Background: This study aimed to examine parents’ awareness of health promotion and preventive care in childhood cancer and to investigate whether children’s HR-QoL (Health-Related Quality of Life) differs according to parental awareness items. Methods: This prospective cross-sectional study included 76 parents of children aged 0 to 18 years diagnosed with cancer and followed at a pediatric hematology/oncology clinic. Parents completed a Demographic Information Form, the Barratt Measure of Social Status, the Pediatric Quality of Life Inventory™ (PedsQL™) 3.0 Cancer Module, and a researcher-developed Health Promotion and Preventive Care Awareness Questionnaire. Differences in PedsQL total scores and socioeconomic status across awareness categories were analyzed using Mann–Whitney U and Kruskal–Wallis tests. Results: While most parents believed that cancer-related problems can be treated (92.1%) and prevented (76.3%), awareness of practical preventive care components was limited. Only 27.6% of parents reported knowing childhood cancer risk factors, 22.4% knew recommended physical activity levels, and 6.6% were aware of their child’s appropriate body mass index. Higher PedsQL total scores were observed among parents who believed cancer is preventable or treatable, knew recommended physical activity levels, and perceived their child as physically active ( P < 0.05). Socioeconomic status differed only for awareness of appropriate body mass index and physical activity recommendations. Discussion: These findings highlight the importance of behavior-oriented health promotion alongside disease-related education in pediatric oncology.
Background: Persistent pain after breast cancer treatment may involve self-reported pain intensity and mechanical pain sensitivity (MPS). Previous reviews of aquatic exercise in women surviving breast cancer mainly synthesized broad rehabilitation outcomes. This review aimed to evaluate the effects of structured aquatic exercise interventions on pain intensity and MPS in this population. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, five databases were searched from inception to November 2025. Controlled studies including women surviving breast cancer who received structured aquatic exercise interventions were eligible. Outcomes were grouped as pain intensity or MPS. Pain intensity was synthesized using random-effects meta-analysis, certainty of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation, and risk of bias was assessed with RoB 2 and ROBINS-I. Results: Four studies (n = 181) were included. Interventions were delivered in heated pools and included supervised aquatic resistance exercise, multimodal water physical therapy, and aqua lymphatic therapy. Low-certainty evidence from three randomized controlled trials (n = 133) suggests that structured aquatic programs may reduce pain intensity compared with land-based exercise, usual care, or home-based exercise with compression therapy over 8 to 12 weeks (SMD = −1.47; 95% CI, −2.40 to −0.55; I 2 = 79.1%). Evidence for MPS, prioritized as shoulder pressure pain threshold, was of very low certainty due to inconsistent findings across two studies (n = 105). Conclusions: Structured, supervised aquatic programs may reduce self-reported pain intensity in women surviving breast cancer; however, evidence remains limited. Effects on MPS are very uncertain, and pain intensity improvements should not be assumed to reflect parallel changes in pressure pain sensitivity.
Background: Near-infrared imaging fluorescence using indocyanine green lymphography (NIRF/ICG-L) has emerged as a useful tool in guiding surgical approaches. However, its use in guiding conservative therapy interventions, such as manual lymph drainage (MLD), remains limited. This study aimed to explore the knowledge, perceptions, and adoption of NIRF/ICG-L in the conservative management of lymphedema among US therapists. Methods: An anonymous online survey was distributed via email to US lymphedema therapists in late 2024. Descriptive statistics and χ 2 tests were used to examine knowledge, perceptions, and adoption of ICG-L findings related to conservative therapy interventions. Results: Data from 509 actively practicing lymphedema therapists were analyzed. Nearly half (49.7%) reported no knowledge of NIRF/ICG-L, while 30.2% were somewhat familiar and 20.1% were familiar. Therapists working alone were significantly less likely to have heard of NIRF/ICG-L ( χ 2 = 13.97, P <.01). While 33.9% felt NIRF/ICG-L studies would impact MLD practice, 39% were optimistic but needed more information. Adoption of NIRF/ICG-L findings in MLD practice was reported by 23.8% of respondents, with higher rates in urban settings ( χ 2 = 8.53, P < .05) and among Lymphology Association of North America (LANA)-certified therapists ( χ 2 = 16.33, P < .001). Key barriers included limited knowledge (55.8%), limited access to testing (40.7%), time constraints (10.4%), organizational protocols (5.5%), and loyalty to established methods (3.4%). Conclusion: There is wide variation in knowledge of NIRF/ICG-L among US lymphedema therapists. Although many recognize its potential benefits, adoption may be limited by knowledge and access barriers. Targeted strategies to enhance education and improve testing access may increase its use in conservative lymphedema management.
