Mitigating functional performance decrement in cancer patients undergoing treatment

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9105-9105
Author(s):  
P. M. Anton ◽  
C. A. Dennehy
Keyword(s):  
Side Effects ◽  
Cancer Patients ◽  
Repeated Measures ◽  
Functional Performance ◽  
Balance Training ◽  
Activity Level ◽  
Control Group ◽  
Exercise Interventions ◽  
Post Surgery ◽  
Muscle Groups

9105 Background: It is well-documented that treatment side-effects cause physical and psychosocial de-conditioning in cancer patient. Decrease in functional performance (FP), as measured by activities of daily living (ADL), is a major contributor to a decline in patient quality of life (QOL). Relatively little information is available on the effects of a specific exercise regimen targeting muscle groups/energy systems involved in FP. Methods: 30 male and female cancer patients receiving treatment were randomly assigned to either the experimental (EX) or control (C) groups. EX participated in two exercise sessions per week for 17 weeks. Sessions included a combination of aerobic, resistance, flexibility, and balance training. C did not participate in any structured exercise. Data were collected post-diagnosis (1), post- surgery (2), at 9 weeks post-diagnosis (3), and at 17 weeks post-diagnosis (4). Measurements included resting heart rate (RHR), fatigue, physical activity level (PA), QOL, and the FP tasks of: treadmill walking (TRED), stair climb/descent (STAIR), lifting/carrying (CARRY), sit to stand (STAND), and balance (REACH). Results: Factor analysis yielded four variables: FP1 = [(0.5 × TRED) - (0.5 × RHR)]; FP2 = [(STAIR) + (CARRY) + (STAND)]/3]; FP3 = [(0.333 × QOL) + (0.333 × PA) - (0.333 × FT)]; FP4 = REACH. Repeated-measures ANOVA with within-subjects contrasts detected significant differences between groups. No significant differences existed at 1 or from 1 to 2. Significant differences were found on all variables from 1 to 4, 1 to 3 and 3 to 4 (p < 0.001) (significant improvement for experimental group vs. significant decline for control group). Mean changes for the experimental vs. control groups from 1 to 4 are as follows: FP1 (+65.5 vs. -29.5); FP2 (-5.3 vs. +3.6); FP3 (+1.8 vs. -3.4); FP4 (+1.7 vs. -0.81). Conclusions: Specifically-designed exercise interventions promote positive adaptations that elicit significant improvement in ADL, QOL, and decrease fatigue. Prescriptive exercise is a viable therapy during treatment for mitigating side effects and avoiding de-conditioning. No significant financial relationships to disclose.

Effect of pretreatment distress on daily fatigue after chemotherapy for breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9090-9090
Author(s):  
S. C. Higgins ◽  
G. H. Montgomery ◽  
D. H. Bovbjerg
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Emotional Distress ◽  
Repeated Measures ◽  
Breast Cancer Patients ◽  
Outpatient Chemotherapy ◽  
Specific Effects ◽  
Post Infusion ◽  
Time Specific

9090 Background: Fatigue is one of the most frequently reported and aversive side effects of cancer chemotherapy. Prospective research has found that cancer patients’ levels of emotional distress prior to treatment are predictive of other side effects (e.g., nausea), but studies of such effects on fatigue are lacking. The present study prospectively tested the hypothesis that patients’ levels of emotional distress in the clinic prior to their first treatment infusion would predict the severity of their post-infusion fatigue. Methods: Sixty Stage I (32.6%) and II (67.4%) breast cancer patients (mean age=44.5 yrs), receiving standard outpatient chemotherapy (e.g., CMF), participated. The independent variable, emotional distress, was assessed (0–100) with a visual analog scale (VAS). The dependent variable, post treatment fatigue (PTF) was assessed (0–100) over each of the subsequent 6 days using end-of-day diaries, which also included assessment of distress (0–100). To explore temporal specificity, pretreatment distress was assessed for “last night”, “this morning” and “right now.” Results: Consistent with previous reports, PTF levels peaked at day 2 and began to decline after day 3, although they remained elevated across the period (p<.026). Repeated measures analysis indicated a significant main effect of pretreatment distress “right now” on PTF (p<.009); prior distress levels were less predictive. Additional regression analyses, controlling for pretreatment fatigue and daily distress, revealed a strongly selective effect of pretreatment distress on post peak PTF on days 5 (p<.002) and 6 (p<.026). Conclusions: This study is the first to demonstrate time-specific effects of pretreatment distress on PTF. Possible mechanisms of these effects now warrant investigation, as do possible benefits of brief interventions to reduce distress immediately prior to treatment. No significant financial relationships to disclose.

