{"id":26680,"date":"2019-03-25T10:44:47","date_gmt":"2019-03-25T10:44:47","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=26680"},"modified":"2020-04-23T10:16:57","modified_gmt":"2020-04-23T10:16:57","slug":"effect-of-physiohterapy-on-fatigue-and-psychological-stress-in-cancer-patients-during-the-course-of-chemotherapy","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol12no1\/effect-of-physiohterapy-on-fatigue-and-psychological-stress-in-cancer-patients-during-the-course-of-chemotherapy\/","title":{"rendered":"Effect of Physiohterapy on Fatigue and Psychological Stress in Cancer Patients During the Course of Chemotherapy"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

A generic term for a large group of diseases, cancer is characterized by the growth of abnormal cells beyond their usual boundaries which then invades adjoining parts of the body and spread to other organs. Regular exercise, adequate intake of food, avoiding alcohol and tobacco and smoking, proper body mass index and avoidance of key risk factors prevents cancer related mortality, reduces disability, suffering and death. Chemotherapy which is used to lessen and shrink the tumour, stops the risk of cancer related health issues. Common side effects caused by chemotherapy include-<\/p>\n

Fatigue, anaemia, hair-loss, muscle and nerve problems such as numbness, tingling and pain.<\/p>\n

Mechanisms explaining development of fatigue include fluid and electrolyte imbalance, pain, weight loss, drugs acting on central nervous system. Impaired muscular function due to inactivity and prolonged bed rest results in loss of muscle mass and plasma volume and a reduction of cardiac output. Consequently after discharge patients need to make greater efforts to carry out normal activities. Pharmacologic treatment though showing results also has side effects.<\/p>\n

Studies report that exercising reduces fatigue during and after treatment thereby rendering gain in muscle mass, improved lung ventilation-perfusion ratio, increasing the concentration of oxidative enzymes in our body inturn reducing fatigue and improving physical performance.<\/p>\n

Physiotherapy is defined as a systematic method of assessing musculoskeletal, neurological,<\/p>\n

Generally, after cancer treatment, the patients tend to become weak and have decreased physical activity. A structured physiotherapy intervention tends to not only make them physically active but also improves their quality of life.<\/p>\n

Pharmacologic treatment of cancer-related fatigue has not shown convincing results.<\/p>\n

Studies have reported that exercise can prevent the manifestation and reduce the intensity of fatigue in cancer patients during and after treatment.<\/p>\n

It has been observed patients participating in a training program are more self-confident and have an improved mood as exercise leads them to a better performance status and thus to higher levels of physical independence.<\/p>\n

There is not much evidence documented on effect of physiotherapy on fatigue in cancer patients undergoing chemotherapy.<\/p>\n

This research was conducted to examine the effect of physiotherapy in cancer patients during chemotherapy.<\/p>\n

Participants:<\/p>\n

35 women diagnosed with breast cancer receiving chemotherapy, of age-group 40-50yrs in Krishna Hospital had participated in this study. They were bounded in a single age group. The pre-outcome measures Brief Fatigue Inventory, Brief Pain Inventory, Cohen Perceived Stress Scale, Borg Scale. Pain assessment was done using the Brief Pain Inventory, fatigue was measured by Brief Fatigue Inventory, psychological stress measured using the Cohen perceived stress scale and exertion level was measured using Borg scale. Specific exercise protocol was given to subjects which included TENS exercises, stretching and 6minute walk.<\/p>\n

Outcome Measures<\/strong><\/p>\n

Brief Fatigue Inventory<\/strong><\/p>\n

The Brief Fatigue Inventory is a questionnaire designed to assess fatigue levels in cancer patients. It consists of 6 interference items relating to quality of life including general activity, mood, relations with other people, normal work, enjoy-ment in life and walking ability in the past 24 hours.<\/p>\n

Brief Pain Inventory<\/strong><\/p>\n

Developed by Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care, the Brief Pain Inventory assess the severity of pain in cancer patients. It focuses on 7 activities of daily living i.e. sleep, relations with other people, general activity, mood, walking ability, normal work and enjoyment in life.<\/p>\n

Cohen Perceived Stress Scale<\/strong><\/p>\n

Developed by Sheldon Cohen, the Cohen Perceived Stress Scale is used for assessing the perception of stress. It consists of 10 questions wherein one rates each question from 0 to 4, in which 0 indicates almost never and 4 indicates very often.<\/p>\n

Rate of Perceived Exertion<\/strong><\/p>\n

The Borg Rating of Perceived Exertion is a scale used to measure intensity of exertion after a physical activity. The rating ranges between 7-20, with 7 indicating very very light and 19 indicating very very hard.<\/p>\n

