Associations between exercise and quality of life in bladder cancer survivors: a population-based study

Physical activity and health-related quality of life in young adult cancer survivors: a Canadian provincial survey

OBJECTIVES

Physical activity (PA) improves health-related quality of life (HRQL) in several cancer survivor groups but no studies have focused on young adult cancer survivors (YACS). This study determined the prevalence of PA in YACS and examined dose-response associations with HRQL.

METHODS

A random sample of 2,000 YACS between the ages of 20-44 were identified through a Canadian provincial cancer registry and mailed a survey that included the Leisure-Time Exercise Questionnaire, the Medical Outcomes Study 36-Item Short Form (SF36) survey, and several validated psychosocial scales. The primary endpoint was the physical component summary (PCS) of the SF36.

RESULTS

Completed questionnaires were received from 588 YACS. In terms of PA prevalence, 23% were completely sedentary, 25% were insufficiently active, 22% were active within public health guidelines, and 29% were active above public health guidelines. Analysis of covariance adjusted for important medical and demographic covariates showed a statistically significant and clinically meaningful dose-response association between PA and the PCS that spanned 6.3 points (95% confidence interval [CI] 3.7 to 8.8; p < 0.001) from completely sedentary to within guidelines. Similar associations were found for the mental component summary scale (p = 0.002), depression (p < 0.001), stress (p < 0.001) and self-esteem (p < 0.001). Associations between PA and HRQL were stronger for YACS that had previously received chemotherapy.

CONCLUSIONS

PA is strongly associated with HRQL in YACS but only half of YACS are meeting public health guidelines and almost a quarter are completely sedentary. Randomized controlled trials examining intervention strategies to increase PA and improve health outcomes in this understudied patient population are warranted.

Physical activity preferences and type 2 diabetes: exploring demographic, cognitive, and behavioral differences

PURPOSE

The purpose of this study was to examine physical activity counseling and program preferences in a sample of adults with type 2 diabetes. Specifically, the objectives were to determine physical activity preferences (objective 1), and whether there were any significant differences between age and/or sex groups for these preferences (objective 1a). A subsidiary objective was to explore potential associations of key social-cognitive constructs (ie, self-efficacy and social support) with physical activity preferences (objective 2).

METHODS

This exploratory study consisted of a quantitative, secondary analysis of survey data from a national sample of adults with type 2 diabetes (N = 244). A qualitative follow-up employing telephone interviews was conducted with 14 individuals.

RESULTS

Consistent with hypotheses, walking was the most preferred physical activity behavior and there was a preference for engaging in physical activity with others. There were significant (P values < .05) differences in counseling and program preferences between demographic (age and sex), and physical activity cognitive scores. For example, a significantly (P < .05) higher physical activity intensity preference was found in men and younger participants.

CONCLUSIONS

Tailoring interventions and physical activity programs to the specific preferences of individuals is an important component for health professionals and researchers in facilitating this behavior.

Quality of life following incontinent cutaneous and orthotopic urinary diversions

The quality of life (QOL) of patients requiring urinary diversion remains an important issue within the field of Urology. The majority of this population has undergone cystectomy as treatment for malignant disease. In the initial phases of treatment counseling, the patient is focused on the eradication of their tumor. However, it is the urinary diversion that will have a lasting functional impact on the patient every day for the rest of their lives. The selection of an appropriate diversion, then, is critical to long-term satisfaction with the surgical treatment. Patients must be fully counseled in all types of urinary diversion and should have ready access to all options. Reported differences in QOL between diversion populations are difficult to interpret in view of limitations in the methodology of study designs and apparent selection bias. Ultimately, as a community, urologists cannot definitively say that one class of urinary diversion is superior to another. Instead, we must empower the patient in their own decision making with an accurate impression of diversion recovery, required education and training, and related side-effects and complications. The choice of urinary diversion still remains a very personal decision to be made between the patient, family members, friends, and the physician.

Physical activity and genitourinary cancer survivorship

In this chapter we discuss common toxicities arising from genitourinary cancer treatments, in particular the adverse effects from androgen deprivation therapy (ADT) for prostate cancer given its well established detrimental effects on physical, physiological, and psychological function, and existing physical activity research in the postdiagnosis period including studies focusing on supportive care and some limited data on disease outcomes. Overall, consistent positive outcomes have been reported across studies showing that exercise is beneficial to reduce a number of treatment-related toxicities and improve symptoms. Additional studies are needed in genitourinary cancers other than prostate to establish specific physical activity requirements and implementation strategies.

Effects of exercise on quality of life and prognosis in cancer survivors

Cancer is a global health problem with over 10 million cancer survivors in the United States alone. Cancer and its treatments often produce side effects that undermine quality of life. The purpose of this article is to review research examining the effects of physical activity (PA) upon quality of life and disease prognosis in cancer survivors. We divide our review into PA studies focusing upon (a) quality of life during treatments, (b) quality of life during survivorship (after treatments), (c) quality of life during palliative care, and (d) disease prognosis end points. Compelling clinical trial data indicate that PA can improve quality of life end points during treatment and survivorship. Data during palliative care is limited. Observational data suggest that PA may reduce the risk of disease recurrence and extend survival in some cancer survivors. Research findings suggest that PA is an appropriate recommendation for most cancer survivors, although many research questions remain.