Background : Arm morbidity can impair function after breast cancer treatment. Physical therapy, including exercise and manual therapy, may reduce its incidence and progression. This systematic review assesses the effect and evidence quality for commonly used physical therapy interventions on arm morbidity in adults with nonmetastatic breast cancer from the early postoperative phase through adjuvant and post-primary therapy. Methods : CINAHL, Medline (Ovid), and EMBASE were searched from inception to August 7, 2024. Randomized controlled trials were included if they delivered physical therapy for ≥3 weeks to adults during or after nonmetastatic breast cancer treatment and reported arm morbidity outcomes (ie, upper extremity function, pain, shoulder range of motion, strength, and/or lymphedema incidence/progression). Data on participants, interventions, and outcomes were extracted and synthesized qualitatively. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework, and risk of bias was assessed using the Cochrane Risk of Bias Tool 1.0. Results: Fifty-seven trials met the inclusion criteria. Interventions most frequently included progressive exercise programs, stretching, and manual therapy, often initiated within 6 weeks postoperatively. Most trials demonstrated benefits in shoulder range of motion (58%), while fewer reported improvements in upper extremity function (49%), pain (46%), upper extremity strength (38%), or lymphedema (38%). Only 23% of trials evaluated arm morbidity as a primary outcome. Conclusion : Physical therapy may reduce incidence and progression of arm morbidity after breast cancer treatment, but evidence quality is generally low. High-quality trials with larger samples, standardized outcome reporting, and better adherence tracking are needed to guide practice.
Background: Survivors of head and neck cancer (sHNC) often show low levels of physical activity (PA), particularly those with advanced disease, despite the well-established benefits of PA. This study explored capabilities, opportunities, and motivation for PA engagement among sHNC and their significant others (SO), and gathered suggestions for PA promotion. Methods: A qualitative descriptive design guided by the COM-B model of behavior was applied. Semistructured interviews were conducted with sHNC and SO. All interviews were audio-recorded, transcribed verbatim, anonymized, and coded using a deductive–inductive approach. Results: Twenty participants (12 sHNC and 8 SO) were interviewed. PA engagement was facilitated by prior PA experience, knowledge, positive beliefs, and intrinsic motivation, but hindered by treatment sequelae and psychosocial factors such as shame and social withdrawal. While structured therapies, expert guidance, and supportive networks presented opportunities, access remained constrained by fragmented care, poor referral coordination, and financial barriers. Participants recommended introducing PA early in treatment, appointing a coordinator, providing structured rehabilitation, and involving families. They emphasized that PA promotion must be tailored, coordinated, and integrated throughout the treatment trajectory. Conclusions: sHNC face multifactorial barriers to PA engagement despite recognizing its importance. Key strategies include enhancing capability through symptom management and education, improving opportunity via coordinated, accessible programs, and strengthening motivation with individualized, supportive approaches. Integrating PA promotion into standard oncologic care and training healthcare professionals in PA counseling may foster sustainable engagement. Future research should evaluate tailored, family-inclusive PA promotion across the cancer care continuum.
Background: While physical activity during chemotherapy is recognized as a vital component of overall health and well-being, there is a lack of ideal measures that can accurately and efficiently measure physical activity. The purposes of this study were to (1) validate the Activities Completed over Time in 24 Hours (ACT24) instrument and (2) evaluate participant use and acceptability of the ACT24 for women undergoing active chemotherapy for the treatment of breast cancer. Methods: Twenty-two women receiving chemotherapy wore an activPAL device for 7 days and completed 3 ACT24 previous day recalls. Criterion validity was assessed using correlation coefficients, paired t tests, and Bland–Altman plots from data collected on matched days for the ACT24 and activPAL. Outcomes of interest included MET-hrs/day, active time, and sedentary time. Acceptability was assessed using the System Usability Scale and Experience survey. Results: The correlations between the ACT24 and activPAL were significant for MET-hrs/day ( ρ = 0.80, P < .001), active time ( ρ = 0.70, P < .001), and sedentary time ( ρ = 0.67, P < .001); and there were no significant differences in measures obtained with the ACT24 and activPAL for all outcomes ( P ranged from 0.222 to 0.706). For usability, the ACT24 exceeded the mean cutoff score of usability on the System Usability Scale, indicating acceptable usability of the measure. Conclusion: The ACT24 is a valid and acceptable tool to quantify physical activity levels in this population. The instrument is a standardized physical activity measure that measures all activity, regardless of type or intensity, which may be ideal for women undergoing chemotherapy.
