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Role of exercise to prevent fatigue and improve quality of life in localized prostate cancer patients undergoing radiation therapy
Proceedings of the 45th Annual ASTRO Meeting
2172
Role of Exercise to Prevent Fatigue and Improve Quality of Life in Localized Prostate Cancer Patients Undergoing Radiation Therapy
U. Monga,1,2 S.L. Garber,1,3 J. Thornby,1 J. Johnston,1 C. Vallbona,3,4 T.N. Monga4,3 1
Radiotherapy, Houston VA Medical Center, Houston, TX, 2Radiology, Baylor College of Medicine, Houston, TX, 3Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 4Rehabilitation Care Line, Houston VA Medical Center, Houston, TX Purpose/Objective: To prevent fatigue and improve quality of life with a cardiovascular conditioning exercise program in patients with localized prostate cancer receiving radiotherapy. Materials/Methods: A prospective IRB approved randomized study. Twenty-one patients were assigned to a structured exercise group (n-11) or a control no exercise group (n⫽10). Assessments were carried out prior to starting and at the completion of radiotherapy. Instruments used included: Cardiac Fitness as measured by Metabolic Equivalents (METS); Piper Fatigue Scale (PFS); Beck Depression Inventory (BDI); and Functional Assessment of Cancer Therapy-Prostate (FACT-P). Lower extremity strength and flexibility also were assessed. Post-Pre changes within each group were assessed using paired-difference t-tests. These changes were compared between the two groups using two-sample t-tests. Each comparison was intended to stand on its own, so P-values were not adjusted for the large number of comparisons performed. Results: Before radiotherapy, there were no significant differences among all the above variables between the two groups. For the exercise group, significant improvements were noted at completion of radiotherapy for the following variables: cardiac fitness as measured by METs (p⬍ 0.0001); Piper Fatigue Scale scores (p⬍0.02); FACT-P (p⬍0.04), Physical Well Being (p⬍0.001) and Social Well Being (p⬍0.02) subscales of FACT-P. Similarly flexibility and lower extremity muscle strength showed significant improvement (p⬍0.005; p⬍0.001 respectively). For the control group, there was a significant increase in Piper Fatigue Scale scores (p⬍0.004) (indicating more fatigue) at completion of radiotherapy as compared to fatigue before starting radiotherapy. However, no significant changes were noted for any of the other variables at completion of radiotherapy as compared to before radiotherapy in this group. When the two groups were compared with respect to their changes from prior to radiotherapy to post completion radiotherapy, significant differences for METs (p⬍0.005), Strength (p⬍0.0002), Flexibility (p⬍0.01), scores on Piper Fatigue Scale (p⬍0.0001), Physical Well Being subscale of FACT-P (p⬍0.0005), Social Well Being subscale of FACT-P (p⬍0.002), Functional Well Being subscale of FACT-P (p⬍0.04) and FACT-P (p⬍0.005) were noted. No significant changes were observed for the Beck Depression Inventory. Conclusions: A structured 8 weeks aerobic exercise program in localized prostate cancer patients undergoing radiotheray prevents fatigue, improves cardiovascular fitness, flexibility, muscle strength and overall QOL. It is suggested that localized prostate cancer patients should be given the opportunity to participate in a cardiovascular conditioning exercise program during their radiotherapy treatment.
2173
Prostate Brachytherapy and Pain?
B.J. Moran, J. Visockis, P. Geary, M. Gurel Radiation Oncology, Chicago Prostate Cancer Center, Westmont, IL Purpose/Objective: To identify the true incidence of pain associated with transperineal ultrasound guided prostate brachytherapy (PB). Materials/Methods: Between November 25, 2002 and January 8, 2003, 114 consecutive patients underwent PB at a single institution. Using the National Cancer Institute’s pain intensity scale, patients verbally reported the level of pain they experienced in 4 areas: pre-operative room, recovery room, discharge and at time of post-operative phone call, which occurs the next working day following implant. On this 0-10 numeric pain intensity scale, O represents “no pain” and 10 is equivalent to the “worst possible pain”. Note that pre-operative pain was not limited to that related to prostate cancer, but included any type of pain from headache to arthritis. General anesthesia was used, however, narcotics and benzodiazopines were not. Each patient’s pain rating was documented by a nurse within that specific area, as well as location of pain and any action taken to alleviate pain. Results: Mean pain ratings for the pre-operative room, recovery room, time of discharge and at time of post-operative phone call were .54 ⫾ 1.62, 1.00 ⫾ 1.76, .59 ⫾ 1.09 and .46 ⫾ 1.02, respectively. Arthritis was the most common type of pain reported in the pre-operative area. Perineal discomfort, followed by urethral burning were the first and second most commonly reported sites of pain in all 3 of the remaining study areas. Table 1 clearly demonstrates pain ratings and areas of pain reported by this study group. Of the 40/114 patients who experienced some degree of pain in the recovery room, 500 mg acetaminophen, administered to 17 patients, was the most frequently used method to alleviate pain. Of the 32/114 patients who continued to experience minimal pain at time of discharge, 25 refused further medication. At time of post-operative phone call, 27 patients indicated they still had slight pain, but 13 continued not to take any action. The remainder of patients seemed to do well with acetaminophen and/or applying ice packs to the perineum. Conclusions: Pain ratings in each area were exceptionally low. The highest pain rating was found in the recovery room, which is logical since the recovery room is where patients will immediately begin to feel the effects of the procedure. Moreover, perineal soreness is expected since this is the site of needle insertion, as is urethral burning, due to post-implant cystoscopy. Further, because this slight discomfort is easily controlled with acetaminophen and/or ice packs, it is easy to see why some patients choose not to take any action and bear the slight pain. Typically, pain ratings of 3 or less are considered acceptable. Therefore, to have 1.00 as the highest mean rating suggests pain associated with PB is negligible.
