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‘Patients with cancer performed significantly worse than we predicted’

Catherine Granger is a physiotherapist who studied how exercise can help patients with lung cancer recover faster after surgery.

Interview by Daniel Horsley
 

‘When I worked as a clinical physiotherapist my job was to rehabilitate patients with lung cancer after surgery.

I found that I was sending them home after the routine five days of rehab but they had made little improvement. They showed symptoms of shortness of breath and fatigue.

This slowed them right down and led to a really bad cycle where, because they were doing less, that in turn lowered their health and made it hard to exercise. They were still struggling and their fitness levels weren’t particularly high. I felt that there was a need for some sort of ongoing exercise program they could follow. 

Physical activity has proven to be positive for breast and colon cancer sufferers but there has been little study to show the same for patients with lung cancer. 

My team and I began an observational study to assess the physical activity levels of 50 just-diagnosed cancer patients and we monitored them at 10 weeks and then six months later. We then compared them to a group of 35 healthy volunteers. 

‘Treatment for patients with lung cancer can start as quickly as two weeks after diagnosis.’

So, patients were approached fairly quickly in order to record and capture a base line level before treatment. 

While it’s a difficult time for families when they are first approached to join the study, I found the consent rate was actually quite high. Of the 90 people who were approached, 60 joined the study. We then dropped 10 more because some had a type of lung cancer that we weren’t studying and the others had benign tumors. We were really amazed by people’s willingness to be involved.

There were no significant differences between consenters and non-consenters for age, gender, cancer stage or their rate in physical activity. They said they wanted to help people in the future and give back to the hospital. 

We started testing by asking patients to fill out a Physical Activity Scale for the Elderly (PASE).

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PASE is a standard questionnaire used in many studies to show how much activity a patient has done over the previous weeks. 

We also did a test which measures how far the patients could walk in six minutes. They then wore an accelerometer for five days.

This data was compared to recommended World Health Organisation (WHO) physical activity guidelines. This measured and recorded the number of steps taken, how long they were walking for and how far. Results showed that our clients weren’t recovering to their regular base line levels of physical activity before they had surgery.

None of the participants were given any exercise training because we wanted a true estimate of how people do physical activity. Results showed that cancer sufferers were less physically active than healthy individuals. There was a strong correlation between patients suffering significant deterioration and their decline in the six-minute walk distance test.

The most frequent form of exercising was walking, while the healthy group were doing more varied activities like cycling, dancing and golf. The healthy group was recorded at an average of 8537 steps while patients with cancer were at an average of 6047. 

Patients with cancer performed significantly worse than we predicted. Strength was significantly worse in those patients.

‘Everyone in the healthy group had normal nutrition while only 59 per cent of patients with cancer were normal.’

Everyone in the healthy group had normal nutrition, while only 59 per cent of patients with cancer were normal. 

Only 40 per cent of patients with cancer met the WHO physical activity guidelines before treatment, compared with 54 per cent of the general Australian population. The healthy group met the guidelines at 71 per cent. 

The benefit these results give us is that we now have pilot data to support the need to do an interventional study providing an exercise program to patients. This next study aims to apply a few different interventions which could be done to improve recovery including exercise training, addressing behavioural changes and motivational interviewing. 

If exercise programs are beneficial, then we can recommend that to doctors and nurses and physios. But right now we don’t quite know that yet.’

Catherine Granger’s PhD is titled: “Engagement in physical activity following a diagnosis of non-small cell lung cancer.”

*My PhD is an irregular series in which The Citizen speaks with recet Melbourne University PhD graduates.

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