Materials and Methodology<\/strong><\/p>\n

Materials used<\/strong><\/p>\n

TENS<\/p>\n

Plinth<\/p>\n

Stop watch<\/p>\n

Chair<\/p>\n

Sphygmomanometer<\/p>\n

Stethoscope<\/p>\n

Pulse oximeter<\/p>\n

Methodology <\/strong><\/p>\n

Study Type<\/strong><\/p>\n

This study was an experimental study.<\/p>\n

Study Design<\/strong><\/p>\n

This study was: Comparative study (Pre-treatment and Post treatment)<\/p>\n

Place of Study<\/strong><\/p>\n

Department of Physiotherapy and Department of medicine, Krishna Hospital, Karad Sampling methods:<\/p>\n

Simple Random Sampling<\/p>\n

Sample size: n = 4pq\/L2<\/sup><\/p>\n

n=35<\/p>\n

Inclusion Criteria<\/strong><\/p>\n

Age group: 40-50yrs Ca. Patients.<\/p>\n

Exclusion Criteria <\/strong><\/p>\n

Relapse cases.<\/p>\n

Any cardiovascular disease.<\/p>\n

Outcome Measures<\/strong><\/p>\n

Brief Pain Inventory<\/p>\n

Brief Fatigue Inventory<\/p>\n

Cohen Perceived Stress Scale<\/p>\n

Rate of Perceived Exertion<\/p>\n

Procedure<\/strong><\/p>\n

A subject fulfilling the inclusion and exclusion criteria was included. Informed consent was taken from each of the subjects prior to the treatment. Instructions were given regarding the techniques to be performed. Prior to treatment, pain, fatigue and stress level was assessed by Brief Pain Inventory, Brief Fatigue Inventory and Cohen Perceived Stress Scale respectively. Accordingly patients were asked to follow a set protocol of exercises for 5 days a week for one month. The effect of physiotherapy on was noticed and post treatment assessment was done.<\/p>\n

Exercise protocol<\/strong><\/p>\n

Treatment<\/strong><\/p>\n

A 35-45min of protocol, will be given comprising of Warm-up exercises, 6 minute walk test, Harvard Step Test and TENS.<\/p>\n

The treatment will begin by giving the patients Warm-up exercises including Stretching.<\/p>\n

Stretching will be followed by 6 minute Walk Test, wherein we will be asking the patient to walk for 6 minutes as fast as he can.<\/p>\n

Patient\u2019s exertion level will then be checked by the Borg Scale.<\/p>\n

Next, Harvard Step Test will be used for further treatment for a period of 3minutes after which pulse rate of patient will be assessed.<\/p>\n

Lastly, TENS will be applied for 20minutes.<\/p>\n

During these 20 minutes, Relaxation will also be given.<\/p>\n

Statistical Analysis<\/strong><\/p>\n

Data of all outcome measures was measured as pre training & post training values.<\/p>\n

Arithmetic mean & standard deviation was calculated for each outcome measure.<\/p>\n

Arithmetic mean was derived from adding all the values together and dividing the total number of values.<\/p>\n

Standard deviation (SD) was calculated according to the following formula.<\/p>\n

\"FORMULA<\/p>\n

Where \u221a\u00a0\u00a0\u00a0\u00a0 = Square root of all the calculations under this symbol.<\/p>\n

X\u00a0\u00a0\u00a0 = the individual score.<\/p>\n

X\u00a0\u00a0\u00a0 = the mean score.<\/p>\n

\u2211\u00a0\u00a0\u00a0 = sum of all the calculations to the right.<\/p>\n

N\u00a0\u00a0\u00a0 = <\/strong>the total number of scores.<\/p>\n

Within group comparison was done by applying \u2018Paired t-test\u2019 to pre and post training values of same group for all outcome measures.<\/p>\n

\"FORMULA<\/p>\n

Where, d = the total of the difference<\/p>\n

(\u2211d) = the total of differences squared<\/p>\n

\u2211d = the total of differences squared differences.<\/p>\n

N = Number of the objects<\/p>\n

\u221a = the square root of the final calculation of everything under the Square Root sign.<\/p>\n\n\n\n
\"Figure<\/td>\nFigure 1: The diagram shows that 35females and 0 male subjects participated in the study.<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 2: The diagram shows that out of 35 females, 20 are in the age group between 40-45 yrs. and the remaining 15 lie in the age group 46-60 yrs.<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Data Analysis<\/strong><\/p>\n