scholarly journals Importance of Providing Additional Choices in Relation to Pupils' Happiness, Mastery, Well-Being, Contentment, and Level of Physical Activity in Physical Education

2021 ◽  
Vol 3 ◽  
Author(s):  
Stian Oldervik ◽  
Pål Lagestad
Keyword(s):  
Repeated Measures ◽  
Well Being ◽  
Activity Level ◽  
Self Determination ◽  
Control Group ◽  
Activity Levels ◽  
Bonferroni Correction ◽  
Tenth Graders ◽  
Self Organized ◽  
Positive Effect

Previous research points to the importance of providing support to autonomy in PE, because it has a particularly positive effect on motivation in PE. However, previous research has not examined the association between autonomy and the variables; happiness, mastery, well-being, contentment and activity level in PE. This study examined how increased self-determination affects happiness, mastery, well-being, contentment and activity level in PE. The study is an intervention (cross-over study) with one control group (one class) and two intervention groups (two classes), using questionnaires and accelerometers among 88 tenth graders (41 boys and 47 girls). The three classes included approximately the same number of boys and girls. The intervention groups included, respectively, 30 and 29 pupils in each class, and 29 pupils' in the control group. The pupils' experiences of happiness, mastery, well-being, contentment was measured three times–after a month with, respectively, ordinary PE, teacher-directed PE, and self-organized PE (autonomy), and the activity levels (accelerometer) was measured during the 24 lessons that took part in the period of teacher-directed PE and self-organized PE. Factor analysis, repeated measures ANOVA (mixed method ANOVA design) and paired sample t-tests with Bonferroni correction were performed, in order to look at differences in happiness, mastery, well-being, contentment and activity level during periods of; self-determination, teacher-directed PE and ordinary PE. The results show that self-determination in PE gives the pupil a significant increased experience of happiness, well-being and contentment, and also a higher activity level in PE. The results indicate that increased self-determination in PE can positively affect lower secondary school pupils' happiness, well-being, contentment and activity level in PE, and that teachers should strive to encourage self-determination among pupils in PE. Further research should be based on intervention studies studying self-determination over longer continuous period, in classes with both older and younger pupils.

Randomized clinical trial of medical qigong on quality of life, fatigue, side effects, mood, status, and inflammation of cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9617-9617
Author(s):  
B. Oh ◽  
P. Butow ◽  
B. Mullan ◽  
S. Clarke ◽  
P. Beale ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Side Effects ◽  
Sleep Disturbance ◽  
Usual Care ◽  
Cancer Patients ◽  
Intervention Group ◽  
Control Group ◽  
Usual Care Control Group

9617 Background: The quality of life (QOL) of cancer patients is often diminished due to the side effects of treatment and symptoms of the disease itself. This study examines the impact of Medical Qigong (MQ), including gentle exercise and relaxation through meditation and breathing exercise based on the Chinese Medicine theory of energy channels, on quality of life (QOL), fatigue, side effects, mood status and inflammation. Methods: One hundred sixty two patients diagnosed with a range of cancers recruited from three university teaching hospitals were randomly assigned to two groups: a control group (n=83) that received usual health care and an intervention group (n=79) who participated in a MQ program for 10 weeks in addition to receiving usual health care at the hospital. Quality of life and symptoms were measured by the FACT-G, cancer related fatigue by FACT-F and mood status by POMS. The inflammatory marker serum C-reactive protein (CRP) was also monitored serially. Results: Regression analysis indicated that the MQ intervention group significantly improved on measures of overall QOL (t144= -5.761, p<0.001), fatigue (t153= -5.621, p<0.001), mood disturbance (t122=2.346, p=0.021) and inflammation (CRP) (t99=2.042, p<0.044) compared to the usual care control group after controlling for baseline variables. Analysis of the FACT-G subscales revealed that the MQ intervention group also significantly improved in satisfaction with sex life (t92=-3.783, p<0.001) and reduced side effects of nausea (t152=-2.071, p=0.040) and sleep disturbance (t150=-2.603, p=0.010) compared to the usual care control group. Pain was improved in both intervention and control groups. Conclusions: This study suggests that MQ with usual health care can improve overall QOL, fatigue, positive mood status and reduce the side effects of nausea, sleep disturbance and inflammation of cancer patients. This study supports the use of MQ as an intervention for cancer care. No significant financial relationships to disclose.

