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Witlox L, Schagen SB, de Ruiter MB, Geerlings MI, Peeters PHM, Koevoets EW, van der Wall E, Stuiver M, Sonke G, Velthuis MJ, Palen JAMVD, Jobsen JJ, May AM, Monninkhof EM. Effect of physical exercise on cognitive function and brain measures after chemotherapy in patients with breast cancer (PAM study): protocol of a randomised controlled trial. BMJ Open 2019; 9:e028117. [PMID: 31227537 PMCID: PMC6597001 DOI: 10.1136/bmjopen-2018-028117] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION After treatment with chemotherapy, many patients with breast cancer experience cognitive problems. While limited interventions are available to improve cognitive functioning, physical exercise showed positive effects in healthy older adults and people with mild cognitive impairment. The Physical Activity and Memory study aims to investigate the effect of physical exercise on cognitive functioning and brain measures in chemotherapy-exposed patients with breast cancer with cognitive problems. METHODS AND ANALYTICS One hundred and eighty patients with breast cancer with cognitive problems 2-4 years after diagnosis are randomised (1:1) into an exercise intervention or a control group. The 6-month exercise intervention consists of twice a week 1-hour aerobic and strength exercises supervised by a physiotherapist and twice a week 1-hour Nordic or power walking. The control group is asked to maintain their habitual activity pattern during 6 months. The primary outcome (verbal learning) is measured at baseline and 6 months. Further measurements include online neuropsychological tests, self-reported cognitive complaints, a 3-tesla brain MRI, patient-reported outcomes (quality of life, fatigue, depression, anxiety, work performance), blood sampling and physical fitness. The MRI scans and blood sampling will be used to gain insight into underlying mechanisms. At 18 months online neuropsychological tests, self-reported cognitive complaints and patient-reported outcomes will be repeated. ETHICS AND DISSEMINATION Study results may impact usual care if physical exercise improves cognitive functioning for breast cancer survivors. TRIAL REGISTRATION NUMBER NTR6104.
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May AM, Gal R, van Gils CH, Groenwold RHH, van den Bongard DHJG, Peeters PHM, Verkooijen HM, Monninkhof EM. Effects Of Exercise On QoL And Fatigue of Inactive Breast Cancer Survivors, A TwiCs study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563195.81354.0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hiensch AE, Mijwel S, Wengström Y, May AM, Rundqvist H. Inflammation Mediates The Effects Of Exercise On Fatigue In Patients With Breast Cancer Undergoing Chemotherapy. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563193.04226.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Buffart LM, May AM, Huijsmans R, Aaronson NK, Stuiver MM. Evaluating The Translation Of Dutch Exercise Oncology Trials Into Clinical Practice Using The RE-AIM Framework. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561778.89965.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Witlox L, Velthuis MJ, Boer JH, Steins Bisschop CN, van der Wall E, van der Meulen WJTM, Schröder CD, Peeters PHM, May AM. Attendance and compliance with an exercise program during localized breast cancer treatment in a randomized controlled trial: The PACT study. PLoS One 2019; 14:e0215517. [PMID: 31067223 PMCID: PMC6505930 DOI: 10.1371/journal.pone.0215517] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/02/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Maintaining high adherence rates (session attendance and compliance) in exercise programs during breast cancer treatment can be challenging. We aimed to identify adherence rates and predictors to an exercise program during adjuvant breast cancer treatment. METHODS Ninety-two patients with localized breast cancer undergoing chemotherapy were randomly assigned to an 18-week supervised moderate-to-high intensity aerobic and resistance exercise program, including two 1-hour sessions/week. Additionally, participants were asked to be physically active for at least 30 minutes/day on at least three other days. We report median percentages for attendance, compliance with the prescribed duration and intensity of aerobic and muscle strength exercises, and the exercise advice given. Predictors included in univariate and multivariable linear regression models were demographical, tumor- and treatment-related factors, constructs of the theory of planned behavior, psychological and physical factors. RESULTS Patients attended 83% (interquartile range: 69-91%) of the supervised sessions. Compliance with the duration of aerobic exercise, high-intensity aerobic exercise (cycling at the ventilatory threshold), muscle strength exercises and the exercise advice were 88%(64-97%), 50%(22-82%), 84%(65-94%) and 61%(33%-79%), respectively. Education, radiotherapy, BMI and physical fatigue were important predictors of adherence to supervised exercise. Beliefs about planned behaviors were important predictors, especially for compliance with the exercise advice. CONCLUSIONS Attendance to and compliance with an 18-week aerobic and strength exercise program were high. The lowest compliance was found for high-intensity supervised aerobic exercise. The identified predictors should be considered when designing or adapting exercise programs for patients with localized breast cancer to increase adherence. TRIAL REGISTRATION Current Controlled Trials ISRCTN43801571 Dutch Trial Register NTR2138.