S445
2172
Role of Exercise to Prevent Fatigue and Improve Quality of Life in Localized Prostate Cancer Patients Undergoing Radiation Therapy
U. Monga,1,2 S.L. Garber,1,3 J. Thornby,1 J. Johnston,1 C. Vallbona,3,4 T.N. Monga4,3 1
Radiotherapy, Houston VA Medical Center, Houston, TX, 2Radiology, Baylor College of Medicine, Houston, TX, 3Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 4Rehabilitation Care Line, Houston VA Medical Center, Houston, TX Purpose/Objective: To prevent fatigue and improve quality of life with a cardiovascular conditioning exercise program in patients with localized prostate cancer receiving radiotherapy. Materials/Methods: A prospective IRB approved randomized study. Twenty-one patients were assigned to a structured exercise group (n-11) or a control no exercise group (n⫽10). Assessments were carried out prior to starting and at the completion of radiotherapy. Instruments used included: Cardiac Fitness as measured by Metabolic Equivalents (METS); Piper Fatigue Scale (PFS); Beck Depression Inventory (BDI); and Functional Assessment of Cancer Therapy-Prostate (FACT-P). Lower extremity strength and flexibility also were assessed. Post-Pre changes within each group were assessed using paired-difference t-tests. These changes were compared between the two groups using two-sample t-tests. Each comparison was intended to stand on its own, so P-values were not adjusted for the large number of comparisons performed. Results: Before radiotherapy, there were no significant differences among all the above variables between the two groups. For the exercise group, significant improvements were noted at completion of radiotherapy for the following variables: cardiac fitness as measured by METs (p⬍ 0.0001); Piper Fatigue Scale scores (p⬍0.02); FACT-P (p⬍0.04), Physical Well Being (p⬍0.001) and Social Well Being (p⬍0.02) subscales of FACT-P. Similarly flexibility and lower extremity muscle strength showed significant improvement (p⬍0.005; p⬍0.001 respectively). For the control group, there was a significant increase in Piper Fatigue Scale scores (p⬍0.004) (indicating more fatigue) at completion of radiotherapy as compared to fatigue before starting radiotherapy. However, no significant changes were noted for any of the other variables at completion of radiotherapy as compared to before radiotherapy in this group. When the two groups were compared with respect to their changes from prior to radiotherapy to post completion radiotherapy, significant differences for METs (p⬍0.005), Strength (p⬍0.0002), Flexibility (p⬍0.01), scores on Piper Fatigue Scale (p⬍0.0001), Physical Well Being subscale of FACT-P (p⬍0.0005), Social Well Being subscale of FACT-P (p⬍0.002), Functional Well Being subscale of FACT-P (p⬍0.04) and FACT-P (p⬍0.005) were noted. No significant changes were observed for the Beck Depression Inventory. Conclusions: A structured 8 weeks aerobic exercise program in localized prostate cancer patients undergoing radiotheray prevents fatigue, improves cardiovascular fitness, flexibility, muscle strength and overall QOL. It is suggested that localized prostate cancer patients should be given the opportunity to participate in a cardiovascular conditioning exercise program during their radiotherapy treatment.
2173
Prostate Brachytherapy and Pain?
B.J. Moran, J. Visockis, P. Geary, M. Gurel Radiation Oncology, Chicago Prostate Cancer Center, Westmont, IL Purpose/Objective: To identify the true incidence of pain associated with transperineal ultrasound guided prostate brachytherapy (PB). Materials/Methods: Between November 25, 2002 and January 8, 2003, 114 consecutive patients underwent PB at a single institution. Using the National Cancer Institute’s pain intensity scale, patients verbally reported the level of pain they experienced in 4 areas: pre-operative room, recovery room, discharge and at time of post-operative phone call, which occurs the next working day following implant. On this 0-10 numeric pain intensity scale, O represents “no pain” and 10 is equivalent to the “worst possible pain”. Note that pre-operative pain was not limited to that related to prostate cancer, but included any type of pain from headache to arthritis. General anesthesia was used, however, narcotics and benzodiazopines were not. Each patient’s pain rating was documented by a nurse within that specific area, as well as location of pain and any action taken to alleviate pain. Results: Mean pain ratings for the pre-operative room, recovery room, time of discharge and at time of post-operative phone call were .54 ⫾ 1.62, 1.00 ⫾ 1.76, .59 ⫾ 1.09 and .46 ⫾ 1.02, respectively. Arthritis was the most common type of pain reported in the pre-operative area. Perineal discomfort, followed by urethral burning were the first and second most commonly reported sites of pain in all 3 of the remaining study areas. Table 1 clearly demonstrates pain ratings and areas of pain reported by this study group. Of the 40/114 patients who experienced some degree of pain in the recovery room, 500 mg acetaminophen, administered to 17 patients, was the most frequently used method to alleviate pain. Of the 32/114 patients who continued to experience minimal pain at time of discharge, 25 refused further medication. At time of post-operative phone call, 27 patients indicated they still had slight pain, but 13 continued not to take any action. The remainder of patients seemed to do well with acetaminophen and/or applying ice packs to the perineum. Conclusions: Pain ratings in each area were exceptionally low. The highest pain rating was found in the recovery room, which is logical since the recovery room is where patients will immediately begin to feel the effects of the procedure. Moreover, perineal soreness is expected since this is the site of needle insertion, as is urethral burning, due to post-implant cystoscopy. Further, because this slight discomfort is easily controlled with acetaminophen and/or ice packs, it is easy to see why some patients choose not to take any action and bear the slight pain. Typically, pain ratings of 3 or less are considered acceptable. Therefore, to have 1.00 as the highest mean rating suggests pain associated with PB is negligible.
S445