scholarly journals A Clinical Evaluation of Guduchi (Tinospora cordifolia) and Yashtimadhu (Glycyrrhiza glabra) as Chemopreventive Agent in Cancer Treatment

2019 ◽  
Vol 05 (02) ◽  
pp. 064-071
Author(s):  
Vijay Kumar Beriwal ◽  
Bhavna Singh ◽  
Sanandan Thapliyal ◽  
Shalini Thapliyal
Keyword(s):  
Side Effects ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Glycyrrhiza Glabra ◽  
Tinospora Cordifolia ◽  
Health Concern ◽  
Control Group ◽  
P Values ◽  
Wide Range ◽  
Group D

Abstract Introduction Guduchi (Tinospora cordifolia (Willd.) Miers ex Hook.f. and Thomas) and Yashtimadhu (Glycyrrhiza glabra Linn.) are the medicinal plants traditionally used for various properties such as rasayana, ayushprada, vayah-sthapana, cakshuya, varnya, keshya, vatapittajit, raktaprasadana, varnahar, shothhar, vishghan, and chhardighan in Ayurveda. Modern studies also have explicitly revealed a wide range of pharmacological effects of both drugs such as antioxidant, immunomodulator, brain tonic and memory enhancer, gastroprotective, anti-inflammatory, antiulcer and wound healing, and antibacterial properties. On the other hand, cancer and various side effects of its treatment with chemotherapy/radiotherapy have emerged as a major public health concern all over the world including India. Aim The main objective of this study was to observe the clinical efficacy of guduchi and yashtimadhu against the adverse effects of chemotherapy. Study Design A clinical research, prospective in style, wherein a hypothesis was based on previous study on the various effects of T. cordifolia and G. glabra, was made to assess its effects on side effects of chemotherapy in cancer patient. Materials and Methods Randomly selected (n = 38) cancer patients, receiving chemotherapy and divided into four groups as A, B, C, D, were administered trial drugs as 1 g guduchi ghan tablet to group B, 1 g yashtimadhu ghan wati to group C and 1 g of guduchi and yashtimadhu ghan tablet both were given to group D thrice a day with water for 90 days. Group A was control group and no drug was given. A follow-up was done on every 15 days for 3 months. Clinical assessment of the study was based on before therapy ( BT) and after therapy (AT) effects of guduchi yashtimadhu in all adjuvant groups on the parameters namely subjective parameters, that is, side effects of chemotherapy and objective on hemoglobin (Hb) gm%, total leucocytes count (TLC), platelet count (PC), B. urea and S. creatinine level. For statistical analysis in both parameters paired t-test was used, and for comparison between all groups ANOVA test was used with corresponding p-values. Results The overall outcome shows, except alopecia (khalitya) in all other adverse symptoms of chemotherapy, p-value was either <0.05 or <0.001 that was considered to be highly significant. Guduchi and yashtimadhu were used as combined adjuvant therapy in group D, and the result was highly significant. In objective parameters, the outcome of p-values (i.e., p ≤ 0.05–0.01) showed the effects of guduchi yashtimadhu on Hb, TLC, PC, which was found to be significant. Conclusion The findings suggest that that there is a marked difference between BT and AT effect of guduchi yashtimadhu on the symptoms of chemotherapy and on Hb, TLC, PC level. Integration of Ayurveda in all adjuvant therapy groups showed significant results at 1% level of significance, against the side effects of chemotherapy in cancer patients.