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Baumeister SE, Schlesinger S, Aleksandrova K, Jochem C, Jenab M, Gunter MJ, Overvad K, Tjønneland A, Boutron-Ruault MC, Carbonnel F, Fournier A, Kühn T, Kaaks R, Pischon T, Boeing H, Trichopoulou A, Bamia C, La Vecchia C, Masala G, Panico S, Fasanelli F, Tumino R, Grioni S, Bueno de Mesquita B, Vermeulen R, May AM, Borch KB, Oyeyemi SO, Ardanaz E, Rodríguez-Barranco M, Dolores Chirlaque López M, Felez-Nobrega M, Sonestedt E, Ohlsson B, Hemmingsson O, Werner M, Perez-Cornago A, Ferrari P, Stepien M, Freisling H, Tsilidis KK, Ward H, Riboli E, Weiderpass E, Leitzmann MF. Association between physical activity and risk of hepatobiliary cancers: A multinational cohort study. J Hepatol 2019; 70:885-892. [PMID: 30582978 DOI: 10.1016/j.jhep.2018.12.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS To date, evidence on the association between physical activity and risk of hepatobiliary cancers has been inconclusive. We examined this association in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC). METHODS We identified 275 hepatocellular carcinoma (HCC) cases, 93 intrahepatic bile duct cancers (IHBCs), and 164 non-gallbladder extrahepatic bile duct cancers (NGBCs) among 467,336 EPIC participants (median follow-up 14.9 years). We estimated cause-specific hazard ratios (HRs) for total physical activity and vigorous physical activity and performed mediation analysis and secondary analyses to assess robustness to confounding (e.g. due to hepatitis virus infection). RESULTS In the EPIC cohort, the multivariable-adjusted HR of HCC was 0.55 (95% CI 0.38-0.80) comparing active and inactive individuals. Regarding vigorous physical activity, for those reporting >2 hours/week compared to those with no vigorous activity, the HR for HCC was 0.50 (95% CI 0.33-0.76). Estimates were similar in sensitivity analyses for confounding. Total and vigorous physical activity were unrelated to IHBC and NGBC. In mediation analysis, waist circumference explained about 40% and body mass index 30% of the overall association of total physical activity and HCC. CONCLUSIONS These findings suggest an inverse association between physical activity and risk of HCC, which is potentially mediated by obesity. LAY SUMMARY In a pan-European study of 467,336 men and women, we found that physical activity is associated with a reduced risk of developing liver cancers over the next decade. This risk was independent of other liver cancer risk factors, and did not vary by age, gender, smoking status, body weight, and alcohol consumption.
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Derksen JWG, Kurk SA, Oskam MJ, Peeters PHM, Punt CJA, Koopman M, May AM. Factors Contributing to Cancer-Related Muscle Wasting During First-Line Systemic Treatment for Metastatic Colorectal Cancer. JNCI Cancer Spectr 2019; 3:pkz014. [PMID: 31360897 PMCID: PMC6649832 DOI: 10.1093/jncics/pkz016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/15/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background Increasing evidence indicates that loss of muscle mass is associated with adverse outcomes in metastatic colorectal cancer. Here, we investigate which demographic, lifestyle- (smoking), tumor-, and treatment-related factors are associated with muscle loss in patients with metastatic colorectal cancer during first-line palliative systemic treatment. Methods Data from 300 patients with computed tomography scans both at start and after six initial cycles of capecitabine plus oxaliplatin and bevacizumab was used (CAIRO3). From computed tomography, muscle mass normalized for stature (skeletal muscle index [SMI]) was calculated. A priori-selected variables were tested using multivariable linear regression models (P values ≤.05). Two models were developed: Model 1 contained variables measured at start and Model 2 contained variables assessed after initial therapy. Results In Model 1, loss of SMI was statistically significantly associated with a higher initial SMI (−0.32%, 95% confidence interval [CI] = −0.45% to −0.19% per unit increase in initial SMI), smoking status (−2.74%, 95% CI = −5.29% to −0.19% for smokers), and interval of metastases (−3.02%, 95% CI = −5.50% to −0.53%) for metachronous vs synchronous metastases), and primary tumor resection was statistically significantly associated with a gain in SMI (2.17%, 95% CI = 0.13% to 4.21% for resection vs no resection). In Model 2, loss of SMI was statistically significantly associated with response to capecitabine plus oxaliplatin and bevacizumab (−2.48%, 95% CI = −4.33% to −0.62% for stable disease vs partial/complete response). Conclusions Our results highlight, given the association of sarcopenia and survival, that patients with higher SMI should not be ignored. In addition, smoking is a potentially modifiable factor associated with muscle loss. The association between smoking and muscle loss might relate to worse clinical outcomes in smokers with metastatic colorectal cancer.
