很少癌症病患與其腫瘤科醫師討論運動


  【24drs.com】雖然越來越多證據認為運動可降低癌症風險且幫助恢復,病患對此似乎尚無所悉。
  
  根據刊載於7月疼痛與症狀處理期刊的一篇研究,許多癌症病患並未從事運動或和他們的腫瘤科醫師討論這項議題。
  
  已確定的是,對於體弱者及年長者、慢性病與虛弱患者,即使是低強度運動,都可有效改善功能和控制症狀。梅約診所物理醫學和復健副教授Andrea L. Cheville醫師他們的研究發現是,病患並未運動;一般大眾不運動,當其發生可能致命的疾病時,也不會想到要運動。
  
  Cheville醫師指出,醫師通常告訴病患運動很重要,但我們不知道腫瘤科醫師是否與他們的病患討論這些。
  
  例如,研究認為運動改善癌症相關的疲勞,這是癌症病患最常見的症狀。Cheville醫師表示,如國家綜合癌症網絡的治療指引將運動納入為對抗疲勞的策略,但是,這項訊息並未傳遞給病患。
  
  這篇研究中,絕大多數病患將日常活動視為他們的運動來源,並不暸解日常活動的運動量最小;他們大多也不知道從事運動可獲得理想效益,如耐力、增加強度與減少症狀。
  
  研究對象也指出會相當接受腫瘤醫師的指引,但沒有人有接受任何有關運動的建議或資訊,只有「保持活動」這類一般鼓勵言語。
  
  相當多研究顯示積極治療期間與結束後的運動,都可改善病患的生活品質;最近發表的兩篇回顧提出了更強力的證據(Cochrane Database Syst Rev. 2012;8:CD008465, CD007566)。
  
  這兩篇都發現,運動有許多和生活品質相關的健康助益,包括癌症方面的特定考量、體型/自尊、情緒健康、性生活、睡眠、社會功能;此外,運動可降低焦慮、疲勞與疼痛。
  
  Cheville醫師解釋,沒有人研究病患對運動的暸解程度,這是首次系統性檢視末期癌症病患對於「自己的癌症與症狀和運動之關聯」的認知研究。
  
  儘管這是小型研究且僅包括末期肺癌病患,Cheville醫師認為研究結果可以在一定程度上擴展到更多癌症病患。
  
  Cheville醫師等人對20名第III B期或第IV期非小細胞肺癌病患進行了半結構式訪談,並定性分析了相關資料;研究對象來自202名末期肺癌存活世代,以每月電話訪談方式瞭解其活動程度和生理功能。
  
  詢問研究對象的活動程度、症狀對活動的影響、有礙促進運動的障礙、健康照護專業人士提供的運動相關導引。
  
  Cheville醫師指出,運動的臨床試驗和現實生活確實脫節,有一些不錯的研究,但是並未切中實際的病患照護,並未落實這些方法。
  
  我們可以如何教育病患,特別是那些發生癌症前不運動者?她指出,應改變行為,而不只是諮商,且病患需要一個支持系統。
  
  運動目標要切合實際,且依個人情況修正。Cheville醫師等人寫道,這篇研究結果顯示,在其他方面,需考量病患一般的運動程度,以及他們的教育程度、天氣等可能的障礙因素,腫瘤科醫師參與於鼓勵和討論運動。
  
  至少有一項社會實務致力於讓病患不要只有一般的日常活動;Frederick C. Tucker Jr.醫師在他的開業處開始一項體適能計畫,免費開放病患參加且由專業的訓練師引導。
  
  Tucker醫師在夏威夷完成了2次鐵人三項競賽,在聽到他的病患描述久坐生活型態後開始了這項計畫;這項計畫從5月開始,當時Tucker醫師問他的健身房老闆是否可以為他的病患設計一套溫和的運動計畫。
  
  Tucker醫師在新聞稿中表示,現在已經很清楚,失調是癌症患者的一個嚴重問題,活動減少意味著生活品質降低,並造成其他治療上的問題;依個別病患的能力規律運動,維持強度與靈活度,參與運動課程已成為情緒與社會支持的另一個來源。
  
  根據新聞稿,整體而言,病患參與計畫且發現氣氛融洽與支持。許多人表示,運動計畫也幫助他們增加能量、靈活度與心智專注力。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6937&x_classno=0&x_chkdelpoint=Y
  

Few Cancer Patients Discuss Exercise With Their Oncologists

By Roxanne Nelson
Medscape Medical News

September 7, 2012 — Although a growing body of evidence has demonstrated that exercise lowers the risk for cancer and aids in recovery, it seems that the message is not reaching patients.