Controlled-release oral morphine sulfate in the treatment of cancer pain with pharmacokinetic correlation.

1987 ◽  
Vol 5 (6) ◽  
pp. 956-961 ◽  
Author(s):  
A Khojasteh ◽  
W Evans ◽  
R D Reynolds ◽  
G Thomas ◽  
J J Savarese
Keyword(s):  
Controlled Release ◽  
Side Effects ◽  
Cancer Patients ◽  
Peak Plasma ◽  
Oral Morphine ◽  
Extended Period ◽  
Morphine Sulfate ◽  
Control Group ◽  
Clinical Effects ◽  
The Mean

The bioavailability and clinical effects of an oral controlled-release morphine sulfate tablet, MS-contin (MSC; Purdue-Frederick, Norwalk, CT) in comparison to an immediate-release (IRMS) preparation were evaluated in normal subjects and cancer patients, respectively. The inherent slow-release character of MSC was confirmed by 2 1/2 X T1/2 absorption rate, one-half Cmax, and twice Tmax relative to IRMS. The T1/2 elimination of the two morphine preparations was similar, demonstrating insignificant risk of MSC accumulation. The difference in the mean number of side effects experienced by the control group per subject was significant (.70 for MSC and 1.26 for IRMS, P = .05) and was consistent with peak plasma morphine attenuation. The cancer patients were initially switched from their previous analgesic to four hourly IRMS and then to MSC at double the dose every eight hours. The majority had their MSC dosing interval lengthened to every 12 hours with a decrease in the total daily morphine requirement. While the mean duration on MSC was 20.5 days, many patients were followed poststudy for an extended period with no appreciable development of tolerance. Overall, MSC analgesia and side effects were perceived by the patients as superior compared with prestudy opioids. The advantage of less frequent dosing may lead to improvement of the quality of life of cancer patients.

The Effects of Acupressure on Meridian Energy as well as Nausea and Vomiting in Lung Cancer Patients Receiving Chemotherapy

2016 ◽  
Vol 19 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Chi-Hsiang Shen ◽  
Li-Yu Yang
Keyword(s):  
Lung Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Lung Cancer Patients ◽  
Clinical Nurses ◽  
Quasi Experimental ◽  
The Mean ◽  
Experimental Group

Nausea and vomiting are the most common side effects of antineoplastic chemotherapy. However, only a small number of studies have been conducted in Taiwan to determine the efficacy of acupressure in treating these side effects in cancer patients receiving chemotherapy. In this quasi-experimental study, we aimed to explore the effects of acupressure on meridian energy as well as nausea and vomiting in 70 lung cancer patients receiving chemotherapy. Patients were assigned to the experimental or control group based on order of hospital admission. The experimental group received acupressure on “Neiguan (PC6)” and “Gongsun (SP4)” points, and the control group received sham acupoint patches on “Houxi (SI3)” point. The results showed that the mean meridian energy in the experimental group after acupressure was significantly higher than in the control group ( F = 28.71, p < .001). The experimental group had significantly less nausea ( p < .001) and vomiting ( p = .006) during the delayed phase than the control group. In conclusion, acupressure significantly increased the mean meridian energy and effectively decreased the severity of nausea and vomiting in lung cancer patients undergoing chemotherapy. We recommend that clinical nurses provide acupressure as an intervention to relieve nausea and vomiting in patients receiving chemotherapy.

scholarly journals Implementing exercise in standard cancer care: Bizi Orain hybrid, clinical and implementation randomized trial study protocol to evaluate the effectiveness of a community-based exercise programme for people living with cancer (Preprint)

2020 ◽  
Author(s):  
Maria Soledad Arietaleanizbeaskoa ◽  
Erreka Gil Rey ◽  
Nere Mendizabal Gallastegui ◽  
Arturo García Álvarez ◽  
Ibon De La Fuente ◽  
...  
Keyword(s):  
Physical Activity ◽  
Overall Survival ◽  
Side Effects ◽  
Physical Function ◽  
Cancer Patients ◽  
Cancer Care ◽  
Exercise Programme ◽  
Programme Evaluation ◽  
Activity Level ◽  
Community Based