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Perfors IAA, May AM, Boeijen JA, de Wit NJ, van der Wall E, Helsper CW. Involving the general practitioner during curative cancer treatment: a systematic review of health care interventions. BMJ Open 2019; 9:e026383. [PMID: 30987988 PMCID: PMC6500297 DOI: 10.1136/bmjopen-2018-026383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The role of primary care providers (PCP) in the cancer care continuum is expanding. In the post-treatment phase, this role is increasingly recognised by policy makers and healthcare professionals. During treatment, however, the role of PCP remains largely undefined. This systematic review aims to map the content and effect of interventions aiming to actively involve the general practitioner (GP) during cancer treatment with a curative intent. STUDY DESIGN Systematic review. PARTICIPANTS Patients with cancer treated with curative intent. DATA SOURCES Randomised controlled trials (RCTs), controlled clinical trials (CCT), controlled before and after studies and interrupted time series focusing on interventions designed to involve the GP during curative cancer treatment were systematically identified from PubMed and EMBASE and were subsequently reviewed. Risk of bias was scored according to the Effective Practice and Organisation of Care Group risk of bias criteria. RESULTS Five RCTs and one CCT were included. Interventions and effects were heterogeneous across studies. Four studies implemented interventions focussing on information transfer to the GP and two RCTs implemented patient-tailored GP interventions. The studies have a low-medium risk of bias. Three studies show a low uptake of the intervention. A positive effect on patient satisfaction with care was found in three studies. Subgroup analysis suggests a reduction of healthcare use in elderly patients and reduction of clinical anxiety in those with higher mental distress. No effects are reported on patients' quality of life (QoL). CONCLUSION Interventions designed to actively involve the GP during curative cancer treatment are scarce and diverse. Even though uptake of interventions is low, results suggest a positive effect of GP involvement on patient satisfaction with care, but not on QoL. Additional effects for vulnerable subgroups were found. More robust evidence for tailored interventions is needed to enable the efficient and effective involvement of the GP during curative cancer treatment. PROSPERO REGISTRATION NUMBER CRD42018102253.
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Wu HS, Gal R, van Sleeuwen NC, Brombacher AC, IJsselsteijn WA, May AM, Monninkhof EM. Breast Cancer Survivors' Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e10820. [PMID: 30789349 PMCID: PMC6403530 DOI: 10.2196/10820] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/11/2018] [Accepted: 11/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background There is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change. Objective This study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial. Methods A total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker. Results The activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker’s inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist. Conclusions Wearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals.
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van Gemert WA, Peeters PH, May AM, Doornbos AJH, Elias SG, van der Palen J, Veldhuis W, Stapper M, Schuit JA, Monninkhof EM. Effect of diet with or without exercise on abdominal fat in postmenopausal women - a randomised trial. BMC Public Health 2019; 19:174. [PMID: 30744621 PMCID: PMC6371569 DOI: 10.1186/s12889-019-6510-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/04/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We assessed the effect of equivalent weight loss with or without exercise on (intra-) abdominal fat in postmenopausal women in the SHAPE-2 study. METHODS The SHAPE-2 study is a three-armed randomised controlled trial conducted in 2012-2013 in the Netherlands. Postmenopausal overweight women were randomized to a diet (n = 97), exercise plus diet (n = 98) or control group (n = 48). Both intervention groups aimed for equivalent weight loss (6-7%) following a calorie-restricted diet (diet group) or a partly supervised intensive exercise programme (4 h per week) combined with a small caloric restriction (exercise plus diet group). Outcomes after 16 weeks are amount and distribution of abdominal fat, measured by magnetic resonance imaging (MRI) with the use of the three-point IDEAL Dixon method. RESULTS The diet and exercise plus diet group lost 6.1 and 6.9% body weight, respectively. Compared to controls, subcutaneous and intra-abdominal fat reduced significantly with both diet (- 12.5% and - 12.0%) and exercise plus diet (- 16.0% and - 14.6%). Direct comparison between both interventions revealed that the reduction in subcutaneous fat was statistically significantly larger in the group that combined exercise with diet: an additional 10.6 cm2 (95%CI -18.7; - 2.4) was lost compared to the diet-only group. Intra-abdominal fat loss was not significantly larger in the exercise plus diet group (- 3.8 cm2, 95%CI -9.0; 1.3). CONCLUSIONS We conclude that weight loss of 6-7% with diet or with exercise plus diet reduced both subcutaneous and intra-abdominal fat. Only subcutaneous fat statistically significantly reduced to a larger extent when exercise is combined with a small caloric restriction. TRIAL REGISTER NCT01511276 (clinicaltrials.gov), prospectively registered.
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Bijlsma RM, Wessels H, Wouters RHP, May AM, Ausems MGEM, Voest EE, Bredenoord AL. Cancer patients' intentions towards receiving unsolicited genetic information obtained using next-generation sequencing. Fam Cancer 2019; 17:309-316. [PMID: 28852913 PMCID: PMC5893692 DOI: 10.1007/s10689-017-0033-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Next-generation sequencing (NGS) can be used to generate information about a patient’s tumour and personal genome. This powerful diagnostic tool provides solicited and unsolicited hereditary genetic (risk) information that could have consequences for cancer patients and their quality of life. A well-defined approach for returning appropriate genetic risk information is needed in personalized cancer care. A qualitative design with semi-structured interviews was used. We conducted interviews with 24 Dutch patients with different types of cancer, both NGS-experienced and NGS-inexperienced, to learn their intentions, needs and preferences towards receiving unsolicited genetic information obtained using NGS. Almost all participants had a positive attitude towards receiving unsolicited findings. After receiving comprehensive background information on NGS, including a binning model of four categories of unsolicited findings, most participants preferred to receive only subsets of genetic information. Their main concern was their own and others’ (including family members) ability to cope with (the increased risk of having) a genetic disorder. Providing background information gave cancer patients the opportunity to select subsets of findings and increased their ability to make an informed choice. Special attention is needed for social and emotional factors to support the patients themselves and when communicating test results with their family members.