Background: Post-mastectomy pain syndrome (PMPS) is a frequent and disabling complication among breast cancer survivors. A subgroup of patients remains refractory to conventional rehabilitation, emphasizing the need for new therapeutic strategies. This study evaluated the clinical impact of botulinum toxin type A (BTX-A) on pain and function in individuals with refractory PMPS. Methods: This retrospective cohort study included 39 women with refractory PMPS who reported persistent pain despite conservative rehabilitation. All individuals received ultrasound-guided BTX-A injections, with follow-up at 1, 3, and 6 months, and additional injections offered at follow-up visits according to clinical evolution. Pain, disability, and shoulder mobility were assessed at baseline and at 1, 3, and 6 months postinjection using the Numerical Pain Rating Score, Shoulder Pain and Disability Index, and goniometric measurement of range of motion. Clinical relevance was evaluated using minimal clinically important difference, and patient acceptable symptom state. Results: Pain and disability improved at all follow-up assessments, while shoulder mobility showed modest gains. Most individuals achieved clinically meaningful pain reduction at 1 and 3 months, with functional gains reflected in Shoulder Pain and Disability Index scores. No adverse events were reported. Conclusions: BTX-A injections used within a rehabilitation framework were associated with clinically meaningful reductions in pain and disability in individuals with refractory PMPS. These findings support a potential complementary role for BTX-A in carefully selected individuals with limited therapeutic options, a population with unmet needs in cancer rehabilitation. Future studies are needed to define optimal treatment timing and evaluate long-term outcomes.
Introduction: Cancer-related fatigue (CRF) is a debilitating symptom experienced by many cancer patients due to the disease itself or the therapy they receive. There was a variety of results in the prevalence of CRF in Ethiopia, this study estimates the pooled prevalence of CRF and its relation with psychosocial factors among patients with cancer in Ethiopia. Methods: A systematic literature search was conducted using different databases, including PubMed, Cochrane Library, Google Scholar, Psycinfo, and EMBASE. Data extraction and cleaning were performed using Microsoft Excel, and analyses were conducted using STATA version 17 statistical software. The estimated pooled prevalence of CRF was calculated using a random effects model. Meta-analysis was used to assess the existence of statistical associations between psychosocial factors and CRF. Results: A total of 10 articles with a total of 3678 study participants were included in the final systematic review and meta-analysis. The estimated pooled prevalence of CRF was 59% (95% CI: 49%-70%) which showed that more than half of patients with cancer experienced fatigue. The study identified significant associations between CRF and psychological factors, particularly anxiety (odds ratio [OR]: 4.16; 95% CI: 3.25-5.33; P = .000), depression (OR: 3.86; 95% CI: 2.84-5.23; P = .000), and poor sleep quality (OR: 3.65; 95% CI: 2.25-5.95; P = .000). Conclusions: The prevalence of CRF in Ethiopia was high, and anxiety, depression, and sleep quality were statistically significant factors. Therefore, a multidisciplinary approach, including integration of psychosocial support into treatment plans, is recommended.
Background: The growing population of survivors of cancer requires physical therapists who are prepared to address their unique rehabilitative needs. However, the integration of oncology content into doctor of physical therapy (DPT) programs in the United States is inconsistent. The purpose of this study was to explore faculty perception of how oncology is taught, assessed, and integrated into DPT curricula, identify barriers to its inclusion, and understand how students are prepared for clinical practice with oncology populations. Methods: This study used a qualitative phenomenological design to understand the perception of DPT faculty who teach and/or influence curricula related to oncology. Data were collected through 10 semistructured interviews (n = 11) and one focus group (n = 5). Transcripts were analyzed using inductive and deductive coding to identify key themes. Results: Five main themes emerged with various subthemes. The main themes were inconsistent and nonstandardized curricular integration, structural and expertise-driven constraints to integration, student preparedness (influenced by exposure, application of foundational knowledge, and mindset), unclear determination of entry-level skills, and accreditation as a driver of curricular priorities. Conclusion: Faculty recognized the critical role of education in DPT programs to prepare entry-level therapists but identified barriers to its consistent integration. Key barriers included limited curricular time, lack of faculty expertise, and competing content priorities. Faculty also described gaps in clinical exposure that affected student preparedness for practice. Results from this study support faculty development, intentional clinical exposure, and clearer accreditation guidance to promote more consistent oncology preparation in DPT education.
