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Corresponding author Alix Sleight, PhD, OTD, MPH, OTR/L, Department of Physical Medicine and Rehabilitation, Center for Integrated Research in Cancer and Lifestyle (CIRCL), Samuel Oschin Cancer Center, Cedars-Sinai, 8700 Beverly Blvd, NT 7217, Los Angeles, CA 90048.
Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United StatesCenter for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United StatesCedars Sinai Cancer, Los Angeles, California, United StatesDivision of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
College of Health and Human Services, George Mason University, Fairfax County, Virginia, United StatesInova Health System, Inova Medicine Services, Falls Church, Virginia, United States
Northwell Health Cancer Institute, New Hyde Park, New York, United StatesCenter for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United StatesDepartment of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United StatesRobert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United StatesRehabilitation Medicine School, Nanjing Medical University, Nanjing, China
Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United StatesDepartment of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
Department of Population Sciences, City of Hope, Duarte, California, United StatesDepartment of Surgery, City of Hope, Duarte, California, United States
Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United StatesRehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains.
Data Sources
PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019.
Study Selection
Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion.
Data Extraction
Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV).
Data Synthesis
Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome.
Conclusions
These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
The number of cancer survivors in the United States—defined as those from the point of cancer diagnosis through the balance of life—is rising steadily, with a projected increase to more than 26 million by 2040.
Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY)-randomized weight loss trial among breast cancer survivors.
Telehealth system: a randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors.
Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy.
particularly regarding function—defined as the ability to perform the basic actions essential for maintaining independence and carrying out more complex activities.
Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer.
The unique and expressed purpose of this review was thus to examine the literature through the lens of measurable and significant changes in function. This differs from other reviews that aggregate and report changes in clinical measures of body structure or physiological measures (impairments) elicited by rehabilitation interventions. Physiologic measures such as maximal aerobic capacity or blood gases and measures of body structure, such as joint range of motion, muscle strength, or limb volume, are critical for clinical assessment and decision making regarding impairment; however, while these measures may correlate with and support function, they do not directly assess functional management of daily activities and engagement in life roles. Achieving statistical significance in physiological measures in clinical trials may not equate to meaningful changes to patients or improvements in desired and needed life activities. We therefore identified the strengths, limitations, and breadth of evidence for rehabilitative interventions designed to promote optimal function for individuals living with and beyond cancer treatment. These findings may inform cancer rehabilitation practice guidelines and future research.
Methods
This systematic review was led by a core team (A.S., C.A., L.G., N.S., T.M.) and a biomedical informationist from the National Institutes of Health Biomedical Library (A.L.). The core team developed the preliminary participants, intervention, comparisons, and outcomes question and search criteria with support from the National Institutes of Health informationist. For the purpose of this review, the term cancer rehabilitation intervention is defined based on the definition by Silver et al
Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer.
an intervention directed at managing patients’ physical and/or cognitive impairments in an effort to maintain or restore function, maximize participation, and/or improve quality of life. These interventions can be provided at any time throughout the oncology care continuum.” Rehabilitation professionals were defined to include physiatrists, physical therapists, occupational therapists, behavioral therapists, speech and language pathologists, recreational therapists, music therapists, vocational rehabilitation specialists, neurocognitive specialists, and rehabilitation nurses.
Search
Search terms were formulated using the participants, intervention, comparisons, and outcomes structure. Participants were adults (older than 18 years) with any type of cancer, including adult populations of childhood cancer survivors. Intervention was any intervention within the scope of practice of a rehabilitation provider delivered to cancer survivors in any setting with therapeutic intent to affect physical or cognitive function (interventions designed to affect psychosocial function were excluded from this review). Comparisons broadly addressed rehabilitative intervention vs none, supervised vs unsupervised, varied frequency and duration of interventions, as well as comparison of different types of rehabilitative interventions. Outcomes were determined a priori based on the International Classification of Functioning, Disability, and Health framework and the multidisciplinary author team's clinical expertise about the top areas of concern in cancer rehabilitation. These included outcome measures of activities of daily living (ADL) and/or IADL, exercise behavior, fatigue, functional mobility, cognition, communication, health-related quality of life (HRQOL), return to work, and sexual function.