Brief Pain Inventory<\/strong><\/p>\n\n\n\n\n
Group <\/strong><\/td>\nPre training <\/strong><\/td>\nPost training <\/strong><\/td>\nt value <\/strong><\/td>\np value <\/strong><\/td>\nSignificance <\/strong><\/td>\n<\/tr>\n
<\/td>\n71.90\u00b112.33<\/td>\n61.03\u00b111.47<\/td>\n7.028<\/td>\n<0.0001<\/td>\nES<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 3<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Interpretation<\/strong><\/p>\n

The above table and graph shows pre and post comparison within the group. Post training there was extremely significant improvement noted in both the groups according to the p values.<\/p>\n

Brief Fatigue Inventory<\/strong><\/p>\n\n\n\n\n
Group <\/strong><\/td>\nPre training <\/strong><\/td>\nPost training <\/strong><\/td>\nt value <\/strong><\/td>\np value <\/strong><\/td>\nSignificance <\/strong><\/td>\n<\/tr>\n
<\/td>\n53.83\u00b111.03<\/td>\n41.78\u00b113<\/td>\n9.57<\/td>\n<0.0001<\/td>\nES<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 4<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Interpretation<\/strong><\/p>\n

The above table and graph shows pre and post comparison within the group. Post training there was extremely significant improvement noted in both the groups according to the p values.<\/p>\n

ES: Extremely Significant.<\/p>\n

Cohen Perceived Stress Scale<\/strong><\/p>\n\n\n\n\n
Group<\/strong><\/td>\nPretreatment<\/strong><\/td>\nPosttreatment<\/strong><\/td>\nT Value<\/strong><\/td>\nP Value<\/strong><\/td>\nSignificance<\/strong><\/td>\n<\/tr>\n
<\/td>\n21.71\u00b12.27<\/td>\n19.86\u00b12.23<\/td>\n4.998<\/td>\n<0.0007<\/td>\nEs<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 5<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Interpretation:\u00a0 The above table and graph shows pre and post comparison within the group. Post training there was extremely significant improvement noted in both the groups according to the p values.<\/p>\n

Rate of Perceived Exertion<\/strong><\/p>\n\n\n\n\n
Group<\/strong><\/td>\nPretreatment<\/strong><\/td>\nPosttreatment<\/strong><\/td>\nT Value<\/strong><\/td>\nP Value<\/strong><\/td>\nSignificance<\/strong><\/td>\n<\/tr>\n
<\/td>\n12.49\u00b13.23<\/td>\n10.34\u00b12.94<\/td>\n8.945<\/td>\n<0.007<\/td>\nEs<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 6<\/strong><\/p>\n

 <\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Interpretation<\/strong><\/p>\n

The above table and graph shows pre and post comparison within the group. Post training there was extremely significant improvement noted in both the groups according to the p value.<\/p>\n

Discussion<\/strong><\/p>\n

This study \u201cEffect of Physiotherapy on Fatigue and Psychological stress in cancer patients during the course of chemotherapy\u201d was conducted to find out the effect of physiotherapy in cancer patients. A generic term for a large group of diseases, cancer is characterized by the growth of abnormal cells beyond their usual boundaries which then invades adjoining parts of the body and spread to other organs [1]<\/sup> Chemotherapy which is used to treat, cure, lessen and shrink the tumour stops or slows the growth of cancer cells. [2] <\/sup>Common side effects caused by chemotherapy include:<\/p>\n

Fatigue, anaemia, nerve and muscle problems such as numbness, tingling, and pain.[2]<\/sup><\/p>\n

The objectives of this study were determine the effect of exercises to reduce fatigue during the course of chemotherapy. To determine the effect of relaxation techniques for reducing psychological stress in cancer patients during the course of chemotherapy. To determine the effect of pain reducing agents in cancer patients during the course of chemotherapy.<\/p>\n

The study was conducted with 35 subjects. Prior consent was taken from them. The interventions were carried out for 5 days per week for 4 weeks. The outcome measures for this study were Brief Fatigue Inventory, Brief Pain Inventory, Cohen Perceived Stress Scale and Borg Scale.<\/p>\n

The subjects received TENS for pain, Stretching, Warm up and Exercises and Relaxation along with 6minute walk and Harvard Step for decreasing fatigue and psychological stress. The exercises were prescribed based on FITTs principle.<\/p>\n

This study showed that there was significant improvement in the outcome variables concluding that it decreases fatigue and stress.<\/p>\n

This was confirmed using statistical analysis by using \u2018Paired t- test\u2019.<\/p>\n

