Feasibility and Efficacy of Inspiratory Muscle Training in Patients with Head and Neck Cancer receiving Concurrent Chemoradiotherapy.

OBJECTIVES: Patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT) often experience pulmonary symptoms. This study evaluated if a 7-week inspiratory muscle training (IMT) program during CCRT is feasible, adherent, and safe in patients with HNC. This study also evaluated the effect of IMT on diaphragm thickness, mobility, and cardiorespiratory parameters in patients with HNC receiving CCRT. METHODS: Ten participants with advanced stage HNC receiving CCRT were recruited for the study. Feasibility, adherence, and safety of the intervention were the primary outcomes. Changes in diaphragm thickness and mobility, maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, forced expiratory volume in first second and functional capacity using 6-MWT were measured at baseline and post 7 weeks of CCRT. IMT was performed at one session per day for 5 days a week for 7 weeks. Eight sets of two minutes of inspiratory manoeuvres with one minute rest period between them with intensity of 40% MIP were given. RESULTS: Ten participants  were included in this study out of the 13 patients screened, indicating the feasibility to be 76.9%. Participants completed a total of 260 training sessions out of the 350 planned sessions denoting the adherence level as 74%. Diaphragm thickness and MEP remained significantly unchanged while significant decline was seen in diaphragm mobility, MIP,FVC, FEV1 and 6-MWD at the end of 7 weeks. No adverse events were reported following the intervention. CONCLUSION: Inspiratory muscle training did not show significant effect on the diaphragm thickness, mobility, and cardiorespiratory parameters; however, it was feasible, adherent, and safe in patients with HNC receiving CCRT.

Role of Physiotherapy in Hospice Care of Patients with Advanced Cancer: A Systematic Review.

OBJECTIVE: To review the role of physiotherapy and its effects in hospice care of patients with advanced cancer. METHODS: A comprehensive literature search was performed in PubMed, Scopus, Web of Science, CINAHL and PEDro. The search strategy was devised, articles were screened, and 2 independent reviewers conducted data extraction. Eligible studies were methodologically assessed for quality rating using modified Downs and Black's checklist. The extracted data was summarized according to site/stage of cancer, details of intervention, outcome measures and the results. RESULT: The total number of screened articles were 2102, out of which 9 were identified as suitable for the purposes of comprehensive review. The studies included exercise therapy, massage therapy, relaxation therapy, compression bandaging and use of TENS as the various physiotherapy interventions under consideration. Studies were generally of low to moderate quality. A broad range of outcomes were employed including physical symptoms like loss of function, pain, fatigue, edema, sleep disturbances and quality of life. The findings of the studies supported the benefits of the interventions. CONCLUSION: A structured exercise protocol, massage therapy, TENS and compression bandaging are useful in alleviating the symptoms experienced by patients with advanced cancer in hospice care. The reduced symptom burden has reflected as an improvement in their quality of life. However, there is a further need for high quality studies to strengthen the findings of this review.

Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors-a systematic review.

PURPOSE: Cancer survivors may experience sleep disturbances during and after their cancer treatments. While pharmacological approaches are commonly used to address sleep disturbances, they may have a number of adverse effects. This review studied the effect of two non-pharmacological interventions (massage and relaxation therapy) on sleep disturbances in cancer survivors. METHODS: A search for randomised controlled trials (RCTs) was conducted on PubMed, Scopus, Web of Science, PEDro, and CINAHL using relevant keywords. RESULTS: The search yielded 371 articles, with 4 RCTs studying massage therapy and 3 RCTs studying relaxation therapy included for qualitative analysis. Massage therapy studies showed statistically significant improvement in self-reported sleep questionnaires and objectively recorded long sleep episodes, as assessed via an accelerometer. No significant improvements in sleep outcomes were observed in the relaxation therapy studies, although there were trends for improved self-reported sleep quality. CONCLUSION: While massage therapy provided by massage therapists may have some potential for improving sleep outcomes for cancer survivors, there is no such current evidence regarding relaxation therapy. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors who experience sleep disturbances may benefit from regular sessions with a massage therapist. However, future studies should examine the long-term feasibility of massage therapist-delivered services, particularly for cancer survivors with limited finances, and determine if benefits can be obtained if massage is provided by non-certified individuals. Relaxation therapy appears to be safe for cancer survivors, but future RCTs involving larger sample sizes need to be conducted to better determine its feasibility and efficacy.