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Kurk SA, Steensma BR, May AM, Koopman M, Hoogduin HM, van der Velden TA, Klomp DWJ, van der Kemp WJM. Feasibility of 7-T fluorine magnetic resonance spectroscopic imaging (19F MRSI) for TAS-102 metabolite detection in the liver of patients with metastatic colorectal cancer. Eur Radiol Exp 2018. [PMCID: PMC6091717 DOI: 10.1186/s41747-018-0043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Trifluridine/tipiracil (TAS-102) has shown a significant overall survival benefit in patients with heavily pre-treated metastatic colorectal cancer. However, predicting treatment response and toxicity in individual patients remains challenging. Fluorine (19F)-containing drugs can be detected with magnetic resonance spectroscopy (MRS) to determine the metabolic rates and the biodistribution of the drug in normal and tumour tissue, which are related to treatment efficacy and toxicity. This is the first study to investigate the potential of 7-T 19F-MRS to detect TAS-102 metabolites in humans. We demonstrate that, with the used setup, TAS-102 is not detectable in liver metastases of metastatic colorectal cancer patients on a normal treatment schedule. Therefore, 19F-MRS TAS-102 metabolite detection is not yet useful for the clinical early prediction of treatment response. As 19F-MRS is able to detect TAS-102 in phantom and murine models, the use of 19F-MRS remains a potential tool to noninvasively detect and possibly monitor the metabolism when higher dosages of TAS-102 are administered, for example in organoid and animal studies.
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Campanella G, Gunter MJ, Polidoro S, Krogh V, Palli D, Panico S, Sacerdote C, Tumino R, Fiorito G, Guarrera S, Iacoviello L, Bergdahl IA, Melin B, Lenner P, de Kok TMCM, Georgiadis P, Kleinjans JCS, Kyrtopoulos SA, Bueno-de-Mesquita HB, Lillycrop KA, May AM, Onland-Moret NC, Murray R, Riboli E, Verschuren M, Lund E, Mode N, Sandanger TM, Fiano V, Trevisan M, Matullo G, Froguel P, Elliott P, Vineis P, Chadeau-Hyam M. Epigenome-wide association study of adiposity and future risk of obesity-related diseases. Int J Obes (Lond) 2018; 42:2022-2035. [PMID: 29713043 DOI: 10.1038/s41366-018-0064-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/31/2018] [Accepted: 02/13/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Obesity is an established risk factor for several common chronic diseases such as breast and colorectal cancer, metabolic and cardiovascular diseases; however, the biological basis for these relationships is not fully understood. To explore the association of obesity with these conditions, we investigated peripheral blood leucocyte (PBL) DNA methylation markers for adiposity and their contribution to risk of incident breast and colorectal cancer and myocardial infarction. METHODS DNA methylation profiles (Illumina Infinium® HumanMethylation450 BeadChip) from 1941 individuals from four population-based European cohorts were analysed in relation to body mass index, waist circumference, waist-hip and waist-height ratio within a meta-analytical framework. In a subset of these individuals, data on genome-wide gene expression level, biomarkers of glucose and lipid metabolism were also available. Validation of methylation markers associated with all adiposity measures was performed in 358 individuals. Finally, we investigated the association of obesity-related methylation marks with breast, colorectal cancer and myocardial infarction within relevant subsets of the discovery population. RESULTS We identified 40 CpG loci with methylation levels associated with at least one adiposity measure. Of these, one CpG locus (cg06500161) in ABCG1 was associated with all four adiposity measures (P = 9.07×10-8 to 3.27×10-18) and lower transcriptional activity of the full-length isoform of ABCG1 (P = 6.00×10-7), higher triglyceride levels (P = 5.37×10-9) and higher triglycerides-to-HDL cholesterol ratio (P = 1.03×10-10). Of the 40 informative and obesity-related CpG loci, two (in IL2RB and FGF18) were significantly associated with colorectal cancer (inversely, P < 1.6×10-3) and one intergenic locus on chromosome 1 was inversely associated with myocardial infarction (P < 1.25×10-3), independently of obesity and established risk factors. CONCLUSION Our results suggest that epigenetic changes, in particular altered DNA methylation patterns, may be an intermediate biomarker at the intersection of obesity and obesity-related diseases, and could offer clues as to underlying biological mechanisms.
