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Schumacher O, Galvão DA, Taaffe DR, Chee R, Spry N, Newton RU. Exercise modulation of tumour perfusion and hypoxia to improve radiotherapy response in prostate cancer. Prostate Cancer Prostatic Dis 2020; 24:1-14. [PMID: 32632128 PMCID: PMC8012204 DOI: 10.1038/s41391-020-0245-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/25/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
Background An increasing number of studies indicate that exercise plays an important role in the overall care of prostate cancer (PCa) patients before, during and after treatment. Historically, research has focused on exercise as a modulator of physical function, psychosocial well-being as well as a countermeasure to cancer- and treatment-related adverse effects. However, recent studies reveal that exercise may also directly influence tumour physiology that could beneficially affect the response to radiotherapy. Methods In this narrative review, we provide an overview of tumour vascular characteristics that limit the effect of radiation and establish a rationale for exercise as adjunct therapy during PCa radiotherapy. Further, we summarise the existing literature on exercise as a modulator of tumour perfusion and hypoxia and outline potential future research directions. Results Preclinical research has shown that exercise can reduce intratumoral hypoxia—a major limiting factor in radiotherapy—by improving tumour perfusion and vascularisation. In addition, preliminary evidence suggests that exercise training can improve radiotherapy treatment outcomes by increasing natural killer cell infiltration in a murine PCa model. Conclusions Exercise is a potentially promising adjunct therapy for men with PCa undergoing radiotherapy that may increase its effectiveness. However, exercise-induced tumour radiosensitisation remains to be confirmed in preclinical and clinical trials, as does the optimal exercise prescription to elicit such effects.
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Affiliation(s)
- Oliver Schumacher
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. .,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,GenesisCare, Joondalup, WA, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,GenesisCare, Joondalup, WA, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
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252
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Newton RU, Hart NH, Clay T. Keeping Patients With Cancer Exercising in the Age of COVID-19. JCO Oncol Pract 2020; 16:656-664. [PMID: 32603253 PMCID: PMC7564134 DOI: 10.1200/op.20.00210] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The novel 2019 coronavirus disease (COVID-19) pandemic is a global public health emergency. To date, physical distancing and good personal hygiene have been the only effective measures to limit spread. The pandemic has altered routine cancer care, including allied health and supportive care interventions. Clinicians must adapt and find ways to continue to deliver optimal patient care at this time. The prescription of exercise to people with cancer has been demonstrated to have meaningful benefits for both physical and mental health and quality of life, and may even enhance survival. Such exercise interventions provide the largest benefit to patients when delivered in a supervised, group, clinic-based setting. In the age of COVID-19, group-based exercise in communal facilities presents risks for both aerosol and surface transmission of the virus among people exercising, necessitating a pivot from the usual methods of exercise delivery to home-based exercise programs. In this article, we discuss the challenges that need to be overcome in moving to a home-based program for patients with cancer while maintaining the benefits of targeted and high-fidelity exercise medicine. We provide practical recommendations for how home-based exercise can be supported and nurtured by qualified exercise professionals who treat people living with cancer, as well as pointing to resources that are available online to assist practitioners. Despite the challenges faced during this pandemic, we believe that it is important for people to continue to benefit from exercise in a safe environment with the support of exercise specialists.
