Tailoring exercise interventions to comorbidities and treatment-induced adverse effects in patients with early stage breast cancer undergoing chemotherapy: a framework to support clinical decisions

Abstract

Comorbidities and adverse effects of breast cancer treatment require exercise adaptations. The proposed framework provides guidance on tailored exercise prescriptions in patients with breast cancer undergoing chemotherapy. Implications for Rehabilitation Exercise is recommended for patients with breast cancer undergoing chemotherapy, but requires complex clinical decisions of the health professional. We identified the most important comorbidities and adverse effects of breast cancer treatment, and the resultant contra-indications and restrictions to exercise. We incorporated these findings into a clinical decision framework that provides suggestions for exercise adaptations in patients with breast cancer undergoing chemotherapy.

Structured clinical reasoning for exercise prescription in patients with comorbidity

“…However, coexisting conditions (referred to as comorbidity) are highly prevalent in most chronic diseases and may impact on the ability to exercise (e.g., because of reduced exercise tolerance in case of comorbid diabetes). Adaptations to the exercise program may therefore be needed [5,6]. To provide an effective and safe exercise program for patients with multiple morbidity, advanced clinical reasoning of health professionals (HPs) is required.…”

“…Exercise guidelines provide limited support to fill this gap, since these guidelines are developed for a single disease and usually do not take comorbidity into account [10]. Therefore, we previously developed recommendations for exercise adaptations to comorbidity in patients with knee osteoarthritis [5] and with breast cancer [6]. Although these recommendations aim to support HPs in their clinical decision making, they cannot substitute clinical reasoning, which is still needed to apply the recommendations to an individual patient.…”

Physical interventions for patients suffering from chemotherapy-induced polyneuropathy

“…Medical exercise to improve endurance capacity and/or muscular strength and sensorimotor functions has many beneficial effects for healthy people and for cancer patients [4,[7][8][9]. In our opinion, before starting any exercise program, contraindication potential must be assessed (e.g., psychosocial assessment, cardiotoxicity assessment, such as by echocardiography, pulmonary function testing, musculoskeletal strength, and flexibility testing) and patients are to be excluded if clinically determined to be at increased risk of harm.…”

“…Nevertheless, these modalities are part of a very traditional, experienced based medicine approach and have shown good results when applied in a multimodal setting for many years. Finally, these physical modalities normally show fewer sideeffects than medication-based approaches [9,10].…”

“…In our opinion, before starting any exercise program, contraindication potential must be assessed (e.g., psychosocial assessment, cardiotoxicity assessment, such as by echocardiography, pulmonary function testing, musculoskeletal strength, and flexibility testing) and patients are to be excluded if clinically determined to be at increased risk of harm. Every exercise intervention should be planned on the basis of such assessments and performed under regular medical supervision in order to minimize or to avoid side effects and (possibly life-threatening) complications [2,4,[7][8][9]. In addition, self-management interventions should be incorporated into the protocol-patients are able to help themselves to mitigate the symptoms and sequelae of cancer and its necessary treatment and certainly can be educated to incorporate appropriate self-monitoring and report any sequelae before these are exacerbated and thereby risk adherence to treatment and rehabilitation.…”