of the 199 PT respondents, 36% reported screening for CRF at every encounter. Screening included interviews (46%) and/or standardized questionnaires (37%). The most common barriers to receiving treatment for CRF was lack of physician referrals and time constraints. Of patient responses (n = 61), 84% reported CRF as an important ongoing issue; 77% reported that they initiated the discussion about CRF with their provider, and 23% reported being told there were treatment options for CRF. CRF is common among cancer survivors. However, consistent screening by PTs is lacking. Patients with CRF frequently initiated the conversation with their providers because of symptoms and many patients were not told of treatment options. These findings represent a substantial gap in clinical practice regarding CRF screening and management.

Purpose: The purpose of this systematic review and meta-analysis was to synthesize the current literature on the effects of bone-loading exercise on bone mineral density (BMD) in women after treatment of breast cancer (BC). Methods: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Web of Science databases were searched through March 31, 2016. A combination of MeSH terms and key words was used: (physical therapy OR physiotherapy OR resistance training OR weight training OR aerobic OR exercise) AND (bone density OR osteoporosis) AND breast cancer. Search terms for PEDro were as follows: (breast cancer AND bone breast cancer) and (breast cancer AND osteoporosis). Studies included were experimental studies that compared any type of bone-loading exercise intervention with a comparison group and reported dual-energy x-ray absorptiometry for assessment of BMD of the lumbar spine and/or proximal femur (femoral neck, trochanter, and/or total hip). Between-group BMD effect sizes and 95% confidence intervals (CIs) were calculated for each study (bone-loading exercise vs usual care/non–bone-loading exercise) and pooled across studies. Risk of bias in and across studies was addressed using the PEDro scale. Results: Five randomized controlled studies were included. Pooled effect sizes were statistically significant, favoring the bone-loading exercise group for proximal femur (d = 0.15; 95% CI, 0.03-0.28) and for lumbar spine BMD (d = 0.14; 95% CI, 0.01-0.27). Conclusion: Results provide modest evidence that bone-loading exercise interventions have statistically and clinically significant effects on proximal femur and lumbar spine BMD in women treated for BC. Further research is warranted to determine the most effective types and intensities of exercise for improving BMD in BC survivors.

ObjectivesTo assess the feasibility, safety, and initial estimates of efficacy of a yoga program in postoperative care for women at high risk for breast cancer-related lymphedema (BCRL).DesignSingle-group pretest-post-test design.Settings/locationPatients were recruited from the University of California, San Francisco Carol Franc Buck Breast Care Center.SubjectsTwenty-one women were enrolled in the study. Women were >18 years of age, had undergone surgical treatment for breast cancer, and were at high risk for BCRL.InterventionThe women participated in an Ashtanga yoga intervention for 8 weeks. Sessions consisted of once/week instructor-led practice and once/week home practice. Particular attention was given to poses that emphasized upper body strength and flexibility, while avoiding significant time with the upper extremity (UE) in a dependent position.Outcome measuresUE volume was assessed through circumferential forearm measurement, which was converted to volume using the formula for a truncated cone. Range of motion (ROM) was assessed for the shoulders, elbows, and wrists, using a standard goniometer. UE strength was assessed for shoulder abduction, elbow flexion, wrist flexion, and grip using a dynamometer.ResultsTwenty women completed the yoga intervention, with 17 returning for final assessment. Mean age was 52 (±9.1) years and body mass index was 24.8 (±5.1) kg/m2. Postintervention, mean volume in the at-risk UE was slightly reduced (p = 0.397). ROM for shoulder flexion (p

OBJECTIVES: To describe and compare physical performance profiles in men and women with lymphoma with age- and gender-matched controls and to examine relationships among fatigue severity and physical performance in men and women with lymphoma. DESIGN: Case-control study. SETTING: Outpatient lymphoma service in a major cancer teaching hospital. PARTICIPANTS: Fifty-one patients with lymphoma (26 women, 25 men), age- and gender-matched to 51 subjects without lymphoma. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A physical performance test battery consisting of a 50-ft (15-m) walk, a 6-minute walk, forward reach, repeated sit-to-stand, repeated reach-up, timed belt tie, sock test, and coin test. Patients also completed the Brief Fatigue Inventory (BFI). RESULTS: Multivariate analysis of variance was significant for main effects of group (F(8,89)=27.12, P