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van de Wiel HJ, Stuiver MM, May AM, van Grinsven S, Aaronson NK, Retèl VP, Oldenburg HSA, van der Poel HG, Horenblas S, van Harten WH, Groen WG. (Cost-)effectiveness of an internet-based physical activity support program (with and without physiotherapy counselling) on physical activity levels of breast and prostate cancer survivors: design of the PABLO trial. BMC Cancer 2018; 18:1073. [PMID: 30400784 PMCID: PMC6220515 DOI: 10.1186/s12885-018-4927-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Higher levels of physical activity (PA) after treatment are associated with beneficial effects on physical and psychosocial functioning of cancer survivors. However, survivors often do not meet the recommended levels of PA. In order to promote PA, we developed a closed internet-based program. The aim of the study is to evaluate the (cost-)effectiveness of an internet-based PA-promotion program, alone or combined with physiotherapy counselling, compared to usual care, on PA-levels of breast or prostate cancer survivors. In this multicenter randomised controlled trial (RCT), breast or prostate cancer survivors who completed their primary treatment 3-12 months earlier, will be randomised to either 6-months access to a fully-automated internet-based intervention alone, an internet-based intervention plus remote support by a physiotherapist, or a control group. The intervention is based on the Transtheoretical Model and includes personalized feedback, information, video's and assignments. Additionally, in a second arm, physiotherapy counselling is provided through monthly scheduled and on-demand telephone calls. The control group will receive usual care and a leaflet with PA guidelines. METHODS At baseline, 6 and 12 months, the primary outcome (PA) will be measured during 7 consecutive days by accelerometers. Secondary outcomes are self-reported PA, fatigue, mood, health-related quality of life, and costs. The group differences for primary and secondary outcomes will be analyzed using linear mixed models. DISCUSSION If proven to be (cost)effective, this internet-based intervention, either alone or in combination with telephone support, will be a welcome addition to previous RCT's. TRIAL REGISTRATION Netherlands trial register (NTR6911), Date of trial registration: December 21, 2017.
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Derksen JW, Beijer S, Koopman M, Verkooijen HM, van de Poll-Franse LV, May AM. Monitoring potentially modifiable lifestyle factors in cancer survivors: A narrative review on currently available methodologies and innovations for large-scale surveillance. Eur J Cancer 2018; 103:327-340. [DOI: 10.1016/j.ejca.2018.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
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Buffart LM, Sweegers MG, May AM, Chinapaw MJ, van Vulpen JK, Newton RU, Galvão DA, Aaronson NK, Stuiver MM, Jacobsen PB, Verdonck-de Leeuw IM, Steindorf K, Irwin ML, Hayes S, Griffith KA, Lucia A, Herrero-Roman F, Mesters I, van Weert E, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Arbane G, Schmidt ME, Potthoff K, van Beurden M, Oldenburg HS, Sonke GS, van Harten WH, Garrod R, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, José Kersten M, Nollet F, Wenzel J, Wiskemann J, Brug J, Courneya KS. Targeting Exercise Interventions to Patients With Cancer in Need: An Individual Patient Data Meta-Analysis. J Natl Cancer Inst 2018; 110:1190-1200. [PMID: 30299508 PMCID: PMC6454466 DOI: 10.1093/jnci/djy161] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/23/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment. Methods Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided. Results Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values. Conclusion Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.
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Degeling K, Franken MD, May AM, van Oijen MGH, Koopman M, Punt CJA, IJzerman MJ, Koffijberg H. Matching the model with the evidence: comparing discrete event simulation and state-transition modeling for time-to-event predictions in a cost-effectiveness analysis of treatment in metastatic colorectal cancer patients. Cancer Epidemiol 2018; 57:60-67. [PMID: 30317148 DOI: 10.1016/j.canep.2018.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Individual patient data, e.g. from clinical trials, often need to be extrapolated or combined with additional evidence when assessing long-term impact in cost-effectiveness modeling studies. Different modeling methods can be used to represent the complex dynamics of clinical practice; the choice of which may impact cost-effectiveness outcomes. We compare the use of a previously designed cohort discrete-time state-transition model (DT-STM) with a discrete event simulation (DES) model. METHODS The original DT-STM was replicated and a DES model developed using AnyLogic software. Models were populated using individual patient data of a phase III study in metastatic colorectal cancer patients, and compared based on their evidence structure, internal validity, and cost-effectiveness outcomes. The DT-STM used time-dependent transition probabilities, whereas the DES model was populated using parametric distributions. RESULTS The estimated time-dependent transition probabilities for the DT-STM were irregular and more sensitive to single events due to the required small cycle length and limited number of event observations, whereas parametric distributions resulted in smooth time-to-event curves for the DES model. Although the DT-STM and DES model both yielded similar time-to-event curves, the DES model represented the trial data more accurately in terms of mean health-state durations. The incremental cost-effectiveness ratio (ICER) was €172,443 and €168,383 per Quality Adjusted Life Year gained for the DT-STM and DES model, respectively. CONCLUSION DES represents time-to-event data from clinical trials more naturally and accurately than DT-STM when few events are observed per time cycle. As a consequence, DES is expected to yield a more accurate ICER.
