Authors (including presenting author) :
Chan CK(1),Au TK(1),Fung YK(1),Kwan CK(2),So KY(1)
Affiliation :
(1)Physiotherapy Department,Tseung Kwan O Hospital,(2)Oncology Department,United Christian Hospital
Introduction :
NSCLC patients suffer from distressing symptoms including dyspnea, fatigue and pain caused by the disease, cancer therapy and complications. During lung cancer journey, patient’s physical decline is expected. From literature review, immediate physiotherapy before commencing cancer treatment improves outcomes including mood, comfort, endurance and adherence to treatment. Moreover, supervised physical training during chemotherapy infusion has potential physiological benefits of improved perfusion and enhanced drug delivery to tumor cells. Therefore, physiotherapy plays an imperative role in every stage of cancer care for better symptoms control, physical optimization and quality of life(QoL) enhancement.
Objectives :
- To have synergic effect with oncologist during collaborative consultation in Oncology Clinic by timely on-site initial assessment and immediate intervention
- To engage with NSCLC patients and care-givers and facilitate their understanding to goal and plan of pre-habilitation before cancer therapy
- To optimize physical and respiratory condition of NSCLC patients by out-patient training and during chemotherapy session under a controlled and safe environment at Day Medical Centre(DMC)
Methodology :
This care model was implemented in TKOH in October2019. Physiotherapist conducted NSCLC patient baseline screening in SOPC Oncology Clinic, including functional impairment(Karnofsky Performance Status(KPS)), mobility(Modified Functional Ambulation Classification(MFAC)), functional capacity(6-minute walk test(6MWT)), handgrip strength(HGS), QoL and cancer symptoms(Functional Assessment of Cancer Therapy-General(FACT-G)). Through assessment, tailored symptomatic control strategies including management of breathlessness, pain and fatigue were delivered. Oxygen therapy, fast-track out-patient training or community services were arranged for indicated patients. Collaborative consultation allowed physiotherapists to timely and directly liaison with oncologist. Patients with suboptimal physical condition were recruited to out-patient pre-habilitation before cancer treatment for respiratory and physical optimization. During chemotherapy infusion sessions, supervised physical training was delivered by experienced physiotherapists at DMC. Re-assessment was conducted 4weeks after commencement of cancer treatment.
Result & Outcome :
From October to December2019, 33patients were referred. Eight patients were screened as suitable outpatient pre-habilitation candidates. Re-assessment on 7patients receiving chemotherapy or target therapy shown maintenance in functional impairment(KPS), mobility(MFAC), HGS and QoL(FACT-G) without expected deterioration. In contrast, functional capacity(6MWT) was improved from 2-40.3%. All patients satisfied the innovative enhanced pre-habilitation which proven to improve functional capacity, QoL and benefit functional status for NSCLC patients undergoing chemotherapy and target therapy. Service and data review will be on-going for continuous quality improvement.