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Affiliation(s)
- Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University; and School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University; and School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Western Australia, Australia
| | - Tim Clay
- Exercise Medicine Research Institute, Edith Cowan University; and School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Medical Oncology, St John of God Hospital; Medical Oncology, GenesisCare; and Medical Oncology, Icon Cancer Centre, Western Australia, Australia
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253
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Jones TL, Sandler CX, Spence RR, Hayes SC. Physical activity and exercise in women with ovarian cancer: A systematic review. Gynecol Oncol 2020; 158:803-811. [PMID: 32616402 DOI: 10.1016/j.ygyno.2020.06.485] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE A consistent body of evidence supports participating in physical activity (PA) post-cancer diagnosis as beneficial to function, quality-of-life and potentially survival. However, diagnosis of late stage disease, poor prognosis, receipt of high doses of adjuvant therapy and presence of severe acute and persistent treatment-related side-effects may alter how these findings translate to women with ovarian cancer. Therefore, the objectives of this review were to (I) describe PA levels post-diagnosis of ovarian cancer, (II) explore the relationship between PA levels and health outcomes, and (III) evaluate the effect of exercise interventions for women with ovarian cancer. METHODS PubMed, EMBASE, Scopus and CINAHL were systematically searched to December 31, 2019. Two independent reviewers assessed articles for eligibility. Studies were eligible if they evaluated the relationship between PA levels or an exercise intervention and health outcomes following ovarian cancer. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools. Descriptive statistics were used to collate relevant data. RESULTS 34 articles were eligible for inclusion. Results demonstrated that most women decrease PA from pre- to post-diagnosis and remain insufficiently active following diagnosis. Higher levels of PA were associated with higher health-related quality-of-life (HRQOL), and lower levels of anxiety and depression. Exercise appears safe and feasible during and following treatment and leads to improvements in HRQOL, fatigue and additional physical and psychological outcomes. CONCLUSIONS Findings suggest that PA is relevant to health outcomes for women with ovarian cancer. Interventions that aid women to stay or become sufficiently active, including through exercise interventions during or following treatment have potential to improve the lives of those with ovarian cancer. Future work evaluating targeted interventions that can accommodate disease-specific challenges is now required to ensure scientific findings can translate into improved ovarian cancer care.
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Affiliation(s)
- Tamara L Jones
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia; School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia.
| | - Carolina X Sandler
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia; School of Exercise and Nutrition Science, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
| | - Rosalind R Spence
- Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86, Gold Coast campus, QLD 4222, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia; Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86, Gold Coast campus, QLD 4222, Australia
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254
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Kennedy MA, Bayes S, Galvão DA, Singh F, Spry NA, Davis M, Chee R, Zissiadis Y, Hart NH, Taaffe DR, Newton RU. If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework. Eur J Cancer Care (Engl) 2020; 29:e13251. [PMID: 32495410 DOI: 10.1111/ecc.13251] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/20/2019] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Employ the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the effectiveness of a co-located exercise clinic model in increasing access to exercise for people undergoing cancer treatment in a private clinic in Western Australia. METHODS This retrospective evaluation utilised a mixed-method approach to gather feedback from key stakeholder groups involved with the exercise clinic. Questionnaires and workout summary sheets were gathered from 237 exercise clinic participants over the 50-month evaluation period. These were supplemented by survey results from 119 patients who received cancer treatment at the facility, and semi-structured interviews from seven radiation oncologists, eight nurses, and three accredited exercise physiologists involved with the exercise clinic. RESULTS The co-located clinic demonstrated positive outcomes related to effectiveness and adoption. Participant feedback indicated satisfaction with the exercise programming (effectiveness), and clinicians were receptive to referring patients to the clinic (adoption). However, no clear implementation or maintenance plan was employed and overall reach (12%) remained suboptimal throughout the evaluation period. CONCLUSION Co-locating an exercise clinic into a treatment facility does not in itself overcome the logistical challenges of providing integrated exercise services to people during cancer treatment. To enhance its utilisation, an implementation plan needs to accompany the intervention.
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Affiliation(s)
- Mary A Kennedy
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Sara Bayes
- School of Nursing and Midwifery, Edith Cowan University, Perth, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Favil Singh
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Nigel A Spry
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,GenesisCare, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Perth, WA, Australia
| | | | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,GenesisCare, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Perth, WA, Australia
| | - Yvonne Zissiadis
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,GenesisCare, Perth, WA, Australia.,Faculty of Medicine, University of Western Australia, Perth, WA, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,School of Exercise and Nutrition Sciences, University of Queensland, Brisbane, Qld, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,School of Exercise and Nutrition Sciences, University of Queensland, Brisbane, Qld, Australia
