緩和ケアと医学

抽象的な

Supervised, Individualized Exercise Programs Help Mitigate Costs during Cancer Treatment

Karen Wonders

Background: Cancer and its associated treatments often result in long-term physical and psychological side effects that negatively impact the cancer survivor's quality of life. In addition, the financial costs of cancer are substantial and are projected to reach $158 billion by the year 2020. Research indicates that endurance exercise training is helpful in attenuating the deleterious effects of cancer treatments by increasing survival, attenuating myocardial lesions and myocyte disarray, increasing levels of antioxidants, decreasing lipid peroxidation induced by oxidative stress and markers of apoptosis, and preserving cardiac function. However, nationally less than 5% of patients are ever referred to a cancer rehabilitation exercise program. Cost is a barrier to these programs, as they often are not reimbursable under most insurance plans. Purpose: Therefore, the purpose of this investigation was to determine if exercise training during cancer treatment helped to minimize side effects and reduce health care costs. Specifically, treatment tolerance, length of hospital stay, hospital readmits, ER visits, and treatment compliance were measured. Methods: This was a retrospective, two-group study which ascertained the protective effect of an exercisetraining program during cancer treatment. All oncology patients who received cancer treatment at Kettering Medical Center in Dayton, Ohio between January-December 2016 were identified by office staff. Their medical records were pulled and patients were placed in one of two groups: those who exercised during treatment, and those who remained sedentary. The medical records were reviewed to determine outcome data for length of hospital stays, hospital readmits, ER visits, treatment compliance, fatigue, and anxiety/depression related to oncology conditions. The age range of the patients was 21-93 years. Patients were excluded if they had pre-existing cardiac, liver, and bone marrow conditions prior to treatment. Individuals in the exercise group (EX, n=672) completed 12 weeks of prescribed, individualized exercise that included cardiovascular, strength training, and flexibility components. The intensity level for the cardiovascular exercise ranged from 30%-45% of the individual’s predicted VO2max. The strength training involved a full body workout, with emphasis on all major muscle groups. Individuals in the sedentary group (SED, n=728) did not participate in an exercise program during treatment. Results: Patients in the EX group had significantly lower reports of fatigue, pain, and cardiac problems (p<0.05), as well as fewer notes of depression and anxiety than their SED group counterparts. In addition, the EX group tolerated their treatment significantly better than the SED group (p<0.05). Finally, the EX group had a significantly lower number of ER visits (EX=2, SED=14, p<0.05), 30-day readmits (EX=2, SED=53, p<0.05) as well as a shorter length of stay (EX=0.75, SED=3 p<0.05). Conclusion: Results from this investigation point to a protective effect of moderate-intensity exercise that translated to reductions in ER visits, 30-day readmits, and length of hospital stay, which translated into cost savings for the payer, provider, and patients, alike.