It is estimated that there were 19.3 million newly diagnosed cancer cases and almost 10
million cancer-related deaths globally in 2020. Despite the numerous advances in cancer
treatment, cancer incidence and mortality have been increasing over the years, thus
making cancer one of the greatest health threats to human beings.
In recent decades, the advent of novel therapies in cancer has significantly prolonged
the survival of oncological patients, yet many of these individuals are left with
residual deficits, particularly motor and neurological, as well as cancer-related fatigue
and depression.
Exercise-based cancer rehabilitation is one of the main strategies which has been proved
to be an effective way to improve the quality of life of cancer survivors. There are
three main types of exercise training included as part of cancer rehabilitation:
resistance exercise, aerobic exercise, and the combination of both. Furthermore,
cognitive, and psychological support during this period might have a synergistic effect
with physical activity.
Although rehabilitation procedures are very well established after cardiovascular and
neurological events, such as myocardial infarction or stroke, their role in oncology has
only marginally been investigated nor completely accepted by the medical community.
Nevertheless, cumulating evidence with clinical experience suggests that physical
activity has emerged as an important complementary supportive care for cancer patients
and can improve the care of patients with cancer and their quality of life.
General clinical guidelines recommend that cancer rehabilitation begins ideally at the
time of cancer diagnosis and continues through and beyond cancer treatment, but this is
rarely done in clinical practice.There has been an effort to conduct qualitative studies
to evaluate the effects of physical activity on cancer patients, with a particular focus
on factors influencing an active lifestyle in cancer patients during or right after
conclusion of oncological treatments. Most of these studies have been regrouping patients
with a specific cancer type, with a particular focus on breast cancer. Nevertheless, it
is relatively difficult to gain evidence from single qualitative studies on it owns,
mostly due to the variety of qualitative methodologies employed and the lack of
consistent results.
The principal aim of cancer rehabilitation is to help patients regain functioning,
promote their independence and to increase their social participation, no matter how long
or short the timescale. To evaluate and optimize rehabilitation, it is therefore very
important to measure its outcomes in a structured and reproducible way. In recent
exercise guidelines, most of the available evidence on the efficacy of oncology
rehabilitation is derived from randomized controlled trials (RCTs), which have
strengthened the body of proof for the efficacy of exercise in cancer rehabilitation, but
on the other side they have been reported to lack generalizability to the clinical
setting. In these trials, patients often must meet pre-specified criteria (e.g.,
diagnosis, disease stage, age) to be eligible for enrolment in RCTs and must give consent
to participate. This might bias results toward a healthier, fitter, and more motivated
population, which may not be comparable to a broader population of cancer survivors.
While RCTs have the most powerful study design to investigate the efficacy of
rehabilitation in a specific population under ideal circumstances, observational studies
may be more appropriate to evaluate interventions in daily practice and in more
heterogeneous populations with complex, chronic diseases such as cancer.
A major determinant of functional capacity is exercise behaviour. The beneficial effects
of physical exercise have been shown to improve multiple aspects of health in cancer
survivors, including quality of life, fatigue, as well as all cause and cancer specific
mortality.
Physical impairments and psychosocial symptoms should be assessed and treated
concomitantly, and lifestyle and exercise interventions provided to optimize functioning
and quality of life (QoL). Quality of life can be defined as a multidimensional structure
that reflects a person's subjective evaluation of their well-being and functioning across
multiple life domains, and each of these should be specifically addressed by cancer
support services. According to Ferrans, five dimensions of QoL have been described:
physical; functional; psychological/emotional; social; and spiritual. Ideally, all these
dimensions should be explored in cancer patients in relation to exercise.
Metanalysis across several studies have shown that patients noticed consistent
improvements in their physical and psychological functioning and health. Furthermore,
many patients have reported that exercise has helped them to better manage the physical
consequences of cancer and its treatment, contributing to their overall fitness.