Brief Pain Inventory<\/strong><\/p>\n

Post training there was extremely significant improvement noted in reducing fatigue and psychological stress in cancer patients.<\/p>\n

p value = <0.0001.<\/p>\n

Brief Fatigue Inventory<\/strong><\/p>\n

Post training there was extremely significant improvement noted in reducing fatigue and psychological stress in cancer patients.<\/p>\n

p value = <0.0001.<\/p>\n

Cohen Perceived Stress Scale<\/strong><\/p>\n

Post training there was extremely significant improvement noted in reducing fatigue and psychological stress in cancer patients.<\/p>\n

p value = <0.0007.<\/p>\n

Rate of Perceived Exertion<\/strong><\/p>\n

Post training there was extremely significant improvement noted in reducing fatigue and psychological stress in cancer patients.<\/p>\n

p value = <0.0007.<\/p>\n

Post training improvement in fatigue and psychological stress is due to the fact that ]<\/sup>it produces gain in muscle mass and plasma volume, improved lung ventilation and perfusion, increased cardiac reserve, and a higher concentration of oxidative muscle enzymes thereby reducing fatigue and normalizing physical performance and release of happy hormones i.e. endorphins.[5]<\/sup> Improved physical performance can increase, independence and self-esteem of patients; which in turn can result in better social interaction and a reduction in anxiety and fear and secondary benefits like improved mood state.[5]<\/sup><\/p>\n

This suggests that physiotherapy is effective in reducing fatigue and psychological stress in cancer patients taking chemotherapy.<\/p>\n

Conclusion<\/strong><\/p>\n

We found physiotherapy was significantly effective in decreasing fatigue and psychological stress in cancer patients receiving chemotherapy.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

There is no conflict of Interest.<\/p>\n

Source of Funding<\/strong><\/p>\n

Krishna Institute of Medical Sciences Deemed to be University.<\/p>\n

Ethical Clearance<\/strong><\/p>\n

Study approved by Institutional Ethics Committee of Krishna Institute of Medical Sciences Deemed to be University.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Who.int\/cancer\/en<\/li>\n
  2. Www. cancer.gov<\/li>\n
  3. Smets E.,\u00a0Garssen B.,\u00a0Schuster-Uitterhoeve A.,\u00a0de Haes J.\u00a0Fatigue in cancer patients.\u00a0Br J Cancer.\u00a0<\/em>1993;68:220\u20134.
    \n    CrossRef<\/a><\/li>\n
  4. Winningham M. L.,\u00a0Nail L. M., Burke M. B.,\u00a0Brophy L.,\u00a0Cimprich B.,\u00a0Jones L., et al.\u00a0Fatigue and the cancer experience: the state of the knowledge.\u00a0Oncol Nurs Forum.\u00a0<\/em>1994;21:23\u201336.<\/li>\n
  5. \u00a0 Dimeo M. D. C. F Effects of Exercise on Cancer-Related Fatigue. Cancer. 2001;92(6). version 5 of record online: 28 Sep.<\/li>\n
  6. Greenleaf J. E.,\u00a0Kozlowsky S.\u00a0Physiological consequences of reduced physical activity during bed rest. In:\u00a0Terjung RL.\u00a0Exercise Sport Science Reviews.<\/em> 1982;10:84. Philadelphia: Franklin Institute Press.<\/li>\n
  7. Germain P.,\u00a0Guell A.,\u00a0Marini J. F.\u00a0Muscle strength during bedrest with and without muscle exercise as a countermeasure.\u00a0Eur J Appl Physiol.\u00a0<\/em>1995;71:342\u20138.
    \n    CrossRef<\/a><\/li>\n
  8. Levine B. D.,\u00a0Zuckerman J. H.,\u00a0Pawelczyk J. A.\u00a0Cardiac atrophy after bed-rest deconditioning: a nonneural mechanism for orthostatic intolerance.\u00a0Circulation.\u00a0<\/em>1997;96:517\u201325.
    \n    CrossRef<\/a><\/li>\n
  9. \u00a0Salmon\u00a0G. P.,\u00a0Swank M. A. JEP online. Exercise-based disease management guidelines for individuals with\u00a0 cancer: potential applications in a high-risk mid-southern state.\u00a02002.<\/li>\n
  10. \u00a0Loh J and Gulati A\u00a0The use of transcutaneous electrical nerve stimulation (TENS) in a major cancer centre for the treatment of severe cancer-related pain and associated disability.\u00a02017;10.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction A generic term for a large group of diseases, […]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[63],"tags":[],"class_list":["post-26680","post","type-post","status-publish","format-standard","hentry","category-vol12no1"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/26680","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=26680"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/26680\/revisions"}],"predecessor-version":[{"id":32364,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/26680\/revisions\/32364"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=26680"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=26680"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=26680"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}