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Kurk SA, Peeters PH, Dorresteijn B, de Jong PA, Jourdan M, Kuijf HJ, Punt CJ, Koopman M, May AM. Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients. J Cachexia Sarcopenia Muscle 2018; 9:909-919. [PMID: 30144305 PMCID: PMC6204584 DOI: 10.1002/jcsm.12337] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/19/2018] [Accepted: 06/25/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Observational studies suggest that loss of skeletal muscle mass (SMM) is associated with chemotherapy-related toxicity, poor quality of life, and poor survival in metastatic colorectal cancer (mCRC) patients. Little is known about the evolution of SMM during palliative systemic therapy. We investigated changes in SMM during various consecutive palliative systemic treatment regimens using repeated abdominal computed tomography scans of mCRC patients who participated in the randomized phase 3 CAIRO3 study. METHODS In the CAIRO3 study, mCRC patients with stable disease or better after 6 cycles of first-line treatment with capecitabine + oxaliplatin + bevacizumab (CAPOX-B) were randomized between maintenance treatment with capecitabine + bevacizumab (CAP-B) or observation. Upon first disease progression, in both groups, CAPOX-B or other treatment was reintroduced until the second disease progression, which was the primary study endpoint. We analysed 1355 computed tomography scans of 450 (81%) CAIRO3 patients (64 ± 9.0 years, CAP-B n = 223; observation n = 227) for SMM at four time points (i.e. prior to the start of pre-randomization initial treatment, at randomization, and at first and at second disease progression) using the Slice-o-matic software and single slice evaluation at the lumbar 3 level. By using accepted and widely used formulas, whole body SMM was calculated. A linear mixed effects model, adjusted for relevant confounders, was used to assess SMM changes for the total group and within and between study arms. RESULTS During 6 cycles of initial treatment with CAPOX-B prior to randomization, SMM decreased significantly in all patients [CAP-B arm: -0.53 kg (95% CI -1.12; -0.07) and observation arm: -0.85 kg (-1.45; -0.25)]. After randomization, SMM recovered during CAP-B treatment by 1.32 kg (0.73; 1.90) and observation by 1.20 kg (0.63; 1.78) (median time from randomization to first disease progression 8.6 and 4.1 months for CAP-B arm and observation arm, respectively). After first progression and during reintroduction treatment with CAPOX-B or other treatment, SMM again decreased significantly and comparable in both arms, CAP-B: -2.71 kg (-3.37; -2.03), and observation: -2.01 kg (-2.64; -1.41) (median time from first progression until second progression CAP-B arm: 4.7 months and observation arm: 6.6 months). CONCLUSIONS This longitudinal study provides a unique insight in SMM changes in mCRC patients during palliative systemic treatment regimens, including observation. Our data show that muscle loss is reversible and may be influenced by the intensity of systemic regimens. Although studies have shown prognostic capacity for SMM, the effects of subsequent changes in SMM are unknown and may be clues for new future therapeutic interventions.
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Freisling H, Noh H, Slimani N, Chajès V, May AM, Peeters PH, Weiderpass E, Cross AJ, Skeie G, Jenab M, Mancini FR, Boutron-Ruault MC, Fagherazzi G, Katzke VA, Kühn T, Steffen A, Boeing H, Tjønneland A, Kyrø C, Hansen CP, Overvad K, Duell EJ, Redondo-Sánchez D, Amiano P, Navarro C, Barricarte A, Perez-Cornago A, Tsilidis KK, Aune D, Ward H, Trichopoulou A, Naska A, Orfanos P, Masala G, Agnoli C, Berrino F, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HB, Ericson U, Sonestedt E, Winkvist A, Braaten T, Romieu I, Sabaté J. Nut intake and 5-year changes in body weight and obesity risk in adults: results from the EPIC-PANACEA study. Eur J Nutr 2018; 57:2399-2408. [PMID: 28733927 DOI: 10.1007/s00394-017-1513-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/15/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE There is inconsistent evidence regarding the relationship between higher intake of nuts, being an energy-dense food, and weight gain. We investigated the relationship between nut intake and changes in weight over 5 years. METHODS This study includes 373,293 men and women, 25-70 years old, recruited between 1992 and 2000 from 10 European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Habitual intake of nuts including peanuts, together defined as nut intake, was estimated from country-specific validated dietary questionnaires. Body weight was measured at recruitment and self-reported 5 years later. The association between nut intake and body weight change was estimated using multilevel mixed linear regression models with center/country as random effect and nut intake and relevant confounders as fixed effects. The relative risk (RR) of becoming overweight or obese after 5 years was investigated using multivariate Poisson regressions stratified according to baseline body mass index (BMI). RESULTS On average, study participants gained 2.1 kg (SD 5.0 kg) over 5 years. Compared to non-consumers, subjects in the highest quartile of nut intake had less weight gain over 5 years (-0.07 kg; 95% CI -0.12 to -0.02) (P trend = 0.025) and had 5% lower risk of becoming overweight (RR 0.95; 95% CI 0.92-0.98) or obese (RR 0.95; 95% CI 0.90-0.99) (both P trend <0.008). CONCLUSIONS Higher intake of nuts is associated with reduced weight gain and a lower risk of becoming overweight or obese.