The comprehensive search strategy is provided in appendix 1. Five databases were searched: PubMed, Cumulative Index to Nursing and Allied Health Plus, Web of Science, Embase, and Scopus, with date range from January 1, 2000, through March 30, 2019.
Study identification and selection
Inclusion and exclusion criteria are outlined in detail in table 1. Studies were included if they included a study population with a cancer diagnosis; a rehabilitation intervention focusing on physical, sexual, or cognitive abilities, participation, and/or HRQOL; and an interventional study design with a function-based outcome. The initial search yielded 18,416 results. Fifty-seven duplicates were removed, resulting in 18,359 studies for screening. The review team used the Covidence software program to facilitate reviewer screening and reviews. Two coauthors reviewed each article for relevance of title and abstract and for eligibility of full-text review. In instances of disagreement between reviewers, 2 of the 3 core team authors (A.S., L.G., N.S.) made the final determination on inclusion. After full-text review, the volume of articles exceeded what the core author team believed could be realistically managed for this review, and at this point the team decided to further consolidate the inclusion criteria by (1) reducing the time scope of the project, including only articles from January 1, 2008, through March 30, 2019, and (2) excluding any article identified as a pilot or feasibility study. The rationale for this adjustment was to assure the most contemporary evidence was included for review and to reduce the bias from studies with low statistical power.
Table 1Inclusion and Exclusion Criteria
Inclusion
Exclusion
Publications from January 2008 to March 2019 Study population with cancer diagnosis Participants 18 years or older Rehabilitation intervention that focuses on physical, sexual, and cognitive abilities, participation, or health-related quality of life Controlled intervention trials with 1 or multiple study arms that include a functional or participation-based outcome as a primary, secondary, or exploratory aim Health care delivery interventions that include a rehabilitation component
Articles not available in English Published protocols of ongoing or anticipated trials Case studies or case series with <12 patients Pilot or feasibility studies (identified as such by authors of study) Complementary and alternative medicine interventions that are not movement-based or not considered rehabilitation Intervention studies that included populations without cancer as controls or comparison groups Studies on cancer prevention interventions Studies that reported only physiological outcomes with no reported functional measures Studies that examined interventions for psychological issues only, including anxiety, emotional distress, or depression Studies investigating psychometric properties of measurement tools Pharmacologic interventions that do not report functional outcomes or are out of the scope of rehabilitation provider practice Cross-sectional and descriptive studies of function Observational studies Commentaries, narrative reviews, editorial reviews, published abstracts, systematic reviews, meta-analyses
Data extraction and quality reviews were conducted by 2 coauthors using a standardized data collection form in Excel. Elements extracted from studies included country where the study was conducted, cancer disease type, disease stage, time period in the cancer continuum when the study was conducted, setting in which the intervention was conducted, study cohort(s) and control cohort interventions, between-group and within-group results, primary functional outcome reported, whether statistical significance was achieved, favorability of significance for the intervention, and additional functional outcomes and significance reported (if applicable). All coauthors contributed to data extraction and worked in teams to synthesize results.
Quality assessment
Quality and risk of bias were assessed by authors during the extraction phase using the American Academy of Neurology (AAN) classification of evidence system.
The AAN system is used by the American Congress of Rehabilitation Medicine (ACRM) to inform guideline development and divides studies into 4 classes based on a succinct list of qualities, such as randomization, blinding, and overarching study design, and are presented in detail in table 2. The evidence rankings are noted, by citation, in supplemental table S1 and supplemental table S2 (available online only at http://www.archives-pmr.org/).
