Oncologic rehabilitation

Cancer-related fatigue does not resolve with rest, and it is the symptom patients rate as most limiting. Graded exercise is the intervention with the strongest evidence behind it, delivered at a level set by measurement rather than by how the day feels.

Sessions are monitored for unusual pain, blood counts where relevant, and the specific precautions the oncology team has set.

Work is scheduled around chemotherapy and radiotherapy cycles rather than paused for them, and the load is reduced in the days when it should be.

For people who have finished treatment, the programme shifts to endurance, bone and muscle loading, and returning to work.

A Cochrane review pooling 56 trials with 4,068 participants found that exercise reduced cancer-related fatigue compared with usual care (standardised mean difference −0.27, 95% confidence interval −0.37 to −0.17), both during and after adjuvant treatment 1. The effect is modest rather than dramatic. It is also the most consistent finding available for a symptom that patients rate as their most limiting.

The same review is specific about where the benefit was found and where it was not: in solid tumours, notably breast and prostate cancer, and not in haematological malignancies; and with aerobic exercise, where resistance training and other forms did not reach significance 1. So the prescription is aerobic-led, and if the evidence for your diagnosis is thinner than that, the plan says so rather than implying otherwise.

People during or after treatment for cancer who have lost strength, endurance or function: fatigue that rest does not fix, deconditioning after surgery or a long admission, chemotherapy-induced neuropathy affecting balance, swelling, or the muscle loss that follows steroid courses.

The limits come from the oncology team, not from us: unstable disease, low blood counts, bone metastases that restrict loading, active infection, a recent surgical site. We ask for those restrictions in writing before a plan is built, and where they are not available the programme waits.

Three to six weeks, two to four hours a day, with the load reduced in the days after a treatment cycle rather than the programme pausing for it. Walking distance, strength and a fatigue score are recorded at the start and repeated at the end.

Fatigue usually improves before strength does, and both usually improve before the person feels able to describe themselves as recovered. That ordering is normal and is explained at the start, because a patient who expects the opposite reads a working programme as a failure.

Rehabilitation treats what the disease and its treatment leave behind. It does not slow, shrink or influence the cancer itself, and nothing on this programme should be understood as doing so. Any provider presenting rehabilitation, diet or a device as affecting the disease is selling something other than rehabilitation.

For the same reason the programme is planned with the oncology team rather than around them. The discharge report goes to the treating oncologist, and where a symptom during the programme could be disease-related rather than deconditioning — new bone pain, unexplained breathlessness — it is referred back the same day.