Physiotherapy Role in Geriatric Oncology

Original Editor - Tolulope Adeniji
Top Contributors - Tolulope Adeniji, Vidya Acharya and Kim Jackson

Overview of Geriatric Oncology

Geriatric oncology is a special area that deals with issues surrounding assessment and management of older adults with cancer. Due to ageing process that is complex, most newly diagnosed cancers are among this population[1]. And it is essential to understand the baseline health status of a patient before making treatment decisions. Generally, a geriatric assessment is supposed to be a comprehensive evaluation that includes medical, psychosocial, and functional problems in older patients with cancer[1]. Geriatric oncology should include specific areas such as identification of vulnerability, predicting survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice. The information on this write up will elaborate on how physiotherapy contributes to geriatric oncology practice.

Epidemiology

Ageing is an indirect risk factor for cancer and one reason for this can be linked to increasing exposure to carcinogenic substances in greater time that could predispose such individual to genetic changes and eventually tumor[2] Cancer is highly prevalent among the older adults and the incidence and mortality of cancer increases with age. However, at very old age, >90 years, cancer prevalence decreases.[3] Aside from the ageing being a risk factor for cancer, gender is also associated with some certain cancer. Among common cancer in older adults, incidence of the following cancer are high among male gender: prostate, lung, and bowel cancers, while breast, lung, bowel, stomach, and uterine cancer are of higher incidence in female gender. [4]

Aetiology

The underlying causes of cancer among older adults can be explain based on the biology of cancer and impact of ageing. These can be explained under the following heading:

  • Molecular Changes
  • Cellular Changes
  • Tumorogenesis: A Simplified Model
  • Physiologic Changes

For more information see biology of cancer and ageing .

Assessment and Investigations

Geriatric assessment and investigations is an essential process to evaluate if an older adult is fit, vulnerable, or frail. The assessment encompasses age-related conditions that should be investigated within the period of cancer treatment. One importance of this is that it will guide care to the best management line.

The US National Comprehensive Cancer Network (NCCN) and International Society of Geriatric Oncology (SIOG) recommendation for geriatric oncology assessment are to be a shoulder on the following  features: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes[5]

Oncology Examination

Clinical Manifestations

Clinical manifestations of older adults with cancer are multi-factorial. It is an overlap between the following clinical manifestations:

  • Geriatric comorbidities (Congestive heart failure, diabetes, hypertension, anemia, depression, COPD etc)
  • Age-related deficits in body systems such as increasing prevalence of urinary incontinence in urinary system, Presbycusis in sensory system, sarcopenia in musculoskeletal system, etc.
  • Geriatric syndrome ( a combination of one or more of the following: falls, frailty, polypharmacy, delirium, dementia, etc)

Physiotherapy Management

Physiotherapy intervention requires an assessment of the older adults with cancer, which can be based on neurologic, integumentary, musculoskeletal, comorbidities, and geriatric syndromes. The common problem with an older adult with cancer are:

  • Impaired bed mobility
  • Difficulty with transfers
  • Decreased muscle strength
  • Decreased ambulation
  • Decreased ROM, cardiovascular endurance
  • Impaired balance
  • Pain, etc.

Physical activity guidelines recommendation for Healthy Older Adults

American College of Sports Medicine (ACSM) and the American Heart Association (AHA) on physical activity guideline[6]:

  • Aerobic exercise
  1. Moderate aerobic is recommended for 5 days per week, 30 mins/day, bouts of 10 mins each
  2. Vigorous aerobic exercise is recommended for 3 days per week, continuous for at least 20 mins/day
  • Strengthening exercise is recommended for at least 2 days/wk, 8-10 exercises to major muscle groups for 10-15 reps
  • Flexibility/Balance for at least 2 days/wk; for those at risk for falls it is recommended to include balance.

Exercise Guidelines for Cancer Survivors

American College of Medicine on exercise guidelines for cancer survivors[7] advice to avoid inactivity, return to normal activities of daily living as quickly as possible. Also on the general statement, a person with metastatic bone disease requires modifications to avoid fractures. And those with cardiac conditions may require modifications and supervision to ensure their safety.

  • Aerobic

Individuals with breast, prostate, colon, hematologic, gynecologic cancers are to follow ACSM and AHA physical activity guideline (PAG) for their age group

  • Resistance exercise

Individuals with breast cancer are to be supervised for low resistance exercise.

Individuals with prostate cancer are encouraged to add pelvic floor exercise after undergoing radical prostatectomy.

Individuals with colon cancer are to start with low resistance and progress resistance slowly to avoid herniation

  • Flexibility

Individuals with Breast/Prostate/Hematologic cancer are to exercise at PAG guideline.

Oncology Physiotherapy Management

Resources

The Role of Occupational and Physical Therapy in Geriatric Oncology

Geriatric Cancer Rehabilitation


References

  1. 1.0 1.1 Loh KP, Soto-Perez-de-Celis E, Hsu T, de Glas NA, Battisti NM, Baldini C, Rodrigues M, Lichtman SM, Wildiers H. What every oncologist should know about geriatric assessment for older patients with cancer: young international society of geriatric oncology position paper. Journal of oncology practice. 2018 Feb;14(2):85-94.
  2. Swaminathan D, Swaminathan V. Geriatric oncology: problems with under-treatment within this population. Cancer biology & medicine. 2015 Dec;12(4):275.
  3. Gentner D, Grudin J. The evolution of mental metaphors in psychology: A 90-year retrospective. American Psychologist. 1985 Feb;40(2):181.
  4. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Annals of oncology. 2007 Mar 1;18(3):581-92.
  5. Korc-Grodzicki B, Holmes HM, Shahrokni A. Geriatric assessment for oncologists. Cancer biology & medicine. 2015 Dec;12(4):261.
  6. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094.
  7. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine & Science in Sports & Exercise. 2010 Jul 1;42(7):1409-26.