Objective: This study aims to describe the recovery of physical capacity in patients undergoing wedge resection for lung metastases from bone or soft tissue tumors, with a 12-month follow-up, and to identify prognostic factors influencing recovery. Methods: A prospective observational cohort study was conducted on 61 patients (median age 48 years; 45.9% female) who underwent wedge resection. The 1-minute Sit-to-Stand (1mSTS) test was administered preoperatively, on postoperative day 6, and at 3, 6, and 12 months. Pain, dyspnea, oxygen saturation, and heart rate were also recorded. A mixed-effects linear regression model was applied to analyze predictive factors. Results: The mean number of 1-minute Sit-to-Stand repetitions decreased significantly at 6 days post-surgery (mean reduction: -2.2 repetitions compared to preoperative values; P < .001), followed by substantial improvement at 3 months (+2.8 repetitions from preoperative) and stabilization thereafter. Patients with an American Society of Anesthesiologists score <= 2 and a single metastasis showed the best recovery; American Society of Anesthesiologists score >2 and single or multiple lesions were associated with reduced performance (-3.9 repetitions; P = .039). No significant differences were observed between the thoracotomy and thoracoscopy groups. Conclusions: Wedge resection for bone tumor metastases is associated with a specific recovery trajectory: initial decline, full recovery by 3 months, and stabilization up to 12 months. Preoperative clinical condition and lesion count are key prognostic factors. Extended rehabilitation programs may enhance outcomes in patients at higher risk.
Background: Breast cancer is the most common cancer in women, with a lifetime risk of 1 in 8. Survival rates have improved due to advances in diagnosis and treatment. Many women survive breast cancer aim to enhance their quality of life and reduce long-term complications. Surgery remains a key treatment, but postoperative complications persist despite less invasive approaches. This study evaluated the impact of preoperative Therapeutic Education in Physiotherapy (TEP) on reducing referrals to Rehabilitation Services. A secondary aim was to explore contextual factors for those with and without TEP. Methods: A retrospective cohort study included 6-month follow-up chart reviews of women with breast cancer who underwent surgery with immediate breast reconstruction and/or axillary lymphadenectomy between August 2021 and August 2022. Participants were divided into 2 groups: Group 1 (G1), which received TEP, and Group 2 (G2), which did not receive TEP. TEP included a 30-minute session on shoulder mobility exercises, stretching, skin care, and lymphedema prevention. The primary outcome measure was requiring postoperative rehabilitation based on clinical sequelae. Secondary variables included age, comorbidity index, surgery type, in-hospital physical therapy, hospital stay, prior surgeries, complications, and radiotherapy. Results: Of the 129 women (62 in G1, 67 in G2), 44 (34%) required Rehabilitation referrals. G1 had significantly lower referral rates (32% n:14) compared to G2 (62.8% n: 30) (P < .01). Referrals were associated with adjuvant radiotherapy (93.2%) and axillary surgery type (81.8%) both with P < .001. Conclusion: Preoperative TEP reduces Rehabilitation referrals in women undergoing immediate DIEP flap reconstruction and/or axillary lymphadenectomy.
Background:Motor disability represents a major challenge in children with leukemia, profoundly affecting their ability to perform activities of daily living. The aim of this study is to examine the relationship between motor proficiency and the ability to perform daily tasks in children with leukemia who are not attending school during treatment.Methods:This cross-sectional study was conducted in a Pediatric Oncology Department and included 102 children with leukemia aged 6 to 17 years. Occupational performance was assessed using the Canadian Occupational Performance Measure (COPM), and motor skills were evaluated with the Bruininks-Oseretsky Test of Motor Proficiency-Short Form (BOTMP-SF).Results:Approximately half of the participants were high school students, with 54.9% being male. COPM and BOTMP-SF differed significantly between age groups (P < .05). BOTMP-SF fine and gross motor proficiency found significant differences between primary, secondary, and high school age groups for gross motor proficiency (P < .05).Conclusion:The relationship between motor proficiency and participation in activities of daily living in children with leukemia has a crucial impact on occupational performance. In this context, it is important to implement specific interventions that take into account the age-specific needs of children with cancer.
