Keywords
orthopedics and traumatology
malignant tumor
muscle weakness
lower limb
gait impairment
How to Cite
Abstract
In press
Background. Oncologic joint endoprosthetic replacement imposes increased demands on rehabilitation, as patients, in addition to orthopedic sequelae, frequently experience asthenia and cancer-related fatigue encompassing physical, emotional, and cognitive components, which significantly reduces quality of life.
Aim. To evaluate the effectiveness of a developed physical therapy program in patients with the consequences of oncologic knee endoprosthetic replacement based on indicators of asthenia and parameters of cancer-related fatigue.
Materials and Methods. The study included 7 participants who underwent surgery for osteosarcoma of the distal femur. The physical therapy program was implemented for 12 weeks (strength exercises for extremities and trunk, gait training, correction of individual functional impairments). Outcomes were assessed using the six-minute walk test, handgrip and deadlift dynamometry, and the EORTC QLQ-FA12 questionnaire (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire cancer-related FAtigue (12 items)). Parametric statistical methods (the Student’s t-test) were applied for normally distributed variables, whereas the Wilcoxon signed-rank test was used for non-normally distributed data. The study constitutes a component of the research project «Improvement of Functional Status, Quality of Life, and Correction of Pathological Conditions of Various Origins by Means of Therapy and Rehabilitation», State Registration No.0123U01534, conducted at Vasyl Stefanyk Сarpathian National University (2023–2026).
Research Ethics. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki (1964–2024), with informed consent obtained from all participants. The study protocol was approved by the institutional bioethics committee.
Results. Following the physical therapy program, the distance covered in the six-minute walk test increased by 23.3% (p<0.001), while the median fatigue level according to the Borg scale decreased by 30.8% (p<0.05). Handgrip strength increased by 6.7 kg in males and by 6.3 kg in females (p<0.001). Deadlift strength increased by 19.6 kg in males (p<0.05) and by 8.2 kg in females (p<0.001). According to the QLQ-FA12 questionnaire, a reduction in symptoms was observed across all domains; the total score decreased from 81 to 59 (27.2%; p<0.05).
Conclusions. A functionally oriented physical therapy program is effective in reducing cancer-related fatigue and asthenia in patients after oncologic knee endoprosthetic replacement, improving exercise tolerance and muscle strength while decreasing the impact of fatigue on daily life.
Keywords: physical therapy and rehabilitation, orthopedics and traumatology, malignant tumor, muscle weakness, lower limb, gait impairment.
References
Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients with Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2021;61(1):167-189.e14. DOI: 10.1016/j.jpainsymman.2020.07.037. PMID: 32768552.
Ebeid WA, Abo-Senna WG, Hasan BZ, Badr IT, Mesregah MK. Functional and oncological outcomes of limb-salvage surgery for foot and ankle tumors. Foot (Edinb). 2019;41:34-8. DOI:10.1016/j.foot.2019.06.007. PMID: 31678860.
Gazendam AM, Schneider P, Heels-Ansdell D, Bhandari M, Busse JW, Ghert M. Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction. Curr Oncol. 2022;29(10):7598-606. DOI: 10.3390/curroncol29100600. PMID: 36290877.
Bower JE. Cancer-related fatigue – mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597-609. DOI: 10.1038/nrclinonc.2014.127. PMID: 25113839.
Dong B, Qi Y, Lin L, Liu T, Wang S, Zhang Y, et al. Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis. J Orthop Sports Phys Ther. 2023;53(6):343-52. DOI: 10.2519/jospt.2023.11251. PMID: 36947532.
Yang L, Morielli AR, Heer E, Kirkham AA, Cheung WY, Usmani N, et al. Effects of Exercise on Cancer Treatment Efficacy: A Systematic Review of Preclinical and Clinical Studies. Cancer Res. 2021;81(19):4889-95. DOI: 10.1158/0008-5472.CAN-21-1258. PMID: 34215623.
Dimeo F, Schwartz S, Wesel N, Voigt A, Thiel E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-9. DOI: 10.1093/annonc/mdn068. PMID: 18381369.
Tunn PU, Pomraenke D, Goerling U, Hohenberger P. Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours – a comparative analysis using the MSTS score, the TESS and the RNL index. Int Orthop. 2008;32(5):619-25. DOI:10.1007/s00264-007-0388-8. PMID: 17701173.
Zhao YL, Zhang HR, Zhang JY, Hu YC. Postoperative Functional Assessment in Patients with Tumors Around the Knee Treated with Endoprosthetic Reconstruction: A Multicenter Retrospective Cohort Study. Technol Cancer Res Treat. 2023;22:15330338231181283. DOI: 10.1177/15330338231181283. PMID: 37321206.
Rakaieva AE, Aravitska MG. Study of the effectiveness of rehabilitation intervention for the correction of symptoms of asteno-vegetative syndrome in elderly persons with the consequences of coronavirus infection. Rehabilitation and Recreation. 2024;18(3):41-50. DOI: 10.32782/2522-1795.2024.18.3.4.
Weis J, Tomaszewski KA, Hammerlid E, Ignacio Arraras J, Conroy T, et al. International Psychometric Validation of an EORTC Quality of Life Module Measuring Cancer Related Fatigue (EORTC QLQ-FA12). J Natl Cancer Inst. 2017;109(5):10.1093/jnci/djw273. DOI: 10.1093/jnci/djw273. PMID: 28376231.
Mustian KM, Alfano CM, Heckler C, et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017;3(7):961-8. DOI: 10.1001/jamaoncol.2016.6914. PMID: 28253393.
Penna GB, Otto DM, da Silva TC, Pedroni AS, Macagnan FE. Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment: a systematic review with meta-analysis. Support Care Cancer. 2023;31(2):129. DOI:10.1007/s00520-022-07549-7. PMID: 36683104.
Khan F, Amatya B, Pallant JF, Rajapaksa I, Brand C. Multidisciplinary rehabilitation in women following breast cancer treatment: a randomized controlled trial. J Rehabil Med. 2012;44(9):788-94. DOI: 10.2340/16501977-1020. PMID: 22858869.
Saebye C, Amidi A, Keller J, Andersen H, Baad-Hansen T. Changes in Functional Outcome and Quality of Life in Soft Tissue Sarcoma Patients within the First Year after Surgery: A Prospective Observational Study. Cancers (Basel). 2020;12(2):463. DOI: 10.3390/cancers12020463. PMID: 32079176.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.