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Sweegers MG, Altenburg TM, Brug J, May AM, van Vulpen JK, Aaronson NK, Arbane G, Bohus M, Courneya KS, Daley AJ, Galvao DA, Garrod R, Griffith KA, Van Harten WH, Hayes SC, Herrero-Román F, Kersten MJ, Lucia A, McConnachie A, van Mechelen W, Mutrie N, Newton RU, Nollet F, Potthoff K, Schmidt ME, Schmitz KH, Schulz KH, Sonke G, Steindorf K, Stuiver MM, Taaffe DR, Thorsen L, Twisk JW, Velthuis MJ, Wenzel J, Winters-Stone KM, Wiskemann J, Chin A Paw MJ, Buffart LM. Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data. Br J Sports Med 2018; 53:812. [DOI: 10.1136/bjsports-2018-099191] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
Abstract
ObjectiveTo optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions.DesignWe conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer.Data sourcesWe identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL).Eligibility criteriaWe analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer.ResultsExercise significantly improved UBMS (β=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (β=0.29, 95% CI 0.23 to 0.35), LBMF (β=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (β=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise.ConclusionExercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.
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Gal R, May AM, van Overmeeren EJ, Simons M, Monninkhof EM. The Effect of Physical Activity Interventions Comprising Wearables and Smartphone Applications on Physical Activity: a Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2018; 4:42. [PMID: 30178072 PMCID: PMC6120856 DOI: 10.1186/s40798-018-0157-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/24/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Worldwide physical activity levels of adults are declining, which is associated with increased chronic disease risk. Wearables and smartphone applications offer new opportunities to change physical activity behaviour. This systematic review summarizes the evidence regarding the effect of wearables and smartphone applications on promoting physical activity. METHODS PubMed, EMBASE and Cochrane databases were searched for RCTs, published since January 2008, on wearables and smartphone applications to promote physical activity. Studies were excluded when the study population consisted of children or adolescents, the intervention did not promote physical activity or comprised a minor part of the intervention, or the intervention was Internet-based and not accessible by smartphone. Risk of bias was assessed by the Cochrane collaboration tool. The primary outcome was changed in physical activity level. Meta-analyses were performed to assess the pooled effect on (moderate-to-vigorous) physical activity in minutes per day and daily step count. RESULTS Eighteen RCTs were included. Use of wearables and smartphone applications led to a small to moderate increase in physical activity in minutes per day (SMD = 0.43, 95% CI = 0.03 to 0.82; I2 = 85%) and a moderate increase in daily step count (SMD = 0.51, 95% CI = 0.12 to 0.91; I2 = 90%). When removing studies with an unclear or high risk of bias, intervention effects improved and statistical heterogeneity was removed. CONCLUSIONS This meta-analysis showed a small to moderate effect of physical activity interventions comprising wearables and smartphone applications on physical activity. Hence, wearables and smartphone applications are likely to bring new opportunities in delivering tailored interventions to increase levels of physical activity.
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van der Meulen IC, May AM, Koole R, Ros WJG. A Distress Thermometer Intervention for Patients With Head and Neck Cancer
. Oncol Nurs Forum 2018; 45:E14-E32. [PMID: 29251296 DOI: 10.1188/18.onf.e14-e32] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the feasibility of an intervention using the National Comprehensive Cancer Network Distress Thermometer and Problem List with nurse-guided follow-up and the effect on depressive symptoms, health-related quality of life, and worry of cancer in patients with head and neck cancer.
. SAMPLE & SETTING 110 patients with head and neck cancer in a two-arm randomized, controlled trial in an outpatient clinic of a university hospital.
. METHODS & VARIABLES Patients were randomized to usual care (n = 57) or the intervention group (n = 53), which consisted of screening with the Distress Thermometer and Problem List plus nurse-guided follow-up lasting about 20 minutes three to four times during 12 months. Intention-to-treat analysis was performed using linear mixed models with outcomes at 6 and 12 months and baseline adjustment.
. RESULTS The intervention showed moderate compliance and acceptable session duration. Intervention participants were satisfied with nurses' care. Depressive symptoms, health-related quality of life, and worry of cancer were not significantly different in the two treatment groups. The intervention seemed feasible in clinical practice, but no effects on patient outcomes were seen.
. IMPLICATIONS FOR NURSING Patients with head and neck cancer appreciated the opportunity to discuss their problems and challenges with a nurse. Nurses supported patients with basic psychosocial care, minor interventions, and referral possibilities.