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255
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Pigott A, Obermair A, Janda M, Vagenas D, Ward LC, Reul-Hirche H, Hayes SC. Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. Gynecol Oncol 2020; 158:375-381. [PMID: 32499070 DOI: 10.1016/j.ygyno.2020.04.702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence on the incidence and risk factors for lower limb lymphedema (LLL) associated with endometrial cancer is limited. Our objective was to use data from a prospective, longitudinal gynecological cancer cohort study to determine LLL incidence up to 24 months post-diagnosis of endometrial cancer and to explore the relationship between personal and treatment-related factors and risk of developing LLL. METHODS Women recently diagnosed with endometrial cancer (n = 235) were evaluated at regular intervals post-diagnosis (up to 3-monthly) using bioimpedance spectroscopy (BIS) and self-reported leg swelling (SRLS). RESULTS Incidence of LLL at 24 months post-diagnosis was 33% and 45% according to BIS and SRLS, respectively. When analyses were restricted to obese women, incidence at 24 months post-diagnosis increased to 67% (BIS) and 54% (SRLS). Following adjusted analyses, higher body mass index was associated with higher odds of baseline lymphedema (BIS: OR 1.91, 95% CI 1.47-2.49, p < .01; SRLS: OR 1.06, 95% CI 1.00-1.12, p < .01) and LLL incidence by 24 months post-diagnosis (BIS: OR 1.29, 95% CI: 0.99-1.68, p = .055; SRLS: OR 1.06, 95% CI 1.02-1.11, p = .008). According to SRLS, presence of comorbidities was also associated with baseline lymphedema (OR: 1.43, 95% CI: 1.15-1.78, p = .001), and more extensive lymph node dissection (OR 1.06, 95% CI: 1.01-1.12, p = .026) and receipt of chemotherapy (OR: 2.65, 95% CI: 1.12-6.29, p = .027) were identified as risk factors for lymphedema incidence. CONCLUSIONS These findings suggest that LLL following endometrial cancer is common, particularly in women with high body mass index, or comorbidities, and those requiring more extensive lymph node dissection or chemotherapy. Future studies should examine the potential of weight loss intervention as a strategy to reduce LLL incidence.
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Affiliation(s)
- Amanda Pigott
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Occupational Therapy Department, Brisbane, Queensland, Australia.
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland Centre of Gynaecological Research, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hildegard Reul-Hirche
- Royal Brisbane and Women's Hospital, Physiotherapy Department, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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256
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Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy. Respirology 2020; 25 Suppl 2:80-87. [PMID: 32567236 DOI: 10.1111/resp.13869] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/04/2020] [Accepted: 05/10/2020] [Indexed: 12/13/2022]
Abstract
Exercise training is playing an increasing role in lung cancer care. Lung cancer is associated with significant burden to the individual and healthcare system. There is now substantial evidence that exercise training is safe, feasible and effective at improving several outcomes in people with lung cancer, especially in those with NSCLC. Exercise is beneficial across the lung cancer disease and treatment pathway, including in patients with early stage disease before and after surgery, and in patients with advanced disease. This review describes the impact of lung cancer and lung cancer treatment on patient health outcomes and summarizes the aims, safety, feasibility and effects of exercise training in the context of both early stage and advanced stage lung cancer. The paper also includes a discussion of current topical discussion areas including the use of exercise in people with bone metastases and the potential effect of exercise on suppression of tumour growth. Finally, seven clinical questions are included, which are a priority to be addressed by future research over the next decade as we strive to progress the field of lung cancer and improve patient outcomes.
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Affiliation(s)
- Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,Allied Health, South Metropolitan Health Service, Perth, WA, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia
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257
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Suderman K, Dolgoy N, Yurick J, Sellar C, Nishimura K, Culos-Reed SN, Joy AA, McNeely ML. A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113911. [PMID: 32492824 PMCID: PMC7312668 DOI: 10.3390/ijerph17113911] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022]
Abstract
Background: Our aim was to understand cancer survivor needs prior to, and following the Alberta Cancer Exercise (ACE) pilot randomized trial as a means to inform implementation of a province-wide cancer-specific, community-based exercise program. Methods: Questionnaires and semi-structured stakeholder engagement sessions were conducted with cancer survivors to explore preferences, barriers and facilitators/benefits at two timepoints: (1) pre-ACE: prior to initiation of the ACE pilot trial (n = 13 survivors and n = 5 caregivers); and (2) post-ACE: following participation in the ACE pilot trial (n = 20 survivors). Descriptive statistics were used to summarize quantitative data from questionnaires. Stakeholder engagement data were analyzed using a framework analysis approach. Emergent themes were then mapped to actionable outcomes. Results: Pre-ACE, survivors indicated a preference for exercise programs that were (1) supervised by exercise specialists knowledgeable about cancer, (2) included support from other health care providers, (3) were held in community locations that were easily accessible. Post-ACE, participants identified (1) a lack of exercise counseling from health care providers, (2) the need for earlier introduction of exercise in the care pathway, and (3) supported referral to exercise programming. Conclusions: An integrated knowledge translation approach identified actionable outcomes to address survivor needs related to exercise in clinical cancer and community-based contexts.
