Prostate cancer and beneficial physiotherapy interventions

Cancer is the common term for all malignant tumours and its consequences are a concern for people worldwide. Advances in health and medical science procedures (early diagnosis, improved chemotherapy and radiotherapy) and surgical techniques, and their utilization in the field of oncology, have significantly improved survival and have thus strongly influenced the practice of physiotherapy.

People are living longer with their cancers, which in many cases are treated as chronic disease, due to the early detection and advances in treatment options. Thus, physiotherapists require greater knowledge of the clinical conditions and improved skill in managing patients with cancer, before, during and after the specific medical procedures. They also have the responsibility of managing and treating patients during the pre and postoperative periods with the provision of the best particular physiotherapeutic intervention to each patient.

Besides the knowledge about clinical interventions, the physiotherapist needs to be in contact with the recent advances in the scientific literature in general. Moreover, this professional must know about the risk factors to cancer and participate in actions to aid in the prevention of this disease.

In oncology, for example, there is increasing evidence, initially only from epidemiological studies but increasingly from individuals case studies, that risk of some cancers, such as prostate, may be reduced in people living in areas of high ambient solar radiation or with high sun exposure than in those where the converse is the case. Naturally, the information about the protection against the unnecessary exposition of the sunlight is also very important

Images are suitable tools to aid in the early diagnosis of several types of cancer. However, some modalities of images, as the positron emission tomography (PET) dependenting on the radiopharmaceutical, and in some clinical condition, false negative information can be obtained. As a profisssional of an interdisciplinar team, the physiotherapist must have enough knowledge to suggest a modality of image and to know about the limitations of each procedure.

Epidemiological researches have put in evidence the benefits of physical activity in relation to the risk of cancer. Moreover, the physical activity has been considered as a modifiable lifestyle risk factor that has the potential to reduce the risk of the majority of the types of diseases, as the cancer. The physiotherapist must be also involved in public and private actions to guide the Society to have correct style of the life also related to adequate exercise (kinesiotherapy) and physical activities in general. Naturally, these actions must consider the individual characteristic of each subject.

Undesirable clinical conditions due to the use of some techniques to treat cancer can bring bothersome that can comprise the sexual health and the quality of life. It is important that the interprofessional team be prepared to discuss these questions.

2. Role of physiotherapy

Physiotherapeutic procedures have an important role in the healthcare of people of all ages and with different types of clinical status. These procedures are relevant in the treatment, in the prevention of diseases or complications and in the management or treatment of undesirable pathological conditions to thus minimize the impact these may have in the quality of life of the patient.

Physiotherapy is a profession defined by great diversity in areas of clinical practice with the purpose of developing, maintaining and restoring the maximum movement and functional ability of each person, considering the specific limitations of the individual. The role of the physiotherapist within the interdisciplinary group (physician, nurse, nutritionist, occupational therapy, social worker, psychologist, speech therapist) is well defined in various clinical conditions, as with the patient with cancer.

The pressing need arises for the existence of a differentiated care system with the purpose to cater for the particular needs of the patients and their families. It is desirable that the physiotherapist working in oncology has a broad knowledge of other clinical areas, such as neurology, the musculoskeletal and cardiopulmonary systems and in rehabilitation and kinesiotherapy in general, as well as in services along the entire spectrum of patient care. There is also a considerable role for the physiotherapists in the evaluation of the clinical conditions and management of the patients, as well as in assisting people’s return to work and normal life following treatment.

It is often the fatigue and weakness caused by the disease and/or its treatment that delay this return to normal functions and limit the quality of life of a specific individual. An important aspect related to cancer and its treatment is the typically induced muscle atrophy. Probably this clinical condition is due to perturbations in different pathways of the muscle protein metabolism, including decreased muscle protein synthesis, increased muscle protein degradation, or a combination of both.

The most prevalent symptom in cancer is fatigue, which has now overtaken pain as the most common distressing symptom of the disease. The intensity of the fatigue varies from patient to patient and it is a complex and subjective phenomenon. Non-pharmacological fatigue cares are desirable. There is much evidence to suggest that appropriately prescribed physical exercises (kinesiotherapy) play an important role in the decrease of cancer fatigue and the improvement of the quality of life of the patient. The reduction of fatigue is highly relevant and desirable for the patient to (i) have the ability to continue or return to work; (ii) develop daily activities at home; and (iii) participate in social activities, all of which are clear parts of the overall quality of life of the patient.

It is thus essential that physiotherapists working with cancer patients have a clear and comprehensive understanding of the individual cancers and their staging and development, as well as the techniques that are being used in the diagnosis and treatment of the patient. The physiotherapist must have knowledge of the consequences and complications of clinical procedures, such as surgery, chemotherapy and radiotherapy, and their potential side effects such as neuropathies and cardiomyopathies. Moreover, the physiotherapist must be informed about the specific procedures that were used in the patient during medical intervention. A discussion about these procedures and the possible complications and occurrences are relevant to the management of the patient before and after the surgery. In addition, the physiotherapist must also know how these medical procedures can affect the physiotherapeutic interventions and thus select the best and convenient procedure for each patient.

The physiotherapist also needs to know more about individual medications as patients can survive longer using new cancer treatments, but often with severe side effects, which leave them weaker and often feeling quite unwell during the process. Hormonal therapy, for example, has an important effect on the muscle mass. The decrease in muscle mass, leading to muscle weakness and general debility, can be minimized by specific kinesiotherapy programmes . These appropriated exercises are established and implemented by physiotherapists considering the anatomical area of the disease and specific capabilities and limitations of each patient.