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de Roon M, May AM, McTiernan A, Scholten RJPM, Peeters PHM, Friedenreich CM, Monninkhof EM. Effect of exercise and/or reduced calorie dietary interventions on breast cancer-related endogenous sex hormones in healthy postmenopausal women. Breast Cancer Res 2018; 20:81. [PMID: 30071893 PMCID: PMC6090977 DOI: 10.1186/s13058-018-1009-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Physical inactivity and being overweight are modifiable lifestyle risk factors that consistently have been associated with a higher risk of postmenopausal breast cancer in observational studies. One biologic hypothesis underlying this relationship may be via endogenous sex hormone levels. It is unclear if changes in dietary intake, physical activity, or both, are most effective in changing these hormone levels. Objective This systematic review and meta-analysis examines the effect of reduced caloric dietary intake and/or increased exercise levels on breast cancer-related endogenous sex hormones. Methods We conducted a systematic literature search in MEDLINE, Embase, and Cochrane’s Central Register of Controlled Trials (CENTRAL) up to March 2017. Main outcome measures were breast cancer-related endogenous sex hormones. Randomized controlled trials (RCTs) reporting effects of reduced caloric intake and/or exercise interventions on endogenous sex hormones in healthy, physically inactive postmenopausal women were included. Studies including women using hormone therapy were excluded. The methodological quality of each study was assessed by the Cochrane’s risk of bias tool. Results From the 2599 articles retrieved, seven articles from six RCTs were included in this meta-analysis. These trials investigated 1588 healthy postmenopausal women with a mean age ranging from 58 to 61 years. A combined intervention of reduced caloric intake and exercise, with durations ranging from 16 to 52 weeks, compared with a control group (without an intervention to achieve weight loss) resulted in the largest beneficial effects on estrone treatment effect ratio (TER) = 0.90 (95% confidence interval (CI) = 0.83–0.97), total estradiol TER = 0.82 (0.75–0.90), free estradiol TER = 0.73 (0.66–0.81), free testosterone TER = 0.86 (0.79–0.93), and sex hormone biding globulin (SHBG) TER = 1.23 (1.15–1.31). A reduced caloric intake without an exercise intervention resulted in significant effects compared with control on total estradiol TER = 0.86 (0.77–0.95), free estradiol TER = 0.77 (0.69–0.84), free testosterone TER = 0.91 (0.84–0.98), and SHBG TER = 1.20 (1.06–1.36). Exercise without dietary change, versus control, resulted in borderline significant effects on androstenedione TER = 0.97 (0.94–1.00), total estradiol TER = 0. 97 (0.94–1.00), and free testosterone TER = 0. 0.97 (0.95–1.00). Conclusions and relevance This meta-analysis of six RCTs demonstrated that there are beneficial effects of exercise, reduced caloric dietary intake or, preferably, a combination of exercise and diet on breast cancer-related endogenous sex hormones in physically inactive postmenopausal women. Electronic supplementary material The online version of this article (10.1186/s13058-018-1009-8) contains supplementary material, which is available to authorized users.
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Witlox L, Hiensch AE, Velthuis MJ, Steins Bisschop CN, Los M, Erdkamp FLG, Bloemendal HJ, Verhaar M, Ten Bokkel Huinink D, van der Wall E, Peeters PHM, May AM. Four-year effects of exercise on fatigue and physical activity in patients with cancer. BMC Med 2018; 16:86. [PMID: 29879968 PMCID: PMC5992660 DOI: 10.1186/s12916-018-1075-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/14/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In the earlier randomized controlled Physical Activity during Cancer Treatment (PACT) study, we found beneficial effects of an 18-week supervised exercise program on fatigue in patients with newly diagnosed breast or colon cancer undergoing adjuvant treatment. The present study assessed long-term effects of the exercise program on levels of fatigue and physical activity 4 years after participation in the PACT study. METHODS The original study was a two-armed, multicenter randomized controlled trial comparing an 18-week supervised exercise program to usual care among 204 breast cancer patients and 33 colon cancer patients undergoing adjuvant treatment. Of the 237 PACT participants, 197 participants were eligible and approached to participate in the 4-year post-baseline measurements, and 128 patients responded. We assessed fatigue and physical activity levels at 4 years post-baseline and compared this to levels at baseline, post-intervention (18 weeks post-baseline), and at 36 weeks post-baseline. RESULTS Intention-to-treat mixed linear effects model analyses showed that cancer patients in the intervention group reported significantly higher moderate-to-vigorous total physical activity levels (141.46 min/week (95% confidence interval (CI) 1.31, 281.61, effect size (ES) = 0.22) after 4 years compared to the usual care group. Furthermore, cancer patients in the intervention group tended to experience less physical fatigue at 4 years post-baseline compared to the usual care group (- 1.13, 95% CI -2.45, 0.20, ES = 0.22), although the result was not statistically significant. CONCLUSION Patients with breast or colon cancer who participated in the 18-week exercise intervention showed significant higher levels of moderate-to-vigorous total physical activity levels and a tendency towards lower physical fatigue levels 4 years post-baseline. Our result indicate that exercising during chemotherapy is a promising strategy for minimizing treatment-related side effects, both short and long term. TRIAL REGISTRATION Current Controlled Trials ISRCTN43801571 , Dutch Trial Register NTR2138 . Trial registered on 9 December 2009.
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May AM, Koo B, Yaffe K, Leng Y, Cawthon PM, Redline S, Stone KL, Mehra R. 1015 Frequent Periodic Limb Movements During Sleep and Risk of Incident Stroke. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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