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Affiliation(s)
- Kirsten Suderman
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
| | - Naomi Dolgoy
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
| | - Janice Yurick
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada; (J.Y.); (A.A.J.)
| | - Christopher Sellar
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
| | - Kathryn Nishimura
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Anil A. Joy
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada; (J.Y.); (A.A.J.)
| | - Margaret L. McNeely
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada; (J.Y.); (A.A.J.)
- Correspondence: ; Tel.: +1-780-248-1531
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258
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Alves CRR, Neves WD, de Almeida NR, Eichelberger EJ, Jannig PR, Voltarelli VA, Tobias GC, Bechara LRG, de Paula Faria D, Alves MJN, Hagen L, Sharma A, Slupphaug G, Moreira JBN, Wisloff U, Hirshman MF, Negrão CE, de Castro G, Chammas R, Swoboda KJ, Ruas JL, Goodyear LJ, Brum PC. Exercise training reverses cancer-induced oxidative stress and decrease in muscle COPS2/TRIP15/ALIEN. Mol Metab 2020; 39:101012. [PMID: 32408015 PMCID: PMC7283151 DOI: 10.1016/j.molmet.2020.101012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that exercise training would attenuate metabolic impairment in a model of severe cancer cachexia. METHODS We used multiple in vivo and in vitro methods to explore the mechanisms underlying the beneficial effects induced by exercise training in tumor-bearing rats. RESULTS Exercise training improved running capacity, prolonged lifespan, reduced oxidative stress, and normalized muscle mass and contractile function in tumor-bearing rats. An unbiased proteomic screening revealed COP9 signalosome complex subunit 2 (COPS2) as one of the most downregulated proteins in skeletal muscle at the early stage of cancer cachexia. Exercise training normalized muscle COPS2 protein expression in tumor-bearing rats and mice. Lung cancer patients with low endurance capacity had low muscle COPS2 protein expression as compared to age-matched control subjects. To test whether decrease in COPS2 protein levels could aggravate or be an intrinsic compensatory mechanism to protect myotubes from cancer effects, we performed experiments in vitro using primary myotubes. COPS2 knockdown in human myotubes affected multiple cellular pathways, including regulation of actin cytoskeleton. Incubation of cancer-conditioned media in mouse myotubes decreased F-actin expression, which was partially restored by COPS2 knockdown. Direct repeat 4 (DR4) response elements have been shown to positively regulate gene expression. COPS2 overexpression decreased the DR4 activity in mouse myoblasts, and COPS2 knockdown inhibited the effects of cancer-conditioned media on DR4 activity. CONCLUSIONS These studies demonstrated that exercise training may be an important adjuvant therapy to counteract cancer cachexia and uncovered novel mechanisms involving COPS2 to regulate myotube homeostasis in cancer cachexia.
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Affiliation(s)
- Christiano R R Alves
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil; Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Willian das Neves
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil; Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HC FMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ney R de Almeida
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Eric J Eichelberger
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paulo R Jannig
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Vanessa A Voltarelli
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Gabriel C Tobias
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Luiz R G Bechara
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Daniele de Paula Faria
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Maria J N Alves
- Heart Institute, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Lars Hagen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Proteomics and Modomics Experimental Core, PROMEC, at NTNU and the Central Norway Regional Health Authority, Stjørdal, Norway
| | - Animesh Sharma
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Proteomics and Modomics Experimental Core, PROMEC, at NTNU and the Central Norway Regional Health Authority, Stjørdal, Norway
| | - Geir Slupphaug
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Proteomics and Modomics Experimental Core, PROMEC, at NTNU and the Central Norway Regional Health Authority, Stjørdal, Norway
| | - José B N Moreira
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisloff
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Michael F Hirshman
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Carlos E Negrão
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil; Heart Institute, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gilberto de Castro
- Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HC FMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Roger Chammas
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Kathryn J Swoboda
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge L Ruas
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Laurie J Goodyear
- Section on Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Patricia C Brum
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil.