BACKGROUND Despite the established benefits of regular exercise for cancer patients to counteract the deleterious effects of the disease itself, and treatment-related side-effects, most of them do not engage in sufficient levels of physical activity and there is a paucity of data on the integration of efficacious exercise programmes that are accessible and generalizable to a large proportion of cancer patients into routine cancer care. This paper describes the implementation of Bizi Orain, a community-based exercise programme for people with cancer, and the protocol for the programme evaluation. OBJECTIVE To describe the implementation of a community-based exercise programme for cancer patients (“Bizi Orain”) and the protocol for programme evaluation. METHODS This will be a hybrid study, with a first experimental phase in which patients diagnosed with any type of cancer will be randomized to two parallel groups, one that immediately performs Bizi Orain, a 3-month supervised exercise programme (3 times a week) in addition to behavioural counselling in a primary healthcare setting, and the other, a reference group that starts the exercise programme 3 months later (delayed treatment). In a second observational phase, the entire cohort of participants will be followed-up for 5 years. Any person diagnosed with cancer in the previous 2 years is eligible for the programme. Evaluation of the programme involves uptake, safety, adherence and effectiveness assessed on the completion of the programme and at 3, 6, 12, 24, 36, 48 and 60 months of follow-ups. The primary outcomes of the experimental study, to be compared between groups, are physical function and patient-reported outcomes, whereas overall survival is the main endpoint of the prospective study. To analyse the association between changes in physical activity level and overall survival, longitudinal mixed-effects models will be used for repeated follow-up measures. RESULTS It is a protocol, so there are no results CONCLUSIONS Bizi Orain is the first population-based exercise programme in Spain that will offer more insight into the implementation of feasible, generalizable and sustainable supportive care services involving structured exercise to extend cancer patients’ survival, improve their physical function and quality of life, and reverse the side-effects of their disease and related treatments, thereby reducing the clinical burden. CLINICALTRIAL Clinical Trials.gov Identifier: NCT03819595. Date of registration: 18/01/2019

scholarly journals The Effects of Individual Diet Therapy on Food Intake, Quality of Life, and Related Serum Proteins in Patients with Breast Cancer: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Azadeh Fallah ◽  
Kiana Parnian ◽  
Hamid Abdolazimi ◽  
Sajjad Tezerji ◽  
Zohreh Mazloom
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Side Effects ◽  
Cancer Patients ◽  
Serum Proteins ◽  
Intervention Group ◽  
Diet Therapy ◽  
Control Group ◽  
Nutritional Needs

Background: In cancer patients, weight loss due to malnutrition has a significant impact on the patients’ treatment and quality of life. This study aimed to determine the appropriate therapeutic strategy to control the side effects of chemotherapy in patients with breast cancer to improve their health, quality of life, and nutritional status. Methods: In our prospective study, we examined gastric cancer patients who were Seventy patients undergoing chemotherapy were included and randomly divided into intervention (n=35) and control groups (n=35). The intervention group received an individualized diet according to their nutritional needs for eight weeks, and the control group received dietary advice on the side effects of chemotherapy. Malnutrition, nutritional barriers, and patients’ quality of life were evaluated by PG-SGA, nutritional barriers, and QLQ-C30 questionnaires. Serum proteins were also assessed at the beginning and the end of the study. Results: The patients’ mean age was 50.91±1.72 years in the intervention group and 51±1.35 in the control group. According to the PG-SGA questionnaire classification, 68.5% of patients had malnutrition at baseline. In the intervention group, the mean score of PG-SGA decreased, which indicated an improvement in patients’ nutritional status. Increased scores in the functional section of QLQC30 and a decrease in the symptom section of this questionnaire indicated the improved quality of life in patients undergoing treatment at the end of the intervention. Albumin (P<0.001) and hemoglobin (P<0.001) levels increased in the intervention group, while there were no significant changes in these variables of the control group. Serum levels of ferritin did not show significant changes in either the intervention or the control group. Conclusion: Identifying nutritional barriers in breast cancer patients and individual diet therapy based on these barriers and nutritional needs reduces nutritional barriers. Consequently, malnutrition would decline, and the quality of life may enhance in these patients.

