4. Discussion
dyspnea, exacerbations, fatigue, cancer, pain, FACT, decreased cancer-related fatigue, COPD, Cancer
CANCER, DISEASE, COPD, BLIND, PATHOLOGY, CANCER
Principal findings:The study showed that the implementation of a one-month post-hospital follow-up with a controlled physical exercise and functional rehabilitation program in oncology patients with cancer-related fatigue achieved functional improvement (Barthel) and decreased cancer-related fatigue (FACT) in patients. However, not all individuals showed a direct relationship between these improvements and health-related quality of life (EuroQoL-5D).In recent years, and due to the exponential increase in survival of cancer patients [The multimodal exercise program was adapted in terms of the frequency and duration of the exercise sessions with respect to the recommendations of the latest update of the ACSM (2019) [Analyzing in more detail the variables related to the levels of dependency of the individuals, we observed a clear benefit of the implementation of the specific post-hospital follow-up program for oncology patients. All individuals showed statistically significant improvements after the implementation of the proposed functional rehabilitation program. This is clearly corroborated by the results of similar studies in other incapacitating pathologies such as COPD or dyspnea [We consider it essential that clinical improvement is generalized with the correct performance of activities of daily living for cancer patients once they are discharged from the hospital complex. We believe that this improvement in terms of autonomy not only benefits the patient themselves, but also the family environment surrounding them, freeing them from assuming the role of caregiver. In fact, we are considering this as a line of future research. Furthermore, as a novelty in this study, we consider it appropriate to prescribe individualized support products, such as walkers or standing frames, which have shown a greater benefit in terms of the autonomy of cancer patients than in recent studies in the scientific literature [With regard to the levels of cancer-related fatigue, we observed that the implementation of the post-hospital follow-up program achieved improvements in these levels, substantially reducing the levels of cancer-related fatigue. Furthermore, a direct relationship was established between this symptomatic improvement and an improvement in terms of dependency. An analysis of the existing literature shows that this correlates directly with studies by Campbell, Covington, and Sleight and his collaborators [A comprehensive analysis of the results related to health-related quality of life reveals some contradictions. In the total scores of the questionnaire, we observed statistically significant improvements in the control group, whereas, in the scores of the general item, “EuroQoL thermometer”, we found that these differences were manifested in the experimental group. In the existing literature, we found similar results to those presented in the “EuroQoL thermometer” [Continuing with the analysis of the variables under study, we found clinical improvements in the functional capacity of the individuals, and in levels of kinesiophobia, which, together with a reduction in the intensity of pain in individuals in the experimental group, leads us to believe that these three parameters may be directly related. One possible hypothesis related to these results is that a reduction in pain will lead to less kinesiophobia, which will have a direct impact on the improvement in the functional capacity of oncology patients. Pergolotti and colleagues, in their CARE study, highlighted the importance of the implementation of a functional rehabilitation program with controlled physical exercise in this type of patient, and how this improved their functional capacity, with positive repercussions for their dependency parameters [Furthermore, in a systematic review by McTiernan and colleagues, the most relevant conclusion was that the implementation of physical activity programs in oncology patients leads to a lower risk of side-effects and improved survival [In our study, we proposed three levels of intervention depending on the degree of symptomatic affectation presented by the patient when prescribing the different exercises in the rehabilitation program, with the possibility, obviously, of making modifications depending on the evolution of the individual (increasing or decreasing the degree of complexity). We believe that greater precision in the prescription of the rehabilitation program can bring us even closer to better clinical practice, as mentioned by Pergolotti and his collaborators in the EXCEEDS study, in which they proposed an algorithm, “Exercise in Cancer Evaluation and Decision Support (EXCEEDS)” [The current results show the benefit of a rehabilitative intervention in the follow-up of post-hospital patients, and how this type of intervention leads to improvements in terms of dependency, functional capacity, and decreased levels of cancer-related fatigue in cancer patients. These results are clinically relevant for several reasons. Firstly, as it is a clinical intervention outside of the hospital environment, and can even be conducted in the individual’s own home, this process of humanization of health care activity is enhanced. Secondly, and taking into account this symptomatic improvement of patients, the intervention provides not only a direct benefit for them; in addition, it also provides indirect benefits, both for their closest relatives, as no extra care will be necessary, and for health policies, preventing possible acute exacerbations of the symptoms treated that lead to a clinical worsening resulting in an earlier hospital admission, with the consequent increase in the need for health resources.Adherence to the prescribed intervention was complete in all individuals in the sample. These data provide greater strength to the study, and we believe adherence is conditioned by the pathology of the individuals, which perhaps contributes to a greater degree of acceptance of the users to the different treatments.In future studies, we consider it essential to carry out this clinical practice of post-hospital follow-up in other types of symptoms related to the oncological disease, such as dyspnea or pain, or in other words, to proceed with a generalization process, which would allow all cancer patients to benefit from this proposed post-hospital functional rehabilitation program.It is important to note the main limitations of this study. Due to the nature of the intervention, it was not possible to completely blind the participants; however, a recent meta-epidemiological study suggested that blinding is less important than is commonly believed [Finally, we consider it important to highlight the important potential for generalization of the results obtained in the study. We believe that these clinical practices should be included in the routine intervention of this type of oncology patients.