Race/ethnicity, physical activity, and quality of life in breast cancer survivors

PURPOSE

To examine associations between recreational physical activity and quality of life (QOL) in a multiethnic cohort of breast cancer survivors, specifically testing whether associations are consistent across racial/ethnic groups after accounting for relevant medical and demographic factors that might explain disparities in QOL outcomes.

METHODS

Data were collected from a population-based cohort of non-Hispanic White (n = 448), Black (n = 197), and Hispanic (n = 84) breast cancer survivors (stage 0-IIIa) in the Health, Eating, Activity, and Lifestyle Study. Physical activity was assessed approximately 2.5 years after breast cancer diagnosis, with QOL assessed on average 6 to 12 months later. We used structural equation modeling to examine relationships between meeting recommended levels of physical activity and QOL, stratifying by race/ethnicity and adjusting for other demographic, comorbidity, and treatment effects.

RESULTS

Structural equation modeling indicated that meeting recommended levels of physical activity had significant positive associations with QOL for Black and non-Hispanic White women (P < 0.05). Fewer Black women reported meeting recommended physical activity levels (P < 0.001), but meeting recommendations was associated with better QOL. Post hoc tests showed that meeting physical activity recommendations was specifically associated with better vitality, social functioning, emotional roles, and global QOL (P < 0.05 for all).

CONCLUSIONS

These results suggest that meeting recommended levels of physical activity is associated with better QOL in non-Hispanic White and Black breast cancer survivors. Findings may help support future interventions among breast cancer survivors and promote supportive care that includes physical activity, although more research is needed to determine these relationships among Hispanic and other ethnic minority women.

Physical activity among lung cancer survivors: changes across the cancer trajectory and associations with quality of life

BACKGROUND

Regular physical activity may offer benefits to lung cancer survivors, many of whom experience quality-of-life (QOL) impairments. However, little is know about lung cancer survivors' engagement in physical activity across the cancer trajectory. The current study addressed this research gap and also examined the association between lung cancer survivors' physical activity and their QOL.

METHODS

The study participants were 175 individuals who completed surgical treatment for early-stage non-small cell lung cancer 1 to 6 years previously. Participants completed a one-time survey regarding their current QOL and their engagement in physical activities currently, during the 6 months after treatment, and during the 6 months before diagnosis.

RESULTS

Participants' reported engagement in both moderate and strenuous intensity activities was lower during the post-treatment period compared with before diagnosis and at the current time. Engagement in light intensity activities did not differ for the three time points. Almost two-thirds of participants did not engage in sufficient activity to meet national physical activity guidelines for any of the three time points. Lung cancer survivors who currently met physical activity guidelines reported better QOL in multiple domains than less active individuals.

CONCLUSIONS

Engagement in physical activity among lung cancer survivors is particularly low during the early post-treatment period. Current engagement in physical activity is associated with better QOL. However, most lung cancer survivors do not meet physical activity guidelines and may benefit from interventions to promote engagement in regular physical activities.

Prospective relationships of physical activity with quality of life among colorectal cancer survivors

PURPOSE

Physical activity can enhance quality of life for cancer survivors. However, few longitudinal studies have examined whether physical activity has a sustained effect on improvements in quality of life. The present study aims to examine the relationships between physical activity and quality of life over 2 years after a colorectal cancer diagnosis.

PATIENTS AND METHODS

Data were collected within the Colorectal Cancer and Quality of Life Study, in which 1,966 people diagnosed with colorectal cancer were recruited through the Queensland Cancer Registry. Participants completed telephone interviews at approximately 6, 12, and 24 months after diagnosis. Generalized linear mixed models were used to estimate the overall, interindividual, and intraindividual level independent effects of participation in physical activity on quality of life.

RESULTS

There was an overall independent association between physical activity and quality of life. At a given time point, participants achieving at least 150 minutes of physical activity per week had an 18% higher quality of life score than those who reported no physical activity. Significant associations were also present at the interindividual level (differences between participants) and intraindividual level (within participant changes).

CONCLUSION

These findings suggest that the positive association between physical activity and quality of life is consistent over time. Encouraging colorectal cancer survivors to be physically active may be a helpful strategy for enhancing quality of life.

Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian Community Health Survey

BACKGROUND

Physical inactivity and obesity are associated with poorer disease outcomes in several cancer survivor groups. Few studies, however, have provided population-based estimates of these risk factors in cancer survivors and compared them with individuals without a history of cancer. Here such estimates for the Canadian population are reported.

METHODS

Data were obtained from the 2005 Canadian Community Health Survey consisting of computer-assisted interviews of 114,355 adults representing an estimated 23,285,548 Canadians. Participants self-reported their cancer history, height, and body weight to calculate body mass index and participation in various leisure-time activities.

