exercise therapy in radiation therapy

Conditions: Metastatic Cancer

Summary: the purpose of this study is to evaluate exercise therapy as a method for potentially improving radiation therapy treatment toxicities for metastatic cancer patients receiving radiation therapy.

study objectives and endpoints: aim 1. to determine the acceptability, feasibility, and safety of an exercise intervention among cancer patients receiving radiation therapy. the investigators anticipate that \>25% of approached patients will consent to the protocol; \>33% of eligible radiation therapy patients who consent will perform the exercise prescribed (based on the response rate from enact); and \<25% of participants will experience a musculoskeletal impairment (without treatment alterations) and \<5% will experience a musculoskeletal injury with symptoms lasting ≥ week or requiring medical attention. the investigators' approach will be to include patients receiving definitive rt; excluding patients at high risk for side effects from combination therapy, including fracture or cardiovascular events. aim 2. to discern the clinical outcomes of patients receiving rt+et. the hypothesis is that adding et to rt will improve patient reported outcomes and physical functioning. the investigators' approach will be to use standardized questionnaires and assessment tools: patient reported outcomes will be assessed using common terminology criteria for adverse events - patient reported outcomes (ctcae-pros), loaded onto tablets that patients use in the clinic. questions will assess global pros relevant to the ability to tolerate rt, including fatigue, pain, nausea, vomiting; and disease-site-specific pros, including genitourinary/sexual symptoms for patients receiving pelvic rt. rt dose alterations will be documented. scores will be compared pre- vs post- rt. the investigators will also use standardized measures already used in enact, including grip strength, 30-second chair stand, timed up-and-go, and 4-stage balance. scores will be compared pre- vs post- rt.

Eligibility criteria:
inclusion criteria: * males and females ≥18 years of age * fluent in written and spoken english * must be able to provide and understand informed consent * must have an ecog ps of ≤ 2 * diagnosed with metastatic disease * cancer patients (stage 1-4) * treatment to primary site or metastatic disease * scheduled to receive radiation therapy at penn state cancer institute * absence of absolute contraindications for exercise according to the american heart association (see below) * primary attending oncologist approval * receiving treatment as an outpatient exclusion criteria: * receiving radiation therapy at a location other than penn state cancer institute * not fluent in written and spoken english * evidence in the medical record of an absolute contraindication for exercise * performing \> 90 minutes/week of physical activity at the time of initial evaluation * cardiac exclusion criteria: * class ii, iii or iv heart failure as defined by the new york heart association (nyha) functional classification system * history of acute coronary syndromes (including myocardial infarction and unstable angina), coronary angioplasty or stenting within the past 6 months prior to the start of radiation therapy * uncontrolled arrhythmias; patients with rate controlled atrial fibrillation for \>1 month prior to start of radiation therapy may be eligible * syncope * acute myocarditis, pericarditis, or endocarditis * acute pulmonary embolus or pulmonary infarction * thrombosis of lower extremities * suspected dissecting aneurysm * pulmonary edema * respiratory failure * acute non-cardiopulmonary disorder that may affect exercise performance or be aggravated by exercise * mental impairment leading to inability to cooperate * pregnant women * in-patient receiving radiation therapy for a radiation emergency (e.g. cord compression, svc syndrome, brain metastases) * high risk of fracture or spine instability (mirels score ≥7, sins ≥7) * children (the protocol will only include individuals 18 and older)