scholarly journals Efektivitas Perendaman Tangan Kaki dengan Air dan Pengolesan Campuran VCO dan Olive Oil dalam Mengatasi Efek Samping Kemoterapi (Palmar-Plantar Erythorodysesthesia) pada Pasien Kanker Kolon di Murni Teguh Memorial Hospital

2020 ◽  
Vol 4 (2) ◽  
pp. 94
Author(s):  
Seriga Banjarnahor ◽  
Harsudianto Silaen
Keyword(s):  
Colon Cancer ◽  
Side Effects ◽  
Olive Oil ◽  
Cancer Patients ◽  
Intervention Group ◽  
Memorial Hospital ◽  
Control Group ◽  
Chi Square ◽  
Control Group Design ◽  
Chi Square Test

Patients with colon cancer undergoing chemotherapy at the Pure Teguh Memorial Hospital both inpatient and outpatient experience many Palmar-Plantar Erythrodysesthesia. Palmar-Plantar Erythrodysesthesia incident that occurs in colon cancer patients due to side effects of chemotherapy. The high incidence of Plamr-Plantar Erythrodysesthesia in colon cancer patients is related to the lack of immersion of the feet with water and the application of a misture of VCO and olive oil. This type of research is a quasy experimental study of post test only non eguivalent control group design that aims to determine the effectiveness of soaking the foot with water and applying a mixture of VCO and Olive Oil in overcoming the side effects of chemotherapy (Palmar-Plantar Erythrodysesthesia) in colon cancer patients in Pure Teguh Memorial Hospital.The population in this study were all colon cancer patients who were undergoing chemotherapy in the Murni Teguh Memorial hospital chemotherapy center as many as 90 patients and a sample of 90 patients consisting of 45 people in the intervention group and 45 in the control group). Data were analyzed with chi square test. The results of the study are the effectiveness of foot immersion soaking with water and the application of a mixture of VCO and olive oil  to overcome the side effects of chemotherapy (Palmar-Plantar Erythrodysesthesia) in colon cancer patients at Murni Teguh Memorial Hospital.As a suggestion in this study, it is expected that immersion of foot hands with water and the application of a mixture of VCO and olive oil  to reduce Palmar-Plantar Erythrodysesthesia in colon cancer patients at Murni Teguh Memorial Hospital and for patients should immerse foot hands with water and basting mixture of VCO olive oil data to reduce the incidence of Palmar-Plantar Erythrodysesthesia.

Review of Exercise Intervention Studies in Cancer Patients

2005 ◽  
Vol 23 (4) ◽  
pp. 899-909 ◽  
Author(s):  
Daniel A. Galvão ◽  
Robert U. Newton
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Resistance Training ◽  
Resistance Exercise ◽  
Cancer Patients ◽  
Small Sample ◽  
Psychological Benefits ◽  
Exercise Interventions ◽  
Cancer Management ◽  
Cardiovascular Training

Purpose To present an overview of exercise interventions in cancer patients during and after treatment and evaluate dose-training response considering type, frequency, volume, and intensity of training along with expected physiological outcomes. Methods The review is divided into studies that incorporated cardiovascular training, combination of cardiovascular, resistance, and flexibility training, and resistance training alone during and after cancer management. Criteria for inclusion were based on studies sourced from electronic and nonelectronic databases and that incorporated preintervention and postintervention assessment with statistical analysis of data. Results Twenty-six published studies were summarized. The majority of the studies demonstrate physiological and psychological benefits. However, most of these studies suffer limitations because they are not randomized controlled trials and/or use small sample sizes. Predominantly, studies have been conducted with breast cancer patients using cardiovascular training rather than resistance exercise as the exercise modality. Recent evidence supports use of resistance exercise or “anabolic exercise” during cancer management as an exercise mode to counteract side effects of the disease and treatment. Conclusion Evidence underlines the preliminary positive physiological and psychological benefits from exercise when undertaken during or after traditional cancer treatment. As such, other cancer groups, in addition to those with breast cancer, should also be included in clinical trials to address more specifically dose-response training for this population. Contemporary resistance training designs that provide strong anabolic effects for muscle and bone may have an impact on counteracting some of the side effects of cancer management assisting patients to improve physical function and quality of life.

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