Where possible, aim for 3x 30 minutes of exercise per week, building to 150 minutes of exercise. This may not be achievable for all people with advanced cancer, especially those towards end of life care. In this case, encourage patients to avoid inactivity and sedentary behaviour.
Ensure a comprehensive medical history is taken to account for co-morbidities and prognosis
Patient goal setting is important
Important to also consider prognosis and disease trajectory
Aim often to maintain current level of function or reduce rate of deterioration
Complete a comprehensive assessment of function including activities of daily living, falls risk, and gait.
For patients admitted to a palliative care unit, often assessment of function needs to be gathered over a number of time points to get an accurate reflection of a patient’s function (which may fluctuate over time)
Limited guidance exists for exercise in advanced cancer. However, benefits of exercise in advanced cancer do not appear to depend on the exercise mode (ie aerobic vs strength). Choose modality based on clients goals and preferences.
A function-based exercise approach may be warranted depending on individual needs
Multidisciplinary input from the broader team, including palliative care physician, occupational therapy, dietitian, pastoral care, nursing staff and social worker is frequently required when working with people with advanced cancer. In addition, working with family members and carers is also important.
Functional decline is common in patients approaching the end of life. There are many contributing factors to functional decline and decreased mobility, including generalised de-conditioning (weakness and endurance), depressed mood, pain and fatigue. Other co-morbidities, the disease process and treatment effects can also contribute to this loss of function.
Patients who have an element of functional decline are often at a higher risk of falling- falls prevention strategies are an important element of rehabilitation in this population.
Fatigue is common symptom in patients with a life- limiting or chronic diseases. There is a wealth of evidence that shows that exercise is effective in managing cancer-related fatigue throughout the cancer journey.