Background: Individuals with cancer who receive rehabilitation experience improved muscle strength, functional performance, and quality of life. To maximize these benefits, they may need rehabilitation at different points along the cancer care continuum requiring a referral for each occurrence. Little is known about who recommends individuals with cancer to rehabilitation and for what services and reasons. We aimed to describe who is providing cancer rehabilitation, what factors are considered when recommending rehabilitation, and when recommendations are made. Methods: We conducted a 21-question online survey of cancer rehabilitation providers through listservs, social media, email invitations, and word-of-mouth. Results: Most respondents were physical therapists who were older than 44 years, white, and female. Medical oncologists were the most common health care provider to initially refer to rehabilitation. An individual's level of independence was the most common factor for the initial referral. Cancer rehabilitation providers working in inpatient rehabilitation and outpatient settings made their recommendations for subsequent rehabilitation within their weekly assessment compared to those in acute care who made recommendations within their initial evaluations. Conclusion: Medical and surgical oncologists were reported to be the most common initial referral source for cancer rehabilitation. Impairments experienced by those with cancer appear to be the primary reason for referring. Factors for recommending subsequent rehabilitation varied by setting: patient goals (acute), level of independence (inpatient rehabilitation), and impairments (outpatient). Research is needed to understand when and why patient goals are the primary reason for recommending therapy.
Background:Upper quadrant dysfunction (UQD) is common after breast conservation therapy (BCT) in breast cancer survivors but is poorly understood. This study aimed to examine patient-reported UQD using the Penn Shoulder Score (PSS) and a custom questionnaire to better understand UQD following BCT.Methods:This was a cross-sectional study nested within a larger study of UQD in survivors of unilateral breast cancer >= 1 year following BCT. The PSS and a custom questionnaire were distributed electronically to 26 study participants.Results:Mean PSS total score (91.8/100) and function subscore (55.4/60) were high. "Some difficulty" was reported placing a 1-gallon container at shoulder level (38.5%). Other common functional limitations were "washing the middle of the back," "sleeping on the affected side," or "carrying a bag of groceries with the affected arm" (26.9%). The custom questionnaire revealed that 42.3% had arm, shoulder, or chest wall symptoms, but only 23.1% complained of "discomfort or pain" while others complained of "stiffness," "tightness," "achiness," "weakness," or "pulling" (23.1%-38.5%). Additionally, symptom location was not just in the shoulder (38.5%) but also in the arm, chest wall, elbow, breast, neck, and back (3.8%-26.9%).Conclusion:Breast cancer survivors who have undergone BCT exhibit high PSS total and function scores; however, many still experience difficulties with activities involving lifting or carrying. Symptom evaluation should encompass pain, stiffness, tightness, and weakness, along with specific locations such as the shoulder, arm, chest wall, back, and/or elbow, to provide a more comprehensive assessment of UQD following BCT.
Background: Pulmonary rehabilitation (PR) can improve muscle strength and balance in individuals with advanced lung cancer. Typically, exercise instructions are provided through brochures; however, these lack engagement. Augmented reality (AR) applications can integrate users into digital interfaces, potentially increasing their motivation to exercise. However, no AR-based PR currently exists for individuals with advanced lung cancer. Methods: Fifty participants with advanced lung cancer were enrolled in this study. Thirty participants received AR-based therapy and 20 received paper-based PR. The PR program, including strength, balance, and breathing training, was performed 3 times daily during hospitalization until the participants were discharged. The primary outcomes were improvements in grip strength, balance, and degree of dyspnea. Results: Quadriceps strength, balance function, and dyspnea significantly improved after PR in the total cohort during hospitalization, while grip strength showed no significant change. Between-group differences were not statistically significant. The questionnaire survey revealed reduced clinical workload and more efficient communication for the nursing staff when implementing AR-based PR. Participants also reported that AR-based pR was associated with higher motivation. Conclusion: AR-based PR was feasible for hospitalized individuals with advanced lung cancer and demonstrated short-term improvements comparable to paper-based PR. Furthermore, AR-based PR was associated with higher participant motivation and lower nursing workload, thus supporting its potential utility as an innovative complementary approach within conventional in-hospital rehabilitation.