RESULTS

Fewer than 22% of Canadian cancer survivors were physically active and over 18% were obese. Few differences were observed between cancer survivors and those without a history of cancer except that: 1) prostate cancer survivors were more likely to be active (adjusted odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.01-1.59) and less likely to be obese (adjusted OR = 0.71; 95% CI = 0.56-0.90); 2) skin cancer survivors (nonmelanoma and melanoma) were more likely to be active (adjusted OR = 1.33; 95% CI = 1.12-1.59); and 3) obese breast cancer survivors were less likely to be active compared with obese women without a history of cancer (adjusted OR = 0.51; 95% CI = 0.27-0.94).

CONCLUSIONS

Canadian cancer survivors have low levels of physical activity and a high prevalence of obesity that, although comparable to the general population, may place them at higher risk for poorer disease outcomes. Population-based interventions to increase physical activity and promote a healthy body weight in Canadian cancer survivors are warranted.

Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial

The purpose of this randomized, controlled clinical trial was to preliminarily examine the effects of a three-week walking exercise program (WEP) on fatigue-related experiences of acute myelogenous leukemia (AML) patients receiving chemotherapy. Eligible AML patients were randomly assigned to either an experimental group (n=11), which received 12 minutes of WEP per day, five days per week for three consecutive weeks, or to a control group (n=11), which received standard ward care. Effects of the WEP were assessed by seven indicators: worst and average fatigue intensities, fatigue interference with patients' daily life, 12-minute walking distance, overall symptom distress, anxiety, and depressive status. All patients were evaluated four times: before chemotherapy (baseline or Day 1), Day 7, Day 14, and Day 21 of chemotherapy. Data were analyzed by Generalized Estimating Equation and revealed that AML patients in the three-week WEP group had a significantly greater increase in 12-minute walking distance than the control group. Patients in the WEP also had lower levels of fatigue intensity and interference, symptom distress, anxiety, and depressive status than the control group. Although preliminary, our results strongly suggest that three weeks of systematic walking exercise is clinically feasible for AML patients undergoing chemotherapy and can effectively improve their fatigue-related experiences.

Quality of life after self-management cancer rehabilitation: a randomized controlled trial comparing physical and cognitive-behavioral training versus physical training

OBJECTIVE

To conduct a randomized controlled trial and compare the effects on cancer survivors' quality of life in a 12-week group-based multidisciplinary self-management rehabilitation program, combining physical training (twice weekly) and cognitive-behavioral training (once weekly) with those of a 12-week group-based physical training (twice weekly). In addition, both interventions were compared with no intervention.

METHODS

Participants (all cancer types, medical treatment completed > or = 3 months ago) were randomly assigned to multidisciplinary rehabilitation (n = 76) or physical training (n = 71). The nonintervention comparison group consisted of 62 patients on a waiting list. Quality of life was measured using the RAND-36. The rehabilitation groups were measured at baseline, after rehabilitation, and 3-month follow-up, and the nonintervention group was measured at baseline and 12 weeks later.

RESULTS

The effects of multidisciplinary rehabilitation did not outperform those of physical training in role limitations due to emotional problem (primary outcome) or any other domains of quality of life (all p > .05). Compared with no intervention, participants in both rehabilitation groups showed significant and clinically relevant improvements in role limitations due to physical problem (primary outcome; effect size (ES) = 0.66), and in physical functioning (ES = 0.48), vitality (ES = 0.54), and health change (ES = 0.76) (all p < .01).

CONCLUSIONS

Adding a cognitive-behavioral training to group-based self-management physical training did not have additional beneficial effects on cancer survivors' quality of life. Compared with the nonintervention group, the group-based self-management rehabilitation improved cancer survivors' quality of life.

Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy

BACKGROUND

Few exercise trials in cancer patients have reported longer-term follow-up. Here, we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients.

METHODS

Breast cancer patients initiating adjuvant chemotherapy (n = 242) were randomly assigned to usual care (n = 82), resistance exercise training (RET; n = 82), or aerobic exercise training (AET; n = 78) for the duration of their chemotherapy. At 6-month follow-up, participants were mailed a questionnaire that assessed quality of life, self-esteem, fatigue, anxiety, depression, and exercise behavior.

RESULTS

Two hundred one (83.1%) participants provided 6-month follow-up data. Adjusted linear mixed-model analyses showed that, at 6-month follow-up, the RET group reported higher self-esteem [adjusted mean difference, 1.6; 95% confidence interval (95% CI), 0.1-3.2; P = 0.032] and the AET group reported lower anxiety (adjusted mean difference, -4.7; 95% CI, -0.0 to -9.3; P = 0.049) compared with the usual care group. Moreover, compared with participants reporting no regular exercise during the follow-up period, those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes, including quality of life (adjusted mean difference, 9.5; 95% CI, 1.2-17.8; P = 0.025).

CONCLUSIONS

Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up. Moreover, adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes. Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes.