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McGowan EL, Speed-Andrews AE, Rhodes RE, Blanchard CM, Culos-Reed SN, Friedenreich CM, Courneya KS. Sport participation in colorectal cancer survivors: an unexplored approach to promoting physical activity. Support Care Cancer 2012; 21:139-47. [PMID: 22639138 DOI: 10.1007/s00520-012-1501-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/14/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Physical activity improves health outcomes in colorectal cancer (CRC) survivors, but participation rates are low. One understudied strategy for increasing physical activity in CRC survivors may be sport participation. Here, we report the sport participation rate, sport preferences, and correlates of sport participation among CRC survivors. METHODS A provincial, population-based mailed survey of CRC survivors in Alberta, Canada was performed and included measures of sport participation, sport preferences, sport benefits and barriers, and medical and demographic variables. RESULTS A total of 600 CRC survivors completed the survey (34 % response rate). Almost a quarter (23.0 %) of CRC survivors reported participating in a sport in the past month, with the most common sport being golf (58.7 %). In multivariate regression analysis, 33.0 % (p = 0.001) of the variance in sport participation was explained by being male (β = 0.12; p = 0.006), in better general health (β = 0.12; p = 0.006), and ≥ 5 years post-diagnosis (β = 0.09; p = 0.031). The most common barriers to sport participation were time, age/agility, and no interest/dislike of sports. The most common anticipated benefits of sport participation were improved physical fitness, meeting people, and improved health. Over half (57.2 %) of CRC survivors were possibly interested in learning about sport participation opportunities. CONCLUSIONS Promotion of sport participation may be a potentially fruitful strategy for increasing physical activity in CRC survivors.
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Affiliation(s)
- Erin L McGowan
- Faculty of Physical Education and Recreation, University of Alberta, E-488 Van Vliet Center, Edmonton, Alberta, Canada, T6G 2H9
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Self-reported physical activity: its correlates and relationship with health-related quality of life in a large cohort of colorectal cancer survivors. PLoS One 2012; 7:e36164. [PMID: 22567135 PMCID: PMC3342261 DOI: 10.1371/journal.pone.0036164] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/02/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Physical activity (PA) is suggested to be an important non-pharmacologic means to improve health-related outcomes among cancer survivors. We aimed to describe the PA level, its correlates, and association with health-related quality of life (HRQoL) in colorectal cancer (CRC) survivors. METHODS CRC survivors identified from the Eindhoven Cancer Registry treated between 1998 and 2007 were included. Survivors completed validated questionnaires on PA, distress, fatigue, and HRQoL. Moderate-to-vigorous physical activity (MVPA) levels were calculated by summing the time spent on walking, bicycling, gardening and sports (≥3 MET). Multiple linear regression analyses were conducted to study which socio-demographic and clinical factors were associated with MVPA. Furthermore, we examined associations between MVPA and physical and mental HRQoL, and whether these associations were mediated by fatigue and distress. RESULTS Cross-sectional data of 1371 survivors (response: 82%) were analysed. Participants were 69.5 (SD 9.7) years old, 56% were male, and survival duration was 3.9 (SD 2.5) years. Participants self-reported on average 95.5 (SD 80.3) min on MVPA per day. Younger age, male sex, being employed, non-smoking, lower BMI, colon cancer (vs. rectal cancer), chemotherapy treatment and having no co-morbidities were associated with higher MVPA (p<0.05). MVPA was positively associated with physical HRQoL (regression coefficient of total association (c) = 0.030; se = 0.004) after adjusting for socio-demographic and clinical factors. Fatigue mediated this association between MVPA and physical HRQoL (44% mediated). The association between MVPA and mental HRQoL was not statistically significant after adjusting for socio-demographic and cancer-related factors (c = 0.005; se = 0.004). CONCLUSION In CRC survivors, clinical factors including the absence of co-morbidity, tumour site and chemotherapy treatment were associated with higher MVPA, in addition to several socio-demographic factors. Higher MVPA was associated with higher physical HRQoL but not with mental HRQoL. Fatigue and distress mediated the association between MVPA and HRQoL.
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van Mossel C, Leitz L, Scott S, Daudt H, Dennis D, Watson H, Alford M, Mitchell A, Payeur N, Cosby C, Levi-Milne R, Purkis ME. Information needs across the colorectal cancer care continuum: scoping the literature. Eur J Cancer Care (Engl) 2012; 21:296-320. [PMID: 22416737 DOI: 10.1111/j.1365-2354.2012.01340.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.
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Affiliation(s)
- C van Mossel
- University of Victoria, Oxford Street, Victoria, BC, Canada.
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104
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Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G. Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 2011; 118:3766-75. [PMID: 22180393 DOI: 10.1002/cncr.26702] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/14/2011] [Accepted: 10/17/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer-related fatigue afflicts up to 33% of breast cancer survivors, yet there are no empirically validated treatments for this symptom. METHODS The authors conducted a 2-group randomized controlled trial to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post-treatment fatigue. Participants were breast cancer survivors who had completed cancer treatments (other than endocrine therapy) at least 6 months before enrollment, reported significant cancer-related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12-week, Iyengar-based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post-treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent-to-treat analyses were conducted with all randomized participants using linear mixed models. RESULTS Thirty-one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post-treatment and over a 3-month follow-up in the yoga group relative to controls (P = .032). In addition, the yoga group had significant increases in vigor relative to controls (P = .011). Both groups had positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed. CONCLUSIONS A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, University of California-Los Angeles, CA 90095, USA.
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105
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Blaney JM, Lowe-Strong A, Rankin-Watt J, Campbell A, Gracey JH. Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology 2011; 22:186-94. [PMID: 23296635 DOI: 10.1002/pon.2072] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 08/23/2011] [Accepted: 08/24/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the exercise barriers, facilitators and preferences of a mixed sample of cancer survivors as well as fatigue levels, quality of life (QoL) and the frequency and intensity of exercise that cancer survivors typically engage in. METHODS An anonymous, postal questionnaire-survey with a convenience sample of 975 cancer survivors was used. Standardised measures were used to establish fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30), exercise frequency and intensity (Leisure Score Index). RESULTS A 52.3% response rate (n = 456) was achieved. A total of 76.0% were female, with stage I (18.3%) or stage II (21.0%) breast cancer (64.4%), and 62.3% were ≥ 3 years post treatment. A total of 73.5% reported fatigue with 57.2% experiencing fatigue on a daily basis. A total of 68.1% had never been given any advice on how to manage fatigue. A total of 9.4% reported to engage in strenuous physical activity, 43.5% in moderate physical activity and 65.5% in mild physical activity. Respondents experienced difficulties with emotional, cognitive and social functioning and the symptoms of fatigue, insomnia and pain. Barriers that interfered with exercise 'often/very often' were mainly related to respondents' health and environmental factors. A total of 50.2% were interested in exercise and 52.5% felt able to exercise. Exercise facilitators, preferences and motivators provide some insight into cancer survivors' needs in terms of becoming more physically active. CONCLUSIONS Although cancer survivors continue to experience fatigue and QoL issues long after treatment completion, over half are willing and feel able to participate in exercise. Exercise barriers were mainly health related or environmental issues, however, the main barriers reported were those that had the potential to be alleviated by exercise.
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Affiliation(s)
- J M Blaney
- Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Co. Antrim, UK
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Speed-Andrews AE, Rhodes RE, Blanchard CM, Culos-Reed SN, Friedenreich CM, Belanger LJ, Courneya KS. Medical, demographic and social cognitive correlates of physical activity in a population-based sample of colorectal cancer survivors. Eur J Cancer Care (Engl) 2011; 21:187-96. [PMID: 21902736 DOI: 10.1111/j.1365-2354.2011.01290.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Physical activity (PA) improves quality of life in colorectal cancer survivors (CRC) and may reduce the risk of disease recurrence and early death. Few studies, however, have examined the correlates of PA in CRC survivors. Using the Alberta Cancer Registry, 2000 randomly selected CRC survivors were mailed a self-reported questionnaire assessing medical, demographic, behavioural and social cognitive variables from the theory of planned behaviour (TPB). Of the 600 survivors who responded, 33% were meeting public health PA guidelines and almost half were completely sedentary. Higher PA was reported by survivors who were younger, unmarried, better educated, wealthier, employed, non-smokers, social drinkers, not treated with radiation therapy, disease-free, in better health and less comorbidity. In multivariate path analysis, these variables were not directly associated with PA after controlling for the TPB variables. The TPB explained 34% (P < 0.001) of the variance in PA behaviour with direct associations for intention (β= 0.22; P= 0.015) and planning (β= 0.18; P= 0.001). Intention, in turn, had 62% (P < 0.001) of its variance explained by perceived behavioural control (β= 0.43; P < 0.001), affective attitude (β= 0.25; P < 0.001) and instrumental attitude (β= 0.15; P < 0.001). The TPB may be a useful framework for developing population-based interventions to increase PA in CRC survivors.
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Affiliation(s)
- A E Speed-Andrews
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
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107
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Wampler MA, Galantino ML, Huang S, Gilchrist LS, Marchese VG, Morris GS, Scalzitti DA, Hudson MM, Oeffinger KC, Stovall M, Leisenring WM, Armstrong GT, Robison LL, Ness KK. Physical activity among adult survivors of childhood lower-extremity sarcoma. J Cancer Surviv 2011; 6:45-53. [PMID: 21681405 DOI: 10.1007/s11764-011-0187-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 05/24/2011] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Adult survivors of childhood lower-extremity sarcoma are largely physically inactive, a behavior which potentially compounds their health burden. Altering this behavior requires understanding those factors that contribute to their physical inactivity. Therefore, this investigation sought to identify factors associated with inactivity in this subpopulation of cancer survivors. METHODS Demographic, personal, treatment, and physical activity information from adult survivors of childhood lower-extremity sarcomas was obtained from the Childhood Cancer Survivor Study (CCSS) cohort. Generalized linear models were used to identify variables that best identified those individuals who were physically inactive. RESULTS Only 41% of survivors met Center for Disease Control (CDC) activity guidelines. Survivors were 1.20 (95% confidence intervals (CI) 1.11-1.30) more likely compared to CCSS sibling cohort and 1.12 (95% CI 1.10-1.15) times more likely than the general population to fail to meet CDC guidelines. Significant predictors of physical inactivity included female sex, hemipelvectomy surgery, and platinum and vinca alkaloid chemotherapy. CONCLUSIONS The primary findings of this study are that survivors of childhood onset lower-extremity sarcoma are (1) highly likely to be physically inactive and (2) less likely than their siblings or the general population to regularly exercise. This study has identified treatment-related risk factors associated with inactivity that will help health and wellness practitioners develop successful exercise interventions to help these survivors achieve recommended levels of physical activity for health. IMPLICATIONS FOR CANCER SURVIVORS These results suggest that physical activity interventions for adult survivors of childhood lower-extremity sarcomas should be sex specific and responsive to unique physical late effects experienced by these survivors.
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Affiliation(s)
- Meredith A Wampler
- Outpatient Rehabilitation, Harrison Medical Center, 2625 Wheaton Way, Bremerton, WA 98310, USA.
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108
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Livingston PM, Salmon J, Courneya KS, Gaskin CJ, Craike M, Botti M, Broadbent S, Kent B. Efficacy of a referral and physical activity program for survivors of prostate cancer [ENGAGE]: rationale and design for a cluster randomised controlled trial. BMC Cancer 2011; 11:237. [PMID: 21663698 PMCID: PMC3141765 DOI: 10.1186/1471-2407-11-237] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/13/2011] [Indexed: 11/12/2022] Open
Abstract
Background Despite evidence that physical activity improves the health and well-being of prostate cancer survivors, many men do not engage in sufficient levels of activity. The primary aim of this study (ENGAGE) is to determine the efficacy of a referral and physical activity program among survivors of prostate cancer, in terms of increasing participation in physical activity. Secondary aims are to determine the effects of the physical activity program on psychological well-being, quality of life and objective physical functioning. The influence of individual and environmental mediators on participation in physical activity will also be determined. Methods/Design This study is a cluster randomised controlled trial. Clinicians of prostate cancer survivors will be randomised into either the intervention or control condition. Clinicians in the intervention condition will refer eligible patients (n = 110) to participate in an exercise program, comprising 12 weeks of supervised exercise sessions and unsupervised physical activity. Clinicians allocated to the control condition will provide usual care to eligible patients (n = 110), which does not involve the recommendation of the physical activity program. Participants will be assessed at baseline, 12 weeks, 6 months, and 12 months on physical activity, quality of life, anxiety, depression, self-efficacy, outcome expectations, goals, and socio-structural factors. Discussion The findings of this study have implications for clinicians and patients with different cancer types or other chronic health conditions. It will contribute to our understanding on the potential impact of clinicians promoting physical activity to patients and the long term health benefits of participating in physical activity programs. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055 Deakin University Human Research Ethics Approval 2011-085
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Affiliation(s)
- Patricia M Livingston
- Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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109
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Hsu HT, Dodd MJ, Guo SE, Lee KA, Hwang SL, Lai YH. Predictors of exercise frequency in breast cancer survivors in Taiwan. J Clin Nurs 2011; 20:1923-35. [DOI: 10.1111/j.1365-2702.2010.03690.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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110
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Ottenbacher AJ, Day RS, Taylor WC, Sharma SV, Sloane R, Snyder DC, Kraus WE, Demark-Wahnefried W. Exercise among breast and prostate cancer survivors--what are their barriers? J Cancer Surviv 2011; 5:413-9. [PMID: 21598023 DOI: 10.1007/s11764-011-0184-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/07/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite proven benefits of regular physical activity, estimates indicate that few cancer survivors meet physical activity guidelines. The purpose of this paper is to identify and compare exercise barriers among cancer survivors, both cross-sectionally and longitudinally as they undergo home-based behavioral interventions. METHODS Data on a sample of 452 breast and prostate cancer survivors who completed the FRESH START trial were analyzed collectively, as well as separately by cancer type. RESULTS More total barriers (3.5 vs. 2.4; p < 0.01) were reported among breast cancer survivors compared with prostate cancer survivors. Commonly reported baseline exercise barriers among both groups were "too busy" (breast, 52% and prostate, 45%) and "no willpower" (breast, 51% and prostate, 44%). At baseline, breast cancer survivors who reported "no willpower" also reported 18.7 fewer minutes of physical activity compared with those not reporting this barrier (p < 0.01). Among prostate cancer survivors, this difference was 39.5 min (p < 0.01). Change in barriers was not associated with change in minutes of physical activity from baseline to post-intervention in either cancer survivor group. CONCLUSIONS This is the largest study evaluating barriers and physical activity over time among cancer survivors. There are similarities and differences that both need to be taken into consideration when promoting physical activity among subgroups of survivors. IMPLICATIONS FOR CANCER SURVIVORS Knowledge concerning barriers associated with reported physical activity may be helpful in designing optimally targeted physical activity interventions among breast and prostate cancer survivors.
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111
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Bailis DS, Thacher TM, Aird NCA, Lipschitz LJ. Affective and Behavioral Traces of Goal Conflict With Physical Activity. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2011. [DOI: 10.1080/01973533.2011.568836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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112
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Noble M, Russell C, Kraemer L, Sharratt M. UW WELL-FIT: the impact of supervised exercise programs on physical capacity and quality of life in individuals receiving treatment for cancer. Support Care Cancer 2011; 20:865-73. [PMID: 21562800 DOI: 10.1007/s00520-011-1175-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/25/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study is to report physical function and quality of life data collected from cancer patients who participated in a supervised exercise intervention at the UW WELL-FIT program over 5 years. METHODS Five hundred seventy-five participants from 18 to 84 years of age (mean, 54 years) were assessed and enrolled in the 24-session program while currently receiving treatment for cancer. Twice weekly, they participated in aerobic exercise, resistance training and stretching exercises for 1 h each time. Pre- and post-assessments were performed to document changes in physical function, while the short form-36 (SF-36) survey assessed changes in quality of life. RESULTS Three hundred eighty-six participants completed the program, while 171 withdrew at some point over the 24 sessions. Pre- and post-cardiovascular assessments were performed on 305 (78.4%) participants. There was a significant increase in the maximum work rate attained and significant decreases in heart rate response, systolic blood pressure and rate of perceived exertion at the submaximal level (p < 0.01). The summary component scales of SF-36 (physical and mental) were significantly improved as well as all eight subscales (p < 0.01). CONCLUSIONS The data collected from this program indicate that a comprehensive physical activity program involving cardiovascular exercise, resistance training and flexibility can significantly improve physical function and various quality of life indices for individuals undergoing treatment for cancer.
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Affiliation(s)
- Madeleine Noble
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave W., Waterloo, ON N2L 3G1, Canada.
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113
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Abstract
Colorectal cancer survivorship begins at diagnosis and continues throughout life. After diagnosis, survivors face the possibility of second cancers, long-term effects of cancer treatment, and comorbid conditions. Interventions that can provide primary, secondary, and tertiary prevention in this population are important. Physical activity has been shown to decrease colon cancer incidence and recurrence risk as well as improve quality of life and noncancer health outcomes including cardiovascular fitness in colon cancer survivors. The data are less robust for rectal cancer incidence and recurrence, although improvements in quality of life and health outcomes in rectal cancer survivors are also seen. Potential mechanisms for this benefit may occur through inflammatory or insulin-like growth factor pathways. The issues of colorectal cancer survivorship and the impact of physical activity on these issues are reviewed, with discussion of possible biologic mechanisms, barriers to physical activity intervention studies, and future research directions for physical activity in this burgeoning survivor population.
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114
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Love C, Sabiston CM. Exploring the links between physical activity and posttraumatic growth in young adult cancer survivors. Psychooncology 2011; 20:278-86. [DOI: 10.1002/pon.1733] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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115
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Yoga for persistent fatigue in breast cancer survivors: results of a pilot study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:623168. [PMID: 21274288 PMCID: PMC3026999 DOI: 10.1155/2011/623168] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 09/01/2010] [Accepted: 10/07/2010] [Indexed: 01/22/2023]
Abstract
Approximately one-third of breast cancer survivors experiences persistent fatigue for months or years after successful treatment completion. There is a lack of evidence-based treatments for cancer-related fatigue, particularly among cancer survivors. This single-arm pilot study evaluated the feasibility and preliminary efficacy of a yoga intervention for fatigued breast cancer survivors based on the Iyengar tradition. Iyengar yoga prescribes specific poses for individuals with specific medical problems and conditions; this trial emphasized postures believed to be effective for reducing fatigue among breast cancer survivors, including inversions and backbends performed with the support of props. Twelve women were enrolled in the trial, and 11 completed the full 12-week course of treatment. There was a significant improvement in fatigue scores from pre- to post-intervention that was maintained at the 3-month post-intervention followup. Significant improvements were also observed in measures of physical function, depressed mood, and quality of life. These results support the acceptability of this intervention and suggest that it may have beneficial effects on persistent post-treatment fatigue. However, results require replication in a larger randomized controlled trial.
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116
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Abstract
Physical activity (PA) participation has been shown to be helpful in improving physical and mental well-being among cancer survivors. The purpose of this chapter is to review the literature on the determinants of physical activity motivation and behavior among cancer survivors. Using theories of behavior change, researchers have sought to identify the correlates of motivation that predict the participation in regular physical activity in observational studies, while intervention studies have focused on manipulating those factors to support the initiation of physical activity. The majority of this work has been conducted with breast cancer survivors, and there is an interest in expanding this work to survivors of others cancers (e.g., prostate, lung, and colorectal cancer). Results suggest that constructs from the Theory of Planned Behavior (TPB), Transtheoretical Model (TTM), and Social Cognitive Theory (SCT) are associated with greater motivation for physical activity, and some of these constructs have been used in interventions to promote physical activity adoption. There is scope for understanding the determinants of physical activity adoption in various cancer survivor populations. Much more needs to done to identify the determinants of maintenance of physical activity.
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Affiliation(s)
- Bernardine M Pinto
- Centers for Behavioral and Preventive Medicine, Coro Bldg, Suite 500, One Hoppin Street, Providence, RI, 02903, USA.
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117
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The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue. Phys Ther 2010; 90:1135-47. [PMID: 20558566 DOI: 10.2522/ptj.20090278] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Despite the evidence to support exercise as an effective management strategy for patients with cancer-related fatigue (CRF), many of the general cancer population are sedentary. OBJECTIVE The aim of this study was to explore the barriers to and facilitators of exercise among a mixed sample of patients with CRF. DESIGN An exploratory, descriptive, qualitative design was used. METHODS Purposive sampling methods were used to recruit patients with CRF who were representative of the cancer trajectory, that is, survivors of cancer and patients in palliative care who were recently diagnosed and undergoing treatment. Focus group discussions were transcribed verbatim and analyzed using a grounded theory approach. Lower-level concepts were identified and ordered into subcategories. Related subcategories then were grouped to form the main categories, which were linked to the core category. RESULTS Five focus groups were conducted with 26 participants. Within the core category of the cancer rehabilitation journey were 3 main categories: (1) exercise barriers, (2) exercise facilitators, and (3) motivators of exercise. Exercise barriers were mainly related to treatment side effects, particularly fatigue. Fatigue was associated with additional barriers such as physical deconditioning, social isolation, and the difficulty of making exercise a routine. Environmental factors and the timing of exercise initiation also were barriers. Exercise facilitators included an exercise program being group-based, supervised, individually tailored, and gradually progressed. Exercise motivators were related to perceived exercise benefits. CONCLUSIONS Individuals with CRF have numerous barriers to exercise, both during and following treatment. The exercise facilitators identified in this study provide solutions to these barriers and may assist with the uptake and maintenance of exercise programs. These findings will aid physical therapists in designing appropriate exercise programs for patients with CRF.
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118
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Sellar CM, Courneya KS. Physical activity and gastrointestinal cancer survivorship. Recent Results Cancer Res 2010; 186:237-53. [PMID: 21113767 DOI: 10.1007/978-3-642-04231-7_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Research examining physical activity in gastrointestinal cancer survivors is in its early stages and has focused primarily on colorectal cancer. Moreover, the majority of the research to date has been observational in nature, with very little interventional research. Though limited, the results of this research have been promising in nature, showing positive associations between physical activity and quality of life as well as disease outcomes, including improved disease-free and overall survival. The potential benefits of physical activity for gastrointestinal cancer survivors warrant further research on the underlying mechanisms of the relationship between physical activity and colorectal cancer disease outcomes, to determine if these associations extend to other gastrointestinal cancers, and to determine appropriate physical activity interventions to realize any potential supportive care benefits in various gastrointestinal cancer survivor groups.
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Affiliation(s)
- Christopher M Sellar
- Behavioural Medicine Lab, E4-88 Van Vliet Centre, University of Alberta, Edmonton, AB, Canada, T6G 2H9
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119
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Battaglini CL, Hackney AC, Garcia R, Groff D, Evans E, Shea T. The effects of an exercise program in leukemia patients. Integr Cancer Ther 2009; 8:130-8. [PMID: 19679621 DOI: 10.1177/1534735409334266] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To examine the feasibility of administering an in-hospital exercise program to acute leukemia patients undergoing chemotherapy. A secondary purpose explored the impact of exercise on selected physiological, psychological, and inflammatory markers. METHODS Ten patients, aged 18 to 50 years, diagnosed with acute leukemia or newly relapsed were assessed for body weight, height, body composition (skinfolds), cardiorespiratory endurance (total minutes on bicycle ergometer at 60% heart rate reserve), dynamic muscular endurance (Rocky Mountain Cancer Rehabilitation Institute protocol), fatigue (Revised Piper Fatigue Scale), depression (Center for Epidemiologic Studies Depression scale, National Institute of Mental Health questionnaire), and quality of life (Functional Assessment of Cancer Therapy-General) at baseline (within 3 days of diagnosis) and at the end of induction phase of treatment. Blood draws were taken at baseline, midpoint, and at the end of induction for analyses of inflammatory markers (Linco Luminex assay). Combined aerobic and strength training exercises were administered 3 times per week, twice daily, for 30 minutes. Paired-samples t-tests were used for the analyses of physiological and psychological parameters. One-way repeated measures analysis of variance was used for the analyses of inflammatory markers. RESULTS Significant improvements in cardiorespiratory endurance (P = .009, baseline 8.9 +/- 8.8 minutes, postexercise intervention 17 +/- 14.3 minutes) with significant reductions in total fatigue scores (P = .009, baseline 4.6 +/- 1.7, postexercise intervention 1.8 +/- 1.6) and depression scores (P = .023, baseline 19 +/- 11.5, postexercise intervention 12 +/- 8.2) were observed. Marginally significant decrease in interleukin-6 (IL-6; P = .059) with no significant changes in IL-10 (P = .223) or interferon-gamma (P = .882) were observed. CONCLUSION Administration of exercise to acute leukemia patients undergoing treatment is feasible. The exercise protocol used increased cardiovascular endurance, reduced fatigue and depression scores, and maintained quality of life. Although no significant change in inflammation was observed, a trend demonstrating a reduction in IL-6 and an increase in IL-10 warrants further investigation.
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Affiliation(s)
- Claudio L Battaglini
- Lineberger Comprehensive Cancer Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, North Carolina 27599, USA.
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120
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Abstract
Exercise improves quality of life (QOL) in people with cancer. Most oncology healthcare providers recognize the statement to be true because the research literature provides strong support for the physical and psychological benefits of exercise. Because the terms exercise, QOL, and people with cancer have different meanings, the contextual connections in which they are used are important to understanding the relationship between exercise and QOL in people with cancer. This article explores the links between exercise and QOL in people with cancer and examines issues that impact the development, implementation, and evaluation of exercise programs for people with cancer. Issues related to exercise goal development, exercise prescription, exercise testing, exercise adherence, and methods to evaluate the efficacy of exercise in relation to QOL are discussed.
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Affiliation(s)
- Eileen Hacker
- Department of Biobehavioral Health Sciences in the College of Nursing, The University of Illinois, Chicago, USA.
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121
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Abstract
PURPOSE OF REVIEW Physical exercise can be both beneficial and harmful for the gastrointestinal tract in a dose-effect relationship between its intensity and health. Mild-to-moderate intensity exercises play a protective role against colon cancer, diverticular disease, cholelithiasis and constipation, whereas acute strenuous exercise may provoke heartburn, nausea, vomiting, abdominal pain, diarrhea and even gastrointestinal bleeding. This review focuses on mechanisms involved in those symptoms and their associations with type of exercises in humans. RECENT FINDINGS One quarter to one half of elite athletes are hampered by the gastrointestinal symptoms that may deter them from participation in training and competitive events. Vigorous exercise-induced gastrointestinal symptoms are often attributed to altered motility, mechanical factor or altered neuroimmunoendocrine secretions. Training, lifestyle modifications, meal composition, adequate hydration and avoidance of excessive use of some medications are the recommendations. SUMMARY Strenuous exercise and dehydrated states would be the causes of gastrointestinal symptoms referred by 70% of the athletes. Gut ischemia would be the main cause of nausea, vomiting, abdominal pain and (bloody) diarrhea. The frequency is almost twice as high during running than during other endurance sports as cycling or swimming and 1.5-3.0 times higher in the elite athletes than the recreational exercisers.
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Affiliation(s)
- Erick Prado de Oliveira
- Centre for Physical Exercise and Nutrition Metabolism, UNESP School of Medicine, Public Health Department, Botucatu City, São Paulo State, Brazil
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122
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Windsor P, Potter J, McAdam K, McCowan C. Evaluation of a Fatigue Initiative: Information on Exercise for Patients Receiving Cancer Treatment. Clin Oncol (R Coll Radiol) 2009; 21:473-82. [DOI: 10.1016/j.clon.2009.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 01/02/2009] [Accepted: 01/22/2009] [Indexed: 11/27/2022]
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123
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Perceived barriers to physical activity for colorectal cancer survivors. Support Care Cancer 2009; 18:729-34. [PMID: 19636595 DOI: 10.1007/s00520-009-0705-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Promoting physical activity among cancer survivors is a high priority. Understanding barriers to physical activity provides an evidence base to inform relevant strategies for doing so. METHODS Telephone interviews were conducted with colorectal cancer survivors at 5 (n = 538) and 12 months post-diagnosis (n = 403). We used an ecological model of health behaviour to classify participants' perceived barriers to physical activity into four sub-categories: physical environment, social environment, personal attributes, and disease-specific barriers. RESULTS Disease-specific barriers were perceived as the greatest challenge to colorectal cancer survivors being more physically active, closely followed by personal attributes. The physical environment presented the least salient perceived barriers; however, the physical environment was most closely associated with achieving sufficient levels of physical activity at 5 months post-diagnosis. The difficulties most frequently reported by participants at both time points were belief that they were already active enough, not feeling well enough to be physically active, and experiencing fatigue. CONCLUSIONS These findings suggest potential points for intervention to influence physical activity among colorectal cancer survivors.
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124
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Self-reported physical activity behaviour; exercise motivation and information among Danish adult cancer patients undergoing chemotherapy. Eur J Oncol Nurs 2009; 13:116-21. [DOI: 10.1016/j.ejon.2009.01.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/11/2009] [Accepted: 01/15/2009] [Indexed: 11/19/2022]
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125
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Cox CL, Montgomery M, Oeffinger KC, Leisenring W, Zeltzer L, Whitton JA, Mertens AC, Hudson MM, Robison LL. Promoting physical activity in childhood cancer survivors: results from the Childhood Cancer Survivor Study. Cancer 2009; 115:642-54. [PMID: 19117349 DOI: 10.1002/cncr.24043] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although physical activity may modify the late effects of childhood cancer treatment, from 20% to 52% of adult survivors are sedentary. The authors of this report sought to identify modifiable factors that influence survivors' participation in physical activity. METHODS Structural equation modeling of data were derived from the Childhood Cancer Survivors Study of adult survivors (current mean age, 30.98 years; mean years since diagnosis, 23.74; mean age at diagnosis, 9.25 years) who were diagnosed between 1970 and 1986. RESULTS Approximately 40% of the variance in male survivors' recent participation versus nonparticipation in physical activity was explained directly and/or indirectly by self-reported health fears (P = .01), perceived primary-care physician (PCP) expertise (P = .01), baseline exercise frequency (P < or = .001), education level (P = .01), self-reported stamina (P = .01), cancer-related pain (P < or = .001), fatigue (P < or = .001), age at diagnosis (P = .01), cancer-related anxiety (P < or = .001), motivation (P = .01), affect (P = .01), and discussion of subsequent cancer risk with the PCP (P < or = .001) (N = 256; chi-square test statistic = 53.38; degrees of freedom [df] = 51; P = .38, Comparative Fit Index [CFI] = 1.000; Tucker Lewis Index [TLI] = 1.000; root mean square of approximation [RMSEA] = 0.014; weighted root mean square residual [WRMR] = 0.76). Thirty-one percent of the variance in women' recent physical activity participation was explained directly and/or indirectly by self-reported stamina (P < or = .001), fatigue (P = .01), baseline exercise frequency (P = .01), cancer-related pain (P < or = .001), cancer-related anxiety (P = .01), recency of visits with PCP (<0.001), quality of interaction with the PCP (P = .01), and motivation (P < or = .001; N = 366; chi-square test statistic = 67.52; df = 55; P = .12; CFI = 0.98; TLI = 0.98; RMSEA = 0.025; WRMR = 0.76). CONCLUSIONS Gender-tailored intervention strategies in which providers specifically target motivation, fear, and affect may support physical activity in childhood cancer survivors.
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Affiliation(s)
- Cheryl L Cox
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
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van Weert E, Hoekstra-Weebers JEHM, May AM, Korstjens I, Ros WJG, van der Schans CP. The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. PATIENT EDUCATION AND COUNSELING 2008; 71:169-190. [PMID: 18255249 DOI: 10.1016/j.pec.2007.11.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This paper describes the development of a physical training programme for cancer patients. Four related but conceptually and empirically distinct physical problems are described: decreased aerobic capacity, decreased muscle strength, fatigue and impaired role physical functioning. The study aimed to identify the optimal content for an exercise programme that addresses these four physical problems, based on the highest level of evidence available. The study further aimed to review the evidence available on the delivery of the programmes. The final goal was to develop a programme in which content and delivery are based on the best available evidence. METHODS Literature searches (PUBMED and MEDLINE, to July 2006) on content looked for evidence about the efficacy of exercise on aerobic capacity, muscle strength, fatigue and impaired role physical functioning. Literature searches on delivery looked for self-management and/or self-efficacy enhancing techniques in relation to outcome, adherence to and/or adoption of a physically active lifestyle. RESULTS Evidence on the effectiveness of exercise in cancer patients varies and increases when moving from muscle strength (RCT level), fatigue and physical role functioning to aerobic capacity (all at the meta-analysis level). Effect sizes for aerobic capacity were moderate, while effect sizes for fatigue and physical role functioning were zero and/or small. Many of the studies have significant methodological shortcomings. There was some evidence (meta-analyses) that self-management programmes and self-efficacy enhancing programmes have beneficial effects on health outcomes in a variety of chronic diseases, on the quality of life in cancer patients, and on exercise adherence and later exercise behaviour. CONCLUSION Limited data are available on the effectiveness of exercise for cancer patients. Although evidence supports the positive effects of exercise on exercise capacity during and after completion of cancer treatment, the effects for fatigue and role functioning are ambiguous. Evidence on the effectiveness of progressive exercise training on muscle strength is promising. In addition, some evidence supports the positive effects of self-management programmes and self-efficacy enhancing programmes on health outcomes, exercise adherence and later exercise behaviour. PRACTICE IMPLICATIONS The resulting programme was developed on the basis of the highest quality of evidence available regarding content and delivery. The content is based on information obtained from the present review, and on the recommendations of the American College of Sports Medicine. Potential advantages of the programme include: (a) tailored physical training towards focusing on the patient's established problems and (b) delivery of the training as a self-management programme that might have beneficial effects on health outcome, exercise adherence and a long-term physically active lifestyle.
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Affiliation(s)
- Ellen van Weert
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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127
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Barriers to Supervised Exercise Training in a Randomized Controlled Trial of Breast Cancer Patients Receiving Chemotherapy. Ann Behav Med 2008; 35:116-22. [DOI: 10.1007/s12160-007-9009-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Indexed: 10/17/2022] Open
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128
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Abstract
Behavioral symptoms are a common adverse effect of breast cancer diagnosis and treatment and include disturbances in energy, sleep, mood, and cognition. These symptoms cause serious disruption in patients' quality of life and may persist for years after treatment. Patients need accurate information about the occurrence of these adverse effects as well as assistance with symptom management. This review considers four of the most common behavioral sequelae of breast cancer, namely fatigue, sleep disturbance, depression, and cognitive impairment. Research on the prevalence, mechanisms, and treatment of each symptom is described, concluding with recommendations for future studies.
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Affiliation(s)
- Julienne E Bower
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
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129
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Harriss DJ, Cable NT, George K, Reilly T, Renehan AG, Haboubi N. Physical activity before and after diagnosis of colorectal cancer: disease risk, clinical outcomes, response pathways and biomarkers. Sports Med 2008; 37:947-60. [PMID: 17953466 DOI: 10.2165/00007256-200737110-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Physical inactivity may be responsible for 13-14% of colon cancer, an attributable risk greater than family history. Epidemiological evidence shows an association between occupational and recreational physical activity and colon cancer, but has not established whether physical activity is protective against low-risk or more advanced adenomas. The evidence is inconclusive as to whether physical activity protects against rectal cancer and is conflicting with respect to whether physical activity has equal effects on male and female risk of colorectal cancer. The effect of exercise 'interventions' on the risk of colorectal cancer is currently not known. Also, although inferences can be made from epidemiological studies, no optimal exercise regimen can be confidently prescribed for protection against colorectal cancer. There is little available evidence for the benefits of physical activity before diagnosis of colorectal cancer for disease-specific survival and prognosis, and the clinical effects of an exercise intervention after diagnosis have not been investigated. There is some evidence that improvements in cardiorespiratory fitness reduce adverse effects from cancer treatment when physical activity is undertaken following diagnosis of colorectal cancer. Markers/mechanisms by which physical activity may protect against colorectal cancer and/or improve disease prognosis include gastrointestinal transit-time, chronic inflammation, immune function, insulin levels, insulin-like growth factors, genetics and obesity. Research evidence is, however, limited as to whether these markers are beneficially affected by physical activity, either before or after diagnosis of colorectal cancer.
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Affiliation(s)
- David J Harriss
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, Liverpool, UK.
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130
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Arroyave WD, Clipp EC, Miller PE, Jones LW, Ward DS, Bonner MJ, Rosoff PM, Snyder DC, Demark-Wahnefried W. Childhood Cancer Survivors' Perceived Barriers to Improving Exercise and Dietary Behaviors. Oncol Nurs Forum 2008; 35:121-30. [DOI: 10.1188/08.onf.121-130] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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131
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Rogers LQ, Courneya KS, Robbins KT, Malone J, Seiz A, Koch L, Rao K. Physical activity correlates and barriers in head and neck cancer patients. Support Care Cancer 2007; 16:19-27. [PMID: 17602246 DOI: 10.1007/s00520-007-0293-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 06/11/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE Our study purpose was to determine physical activity correlates and barriers among head and neck cancer patients. MATERIALS AND METHODS Fifty-nine (response rate = 91%) head and neck cancer patients from an academic oncology clinic enrolled in a cross-sectional study utilizing chart review and self-administered questionnaire. RESULTS The majority were men (83%) and white (92%) with mean age of 58 +/- 12.8 years and mean months since diagnosis of 18.6 +/- 51.9. The strongest bivariate correlates of physical activity included enjoyment (r = 0.41; p = 0.002), symptom index (r = -0.36; p = 0.006), alcohol use (r = 0.36; p = 0.007), task self-efficacy (r = 0.33; p = 0.013), perceived barriers (r = -0.27; p = 0.047), and comorbidity score (r = -0.27; p = 0.042). Stepwise regression demonstrated independent associations with physical activity for enjoyment (beta = 0.38; p = 0.002) and symptom index (beta = -0.33; p = 0.006; R (2) = 0.28). The most prevalent barriers significantly associated with physical activity included dry mouth or throat (r = -0.32; p = 0.016), fatigue (r = -0.27; p = 0.043), drainage in mouth or throat (r = -0.41; p = 0.002), difficulty eating (r = -0.32; p = 0.015), shortness of breath (r = -0.30; p = 0.024), and muscle weakness (r = -0.29; p = 0.033). CONCLUSIONS Our results showed that the strongest independent correlates of physical activity were social cognitive (i.e., enjoyment) and treatment-related (i.e., symptom index). Treatment-related activity barriers were frequent and significantly associated with reduced activity. Efforts to enhance exercise adherence in head and neck cancer patients should focus on optimizing enjoyment and managing treatment-related barriers.
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Affiliation(s)
- Laura Q Rogers
- Department of Medicine, SIU School of Medicine, Southern Illinois University, Springfield, IL 62794-9636, USA.
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132
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Rogers LQ, Courneya KS, Shah P, Dunnington G, Hopkins-Price P. Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study. Eur J Cancer Care (Engl) 2007; 16:55-66. [PMID: 17227354 DOI: 10.1111/j.1365-2354.2006.00705.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With increasing evidence supporting physical activity benefits during breast cancer treatment, addressing exercise adherence with consideration of the unique exercise barriers, outcome expectations and preferences of cancer patients is needed. Our pilot study aimed to determine the following during breast cancer treatment: (1) exercise barriers, outcome expectations/values and associations with exercise stage of change and (2) exercise preferences. A cross-sectional survey was administered to 23 breast cancer patients during treatment. Participants were primarily aged 50-60 years (52%), Caucasian (91%), with stage I (30%), II (44%) or III (26%) disease. A total of 48% were receiving chemotherapy. In total, 50% were in the pre-contemplation/contemplation stage of change, with 34% in action/maintenance. Common exercise adherence barriers (i.e. lack of priority, self-discipline, procrastination and fatigue) demonstrated statistically significant negative associations with exercise. Frequent outcome expectations included improving heart/lungs, reducing disease risk, building muscle strength and losing weight. Important outcomes included improving state of mind, reducing fatigue and avoiding injury. Outcome expectations (i.e. less depression, boredom and nausea) were positively associated with exercise. The majority preferred walking (100%), moderate-intensity (61%), home-based (78%) exercise. Among breast cancer patients during treatment, exercise adherence barriers are general and disease specific. Outcome expectations are physical benefits, with the most important outcomes being psychological or avoidance of risk (i.e. injury).
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Affiliation(s)
- L Q Rogers
- Department of Medicine, SIU School of Medicine, Springfield, IL 62794-9636, USA.
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Rodriguez-Bigas MA, Chang GJ, Skibber JM. Barriers to rehabilitation of colorectal cancer patients. J Surg Oncol 2007; 95:400-8. [PMID: 17345598 DOI: 10.1002/jso.20778] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Colorectal cancer is one of the most common cancers in the United States. Since 1993 there has been a decrease in colorectal cancer mortality. Thus, there are more cancer survivors. In this manuscript potential barriers encountered during the rehabilitation of the colorectal cancer patient will be discussed. METHODS A literature review of manuscripts dealing with the rehabilitation and quality of life of the colorectal cancer patient was performed with specific emphasis on barriers for rehabilitation. RESULTS There is not much literature regarding barriers to the rehabilitation of the colorectal cancer patient. The rehabilitation of the colorectal cancer patient is a complex continuum. In order to maximize the potential for rehabilitation a team approach where the patient, family, friends and health care providers participate actively should be undertaken. The most common barriers are in the domains of knowledge, patient, health care system, and therapy. The impact of these barriers will vary from patient to patient. CONCLUSIONS There is a paucity of literature regarding barriers to the rehabilitation of the colorectal cancer patient. Prospective databases as well as prospective longitudinal studies need to be established so that the barriers that colorectal cancer patients encounter during their rehabilitation are more clearly identified and understood.
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Affiliation(s)
- Miguel A Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1402, USA.
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134
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Hong S, Bardwell WA, Natarajan L, Flatt SW, Rock CL, Newman VA, Madlensky L, Mills PJ, Dimsdale JE, Thomson CA, Hajek RA, Chilton JA, Pierce JP. Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study. Breast Cancer Res Treat 2006; 101:225-32. [PMID: 17028988 DOI: 10.1007/s10549-006-9284-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical activity levels among breast cancer survivors are typically low, and knowledge of the correlates of increased physical activity among cancer survivors is limited. The purpose of this study was to examine factors that are associated with physical activity or inactivity among breast cancer survivors. METHODS Data from 3088 women participating in the Women's Healthy Eating and Living (WHEL) Study, collected prior to randomization, were the focus of the current analyses. Self-reports of physical activity levels, quality of life, depression, and dietary intakes were collected. Pearson correlation analyses were employed to examine the associations among these variables, and multiple regression analyses were performed to examine the relationship between selected health behaviors and physical activity levels, after controlling for demographic, breast cancer-related, and psychosocial variables. RESULTS Demographic and psychosocial variables were related to physical activity levels (P < 0.001 for all). Cancer treatment type and cancer stage were correlated with survivors' physical activity levels (P < 0.01), but the associations were no longer significant after controlling for demographic variables. Physical activity levels were strongly associated with other health behaviors, especially dietary intakes (P < 0.001), even after controlling for demographic, cancer-related, and psychosocial factors. CONCLUSION Low physical activity levels in breast cancer survivors are associated with specific behavioral and other factors, which can be considered as indicators of women at higher risk. Findings of significant differences in physical activity levels based on demographic characteristics suggest the importance of promoting physical activity particularly among breast cancer survivors of ethnic minority or lower education levels.
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Affiliation(s)
- Suzi Hong
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA
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Rogers LQ, Courneya KS, Verhulst S, Markwell S, Lanzotti V, Shah P. Exercise barrier and task self-efficacy in breast cancer patients during treatment. Support Care Cancer 2005; 14:84-90. [PMID: 16007455 DOI: 10.1007/s00520-005-0851-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 05/25/2005] [Indexed: 02/06/2023]
Abstract
Understanding exercise self-efficacy in breast cancer patients during treatment is important for enhancing physical activity adherence. Therefore, the primary study purpose was to determine, among breast cancer patients during treatment, the psychometric properties of scales to measure exercise barrier and task self-efficacy. The study also aimed to determine the following: (1) level of self-efficacy, (2) associations between barrier and task self-efficacy, and (3) associations between self-efficacy and patient age, race, and treatment type. Eighty-six female breast cancer patients recruited from a medical oncologist's office completed the scales once, and 46 repeated the scales 2 weeks later. The majority were Caucasian (95%), with 26% receiving chemotherapy, 64% hormonal therapy alone, and 5% radiation/other. The mean age was 59+/-14 years. The Cronbach's alpha for the nine-item barrier self-efficacy scale was 0.96, with a test-retest correlation of 0.89 (p<0.001). The Cronbach's alpha for the four-item task self-efficacy scale was 0.89, with a test-retest correlation of 0.83 (p<0.001). The mean barrier self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to exercise when nauseated. The mean task self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to jog for 10 min without stopping. Although no significant associations were found between self-efficacy and participant's race or treatment type, lower task self-efficacy was associated with older age (r=-0.36, p=0.001). Both self-efficacy scales demonstrated good internal consistency and test-retest reliability. Self-efficacy may be a useful target for physical activity interventions among breast cancer patients during treatment.
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Affiliation(s)
- Laura Q Rogers
- Department of Medicine, SIU School of Medicine, P.O. Box 19636, Springfield, IL 62794-9636, USA.
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