Table 2AAN classification of evidence system
Class
Criteria
Class I
•
RCT in a representative population
•
Triple-masked studies (ie, the patient, treating provider, and outcome assessors are unaware of treatment assignment)
•
Relevant baseline characteristics of treatment groups (or treatment order groups for crossover trials) are presented and substantially equivalent between treatment groups, or there is appropriate statistical adjustment for differences
•
Additional Class I criteria:
a
Concealed allocation
b
No more than 2 primary outcomes specified
c
Exclusion and inclusion criteria clearly defined
d
Adequate accounting of dropouts (with at least 80% of participants completing the study) and crossovers
Class II
•
RCT that lacks 1 or 2 Class I criteria a-d
•
Cohort studies using methods that successfully match treatment groups on relevant baseline characteristics (eg, propensity score matching) meeting Class I criteria b–d (see above)
•
Randomized crossover trial missing 1 of the following 2 criteria: a. Period and carryover effects described b. Baseline characteristics of treatment order groups presented
•
All relevant baseline characteristics are presented and substantially equivalent across treatment groups (or treatment order groups for crossover trials), or there is appropriate statistical adjustment for differences
•
Masked or objective outcome assessment
Class III
•
Controlled studies (including studies with external controls such as well-defined natural history controls)
•
A description of major confounding differences between treatment groups that could affect outcome
•
Outcome assessment performed by someone who is not a member of the treatment team
•
Crossover trial missing both of the following 2 criteria:
Articles (n=18,359) were initially screened for relevance through title and abstract reviews. A total of 16,130 articles were excluded as irrelevant. The remaining 2229 articles underwent full-text review, with 1394 of those being excluded. The most commonly cited reasons for exclusion were studies did not report a functional outcome (n=411); did not conduct a rehabilitative intervention (n=340); were not prospective, controlled trials (n=235); were case studies or case series (120); and were a secondary analysis of a controlled trial (n=97). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram in fig 1 provides insight on the remaining exclusion categories and flow of article reviews. After full-text reviews, 835 articles were included for extraction. After refined exclusion criteria additional studies were excluded for being out of the revised timeline (n=153), when the article explicitly defined its research as a pilot or feasibility trial (n= 250), and because the article did not have a primary functional outcome listed (n= 70). This resulted in 362 studies remaining for full extraction.
Fig 1Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram.
A descriptive narrative synthesis of the 362 studies within each domain is presented in the text below for those studies with statistically significant interventions followed by those lacking significant functional intervention effects, although the latter with less detail. Supplemental table S1 provides the study characteristics and intervention synopsis for studies that achieved statistical significance through rehabilitative interventions in each functional domain, while supplemental table S2 provides the synopsis for studies that did not achieve statistical significance in their primary outcome. More detailed characteristics of all studies regardless of statistical significance can be found in supplemental table S3 (available online only at http://www.archives-pmr.org/).
Functional outcome domain findings
Figure 2 provides a breakdown by primary domain of interest and whether studies found intervention(s) were statistically significant vs nonsignificant. For those studies that found statistically significant outcomes for the intervention(s), summary data are provided in figs 3-5, with cancer diagnoses studied by domain summarized in fig 3, the participants’ phase of cancer treatment during the study in fig 4, and the study treatment setting in fig 5.
Fig 2Significance and number of studies by functional domain.
A total of 108 studies examined the effects of rehabilitation interventions on the primary outcome of HRQOL and/or quality of life (QOL). HRQOL is defined as an individual's perceived physical and mental health over time, while QOL is a broader concept encapsulating an individual's general perception of their position in life within the context of their culture and value systems. Eighty studies (73%) had a statistically significant effect on HRQOL/QOL. Fifty-four of the statistically significant studies were randomized controlled trials (RCTs), and 26 were single-arm trials. These studies were conducted across breast
Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY)-randomized weight loss trial among breast cancer survivors.
Telehealth system: a randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors.
Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy.
Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer.
Long term improved quality of life by a 2-week group physical and educational intervention shortly after breast cancer chemotherapy completion. Results of the 'Programme of Accompanying women after breast Cancer treatment completion in Thermal resorts' (PACThe) randomised clinical trial of 251 patients.
Long-term improvement of breast cancer survivors' quality of life by a 2-week group physical and educational intervention: 5-year update of the 'PACThe' trial.
Longitudinal assessment of the impact of adapted physical activity on upper limb disability and quality of life in breast cancer survivors from an Italian cohort.
Do compression sleeves reduce the incidence of arm lymphedema and improve quality of life? Two-year results from a prospective randomized trial in breast cancer survivors.
The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial.
Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial.
Effects of complex decongestive physiotherapy on the oedema and the quality of life of lower unilateral lymphoedema following treatment for gynecological cancer.
Implementation of comprehensive rehabilitation therapy in postoperative care of patients with cholangiocarcinoma and its impact on patients' quality of life.
Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial.
Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: adherence and exercise performance levels of a 12-week guided home-based program.
Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: a randomised controlled trial.
Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial.
A randomised, wait-list controlled trial: evaluation of a cognitive-behavioural group intervention on psycho-sexual adjustment for men with localised prostate cancer.
A randomized controlled trial to assess the effectiveness of muscle strengthening and balancing exercises on chemotherapy-induced peripheral neuropathic pain and quality of life among cancer patients.
Working toward a good life as a cancer survivor: a longitudinal study on positive health outcomes of a rehabilitation program for young adult cancer survivors.
Quality of life after self-management cancer rehabilitation: a randomized controlled trial comparing physical and cognitive-behavioral training versus physical training.
Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial.
A variety of cancer stages were represented across the studies, yet 34 studies did not specify stage of cancer for their cohort. Most studies were conducted in the active treatment phase (n=30) or the survivorship postactive treatment phase (n=39), and 3 studies included individuals in both phases. The majority of interventions were delivered in a clinic or hospital-based setting (n=51).
Rehabilitation interventions varied from exercise-based interventions to cognitive therapies, therapeutic exercises, aquatic therapy, and clinical interventions for specific impairments such as lymphedema. HRQOL and/or QOL was investigated as a primary outcome using patient-reported outcome (PRO) measures encapsulating at least 1 domain of either QOL or HRQOL, with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the 36-Item Short Form Survey, and the Functional Assessment of Cancer Therapy: General being the most commonly used across studies. A majority of these studies (n=44) used the subscale of a HRQOL assessment as the only measure of physical or cognitive functional outcomes. Although these studies also included clinical measures such as strength, range of motion, and so on, there were no additional functional outcomes measures reported. Studies that did report secondary functional outcomes of statistical significance included measures of functional mobility,
Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer.
Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial.
A randomized controlled trial to assess the effectiveness of muscle strengthening and balancing exercises on chemotherapy-induced peripheral neuropathic pain and quality of life among cancer patients.
Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: a randomised controlled trial.
Twenty-eight studies (25%) of HRQOL/QOL reported nonsignificant findings. Interventions not achieving statistical significance varied and included psychoeducational interventions such as stress management training and variations of supervised exercise training.
Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects?.
A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care.
Iyengar-yoga compared to exercise as a therapeutic intervention during (neo)adjuvant therapy in women with stage I-III breast cancer: health-related quality of life, mindfulness, spirituality, life satisfaction, and cancer-related fatigue.
Evid Based Complement Alternat Med.2016; 20165931816
Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients.
Implications of a postoperative rehabilitation program on quality of life in women with primary breast cancer treated with sentinel lymph node biopsy or complete axillary lymph node dissection.
Exercise and stress management training prior to hematopoietic cell transplantation: Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902.
Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery - a randomized controlled trial.
Nurse-led follow-up at home vs. conventional medical outpatient clinic follow-up in patients with incurable upper gastrointestinal cancer: a randomized study.
Does physiotherapist-guided pelvic floor muscle training increase the quality of life in patients after radical prostatectomy? A randomized clinical study.
Long-term effects on cancer survivors' quality of life of physical training versus physical training combined with cognitive-behavioral therapy: results from a randomized trial.
Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial.
Activities of daily living and instrumental activities of daily living
Sixty studies investigated rehabilitative interventions for their effect on the primary functional outcome of performing ADL and/or IADL. Forty-two of 61 studies (70%) reported significant improvement in ADL and/or IADL function, 35 RCTs and 7 single-arm trials.107-113 Most interventions were conducted in clinic or hospital system-based settings, with 3 exceptions: an independent, self-directed internet-based intervention
Long term improved quality of life by a 2-week group physical and educational intervention shortly after breast cancer chemotherapy completion. Results of the 'Programme of Accompanying women after breast Cancer treatment completion in Thermal resorts' (PACThe) randomised clinical trial of 251 patients.
Hospital and clinic-based interventions focused less on IADL and more on basic ADL (dressing, feeding, etc). ADL and/or IADL studies were conducted with individuals with head and neck
A randomized controlled trail of combination therapy of neuromuscular electrical stimulation and balloon dilatation in the treatment of radiation-induced dysphagia in nasopharyngeal carcinoma patients.
Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients.
Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial.
Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial.
Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection.
The effectiveness of a clinical and home-based physical activity program and simple lymphatic drainage in the prevention of breast cancer-related lymphedema: a prospective randomized controlled study.
Implementing the Prospective Surveillance Model (PSM) of rehabilitation for breast cancer patients with 1-year postoperative follow-up, a prospective, observational study.
Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial.
Efficacy of preoperative uro-stoma education on self-efficacy after radical cystectomy; secondary outcome of a prospective randomized controlled trial.
Changes in and associations among functional status and perceived quality of life of patients with metastatic/locally advanced cancer receiving rehabilitation for general disability.
(n=4). The majority of studies were conducted after the completion of active treatment phase (n=23) in the survivorship phase and during active treatment (n= 15). Four studies tested prehabilitation interventions.
Interventions included various standard physical, occupational, or speech therapy techniques, such as therapeutic exercise and activities for strengthening, kinesiology taping, manual therapy, cognitive behavioral therapy (CBT), electrical stimulation, biofeedback, swallowing exercises (eg, shaker exercises, effortful swallows, tongue strengthening), pelvic floor exercises, and yoga.
providing a neuromuscular electrical stimulation intervention reported significantly worse swallow function in head and neck cancer survivors compared with sham stimulation, suggesting a need for additional research to test outcomes using neuromuscular electrical stimulation in this population. Studies used a variety of outcome measurement approaches including performance-based measures of function and activity (eg, the FIM) and patient-reported measures of function and QOL (eg, Patient-Reported Outcomes Measurement Information System Global-10). Secondary outcomes achieving significance with rehabilitation interventions predominantly included fatigue,
Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial.
Changes in and associations among functional status and perceived quality of life of patients with metastatic/locally advanced cancer receiving rehabilitation for general disability.
Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients.
Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection.
Implementing the Prospective Surveillance Model (PSM) of rehabilitation for breast cancer patients with 1-year postoperative follow-up, a prospective, observational study.
Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy.
Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer.
Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.
Effectiveness of therapeutic inflatable ball self-exercises for improving shoulder function and quality of life in breast cancer survivors after sentinel lymph node dissection.
Effect of preoperative pelvic floor muscle therapy with biofeedback versus standard care on stress urinary incontinence and quality of life in men undergoing laparoscopic radical prostatectomy: a randomised control trial.
The recovery of urinary continence after radical retropubic prostatectomy: a randomized trial comparing the effect of physiotherapist-guided pelvic floor muscle exercises with guidance by an instruction folder only.
Urodynamic quantification of decrease in sphincter function after radical prostatectomy: relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises.
Fifty-nine studies investigated rehabilitation interventions for their effect on cancer-related fatigue as a primary outcome, and 40 of these studies (67%) achieved statistical significance. Thirty-four of these trials were RCTs, and 6 were single-arm trials. The studies were conducted across breast
Effectiveness of core stability exercises and recovery myofascial release massage on fatigue in breast cancer survivors: a randomized controlled clinical trial.
Evid Based Complement Alternat Med.2012; 2012620619
Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial.
Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer.
Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life.
Impact of an incentive-based mobility program, "Motivated and Moving," on physiologic and quality of life outcomes in a stem cell transplant population.
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
Effects of different exercise modalities on fatigue in prostate cancer patients undergoing androgen deprivation therapy: a year-long randomised controlled trial.
A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients.
J Am Coll Surg.2012; 214 ([discussion: 475-7]): 463-475
Effectiveness of two web-based interventions for chronic cancer-related fatigue compared to an active control condition: results of the "Fitter na kanker" randomized controlled trial.
Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial.
Effects of exergaming in cancer related fatigue in the quality of life and electromyography of the middle deltoid of people with cancer in treatment: a controlled trial.
Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial.
Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention.
(n=14). Most studies occurred during active cancer treatment (n= 25), while 13 studies took place during posttreatment survivorship. The most common effective intervention for fatigue was aerobic or resistive exercise; however, 5 studies used movement-based interventions such as yoga,
Effects of Tai Chi exercise on cancer-related fatigue in patients with nasopharyngeal carcinoma undergoing chemoradiotherapy: a randomized controlled trial.
Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer.
Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial.
Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention.
(n=7) with or without exercise interventions. Most studies took place in clinical or hospital-based settings (n=25), with few either being community-based
Effectiveness of two web-based interventions for chronic cancer-related fatigue compared to an active control condition: results of the "Fitter na kanker" randomized controlled trial.
Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial.
A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients.
J Am Coll Surg.2012; 214 ([discussion: 475-7]): 463-475
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