This study aims to examine literature on effectiveness of low-level laser therapy (LLLT) in reducing limb volume and pain in adults with breast cancer-related lymphedema (BCRL). PubMed, PEDro, CINAHL, and Cochrane databases were searched using (lymphedema OR edema OR swelling) AND (breast cancer OR mastectomy) AND (laser OR low-level laser therapy OR LLLT OR cold laser). Intervention studies or meta-analyses reporting LLLT for BCRL were included in the search. Pooled effect sizes (ES) and 95 % confidence intervals (CI) were calculated for volume and pain. No limitations were placed on length of follow-up, publication year, or language. Final search was conducted on October 16, 2014. Nine studies met criteria for inclusion. Within-group pooled ES for volume (six studies) was −0.52 (−0.78, −0.25), representing a 75.7-ml reduction in limb volume after LLLT. Between-group pooled ES for volume (four studies) was −0.62 (−0.97, −0.28), representing a 90.9-ml greater reduction in volume with treatment including LLLT versus not including LLLT. Within-group pooled ES for pain reduction (three studies) was −0.62 (−1.06, −0.19), pain reduction of 13.5 mm (0–100 mm VAS). Between-group pooled ES for pain reduction (two studies) was non-significant at −1.21 (−4.51, 2.10). Moderate-strength evidence supports LLLT in the management of BCRL, with clinically relevant within-group reductions in volume and pain immediately after conclusion of LLLT treatments. Greater reductions in volume were found with the use of LLLT than in treatments without it. LLLT confers clinically meaningful reductions in arm volume and pain in women with BCRL.

Objective To compare the effects of resistance and cardiovascular exercise on functional mobility in individuals with advanced cancer. Design Prospective, 2-group pretest-posttest pilot study with randomization to either resistance or cardiovascular exercise mode. Setting Comprehensive community cancer center and a hospital-based fitness facility. Participants Volunteer sample of individuals (N=66; 30 men; 36 women; mean age, 62y) with advanced cancer recruited through the cancer center, palliative care service, rehabilitation department, and a local hospice. Interventions Ten weeks of individualized resistance or cardiovascular exercise, prescribed and monitored by oncology-trained exercise personnel. Main Outcome Measures Functional mobility was assessed using the Short Physical Performance Battery (SPPB); self-reported pain and fatigue were assessed secondarily using visual analog scales. Data were analyzed using a split plot 2×2 analysis of variance (α=.05). Results Fifty-two patients (78.8%) completed the study: 23 (67.7%) of 34 patients in the resistance arm and 29 (90.6%) of 32 patients in the cardiovascular arm. No participant withdrew because of study adverse events. Ten-week outcomes (n=52) included a significant increase in SPPB total score ( P P =.001), and reduction in fatigue ( P =.05). Although cardiovascular exercise participants had a modestly greater improvement in SPPB total score than resistance training participants (F 1,49 =4.21, P =.045), the difference was not confirmed in a subsequent intention-to-treat analysis (N=66). Conclusions Individuals with advanced cancer appear to benefit from exercise for improving functional mobility. Neither resistance nor cardiovascular exercise appeared to have a strong differential effect on outcome.

Objectives: To determine if therapist supervision of an exercise program produced better functional outcomes in allogeneic stem cell transplant patients than a patient-directed exercise program. Methods: Sixty-one patients who were less than 6 months post allogeneic stem cell transplant were randomly assigned to either a therapist supervised training group (supervised) or a patient-directed training group (Self-directed). Training consisted of aerobic exercises (treadmill, bicycle ergometer versus walking) and resistance exercises (free weights, weight machines versus resistive band activities). Subjects completed physical performance tests (50-foot fast walk, 6-min walk, forward reach, repeated sit-to-stand, uniped stance) and the Brief Fatigue Inventory (BFI) before and after 4 weeks of training. Pre- and post-training outcomes and group differences were analyzed by a Student t-test. Results: Patients in both groups were similarly deconditioned at baseline. Training increased the 6-min walk distance and 50-foot walk in the supervised group by 12 and 14%, respectively, and increased the 6-min walk distance by 10% in the Self-directed group (p

To describe and compare physical performance profiles in men and women with lymphoma with age- and gender-matched controls and to examine relationships among fatigue severity and physical performance in men and women with lymphoma.Case-control study.Outpatient lymphoma service in a major cancer teaching hospital.Fifty-one patients with lymphoma (26 women, 25 men), age- and gender-matched to 51 subjects without lymphoma.Not applicable.A physical performance test battery consisting of a 50-ft (15-m) walk, a 6-minute walk, forward reach, repeated sit-to-stand, repeated reach-up, timed belt tie, sock test, and coin test. Patients also completed the Brief Fatigue Inventory (BFI).Multivariate analysis of variance was significant for main effects of group (F(8,89)=27.12, P.05) and gender (F(8,89)=3.09, P.05), and there was no significant interaction. Subsequent analyses found significant differences between groups and gender in the repeated reach-up task, forward reach, 50-ft walk, and distance walked in 6 minutes. Correlations among physical performance tasks and total BFI interference scores were moderate (r range,.27-.43; P.05) for tasks involving upper extremity, and stronger (r range,.51 to -.73; P.05) for tasks that involved whole-body movements.There is a leveling effect of lymphoma across gender on most tasks. The significant relations between physical performance tasks and fatigue are suggestive of the pervasive influence of fatigue on physical function.