Many cancer patients do not engage in physical activity or discuss the subject with their oncologists, according to a study published in the July issue of the Journal of Pain and Symptom Management.

It has been well established that physical activity and exercise, even at low intensities, effectively improve functioning and control symptoms in frail and elderly patients and in those with chronic and debilitating illnesses. "But what we found in our study is that the patients were not exercising," said lead author Andrea L. Cheville, MD, associate professor of physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minnesota. "As a population, we don't exercise, and when people develop a potentially lethal illness, they don't think about exercise."

Dr. Cheville pointed out that physicians "often tell patients that getting exercise is important. But we don't know if oncologists are discussing this with their patients."

For example, research suggests that exercise improves cancer-related fatigue, one of the most prevalent symptoms reported by cancer patients. "Treatment guidelines, such as those from the National Comprehensive Cancer Network, include exercise as a strategy for fatigue," Dr. Cheville said. "But this information may not be reaching the patients."

In this study, the patients overwhelmingly cited usual daily activities as their source of exercise and did not realize that daily activities tend to require minimal effort. They were also largely unaware that engaging in physical activity could produce desirable benefits such as endurance, increased strength, and a reduction in symptoms.

Participants also reported a strong preference for receiving guidance from their oncologist, but none reported receiving any advice or information about exercise, other than general encouragement to ''stay active.''

Evidence of Benefit

A plethora of studies have shown that exercise, both during and after the end of active treatment, can improve quality of life for patients. The evidence was strengthened with the recent publication of 2 reviews (Cochrane Database Syst Rev. 2012;8:CD008465, CD007566).

Both found that exercise has a beneficial effect on a number of health-related quality-of-life domains, including cancer-specific concerns, body image/self-esteem, emotional wellbeing, sexuality, sleep disturbance, and social functioning. In addition, exercise was found to reduce anxiety, fatigue, and pain.

Nobody has studied what patients know about exercise, Dr. Cheville explained. This is the first systematic examination of beliefs held by patients with advanced cancer "about the interrelationships among their cancers, their symptoms, and exercise."

Despite the fact that this was a small qualitative study and only included patients with advanced lung cancer, Dr. Cheville feels that the results can be extrapolated, to some degree, to the larger population of cancer patients.

Disconnect Between Trials and the Real World

Dr. Cheville and colleagues conducted semistructured interviews with 20 patients with stage IIIB or IV nonsmall-cell lung cancer and qualitatively analyzed the data. The participants were recruited from 202 surviving members of a cohort of patients with late-stage lung cancer whose activity levels and physical function were being monitored with monthly telephone calls.

Participants were asked about activity levels, the influence of their symptoms on their activities, perceived barriers to and facilitators of exercise, and exercise-related instructions that they received from their healthcare professionals.

There is a real disconnect between clinical trials of exercise and the real world.

"There is a real disconnect between clinical trials of exercise and the real world," Dr. Cheville noted. "There is all this great research, but it's not hitting the road, where patients get care. It is not making its way into these settings."

"How can we educate patients, especially those who did not exercise before developing cancer?" she asked. "Changing behavior requires more than just counseling, and patients need a support system," she noted.

Exercise goals need to be realistic and adjusted for individual circumstances. The findings from this study show that among other things, patients' usual levels of activity need to be considered, as do their education level, potential barriers such as weather, and the engagement of oncologists in encouraging and discussing exercise, Dr. Cheville and coauthors write.

One Success Story

At least one community practice is making an effort to get its patients moving beyond normal daily activities. Frederick C. Tucker Jr., MD, has begun a gentle fitness program at his practice in Fredericksburg, Virginia. It is open to patients at no extra charge and is led by professional trainers.

Dr. Tucker, who has finished 2 Ironman triathlons in Hawaii, initiated the program after hearing his patients describe their sedentary lifestyles. The program began in May, when Dr. Tucker asked the owner of his own gym if she could design a gentle program for his patients.

"It has become clear that deconditioning is a serious problem for cancer patients. Decreased activity means decreased quality of life and contributes to other complications of treatment," Dr. Tucker said in a press release. "Regular exercise, scaled to each patient's ability, maintains strength and flexibility, and participation in the exercise class has become another source of emotional and social support."

Overall, the patients appear to enjoy the program and find the atmosphere welcoming and supportive, according to the press release. Several report that the exercise program has also helped increase their energy, flexibility, and mental focus.

The study was funded by a grant from the Fraternal Order of Eagles. The authors have disclosed no relevant financial relationships.

J Pain Symptom Manage. 2012;44:84-94.

    
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