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259
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Codima A, das Neves Silva W, de Souza Borges AP, de Castro G. Exercise prescription for symptoms and quality of life improvements in lung cancer patients: a systematic review. Support Care Cancer 2020; 29:445-457. [PMID: 32388616 DOI: 10.1007/s00520-020-05499-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/24/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to conduct a systematic review to assess the effect of exercise on symptoms and quality of life in lung cancer patients. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, Scopus, Web of Science, and SciELO were searched for studies published from January 1998 to January 2019. The review included all randomized controlled trials that evaluated the effect of exercise on symptoms and quality of life of lung cancer patients. Two reviewers independently assessed the quality of all the included studies using the Physiotherapy Evidence Database scale. RESULTS In total, ten studies (835 participants) met all inclusion criteria. Three studies investigated the effect of exercise after lung resection, whereas four studies investigated it as a pre-surgery intervention. Two studies investigated the effect of exercise in patients under systemic treatment only, and one study included patients on diverse treatment plans. Exercise protocols consisted of different combinations of strength, aerobic, and inspiratory muscle training. Two trials, including 101 participants, found significant difference in quality of life between groups, favoring the intervention group; and five trials, including 549 participants, found significant inter-group differences in isolated symptoms, also favoring the intervention group. CONCLUSIONS Exercise can lead to improvements of symptoms and of quality of life in lung cancer survivors. Providing resistance training combined with high-intensity interval aerobic exercise after lung resection seems to be particularly effective. Further studies are warranted to investigate exercise for patients with poor performance status.
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Affiliation(s)
- Alberto Codima
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil
| | - Willian das Neves Silva
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil.,Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da FMUSP, Av Dr. Arnaldo, 251, 5th floor, São Paulo, SP, 01246-000, Brazil
| | - Ana Paula de Souza Borges
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil.,Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da FMUSP, Av Dr. Arnaldo, 251, 5th floor, São Paulo, SP, 01246-000, Brazil
| | - Gilberto de Castro
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av Dr. Arnaldo, 455, 4th floor, São Paulo, SP, 01246-903, Brazil. .,Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da FMUSP, Av Dr. Arnaldo, 251, 5th floor, São Paulo, SP, 01246-000, Brazil.
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260
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Chang PH, Lin CR, Lee YH, Liu YL, Chang GC, Hoogland AI, Lai YH. Exercise experiences in patients with metastatic lung cancer: A qualitative approach. PLoS One 2020; 15:e0230188. [PMID: 32240205 PMCID: PMC7117721 DOI: 10.1371/journal.pone.0230188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 02/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Patients with metastatic lung cancer can have severe cancer-related symptoms and treatment-induced side effects. Exercise is beneficial for patients with metastatic lung cancer; however, little information is available on guiding patients how to perform exercise during hospitalization. The purpose of this qualitative study was to understand exercise experiences in patients with metastatic lung cancer. Methods Patients with metastatic lung cancer (n = 24) participated in face-to-face in-depth interviews at an inpatient ward of a medical center in central Taiwan. Interview transcripts were evaluated using narrative analysis to extract and validate themes. Results Three primary themes were identified: (1) modifying exercise to maximize physical functions; (2) living with symptoms and frustration, but still exercising; and (3) doing exercise to sustain hopes, inner power, and life. Secondary findings included: (1) adopting walking as their main form of exercise because of its convenience; and (2) among patients with severe symptoms, adjusting exercise towards shorter time durations and shorter distances, slower speeds, and higher frequencies. Conclusions The study found physically active lung cancer patients, although with metastatic condition, adjusted their exercise activities to balance disease and treatment-induced deteriorations and boost themselves to feel hope and fight for cancer. However, the results may not be applicable to physically inactive patients. Future research to explore experiences from those with even worse physical conditions and further helping them to take some mild exercise to enhance the positive side of cancer experiences are suggested.
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Affiliation(s)
- Pi-Hua Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Ching-Rong Lin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, Republic of China
| | - Yun-Hsiang Lee
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yi-Lin Liu
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Gee-Chen Chang
- Division of Chest Medicine, and Comprehensive Cancer Center, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
- National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China
- * E-mail:
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261
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Pituskin E, Kirkham AA, Cox-Kennett N, Dimitry R, Dimitry J, Paterson I, Gyenes GT. Rehabilitation Needs in Cancer Treatment-Related Cardiotoxicity. Semin Oncol Nurs 2020; 36:150986. [PMID: 31983487 DOI: 10.1016/j.soncn.2020.150986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine and summarize current international guidelines regarding cardiovascular risk reduction before and during cancer therapy, and to discuss the emerging role of cardio-oncology as a subspecialty in cancer care and the role of cardio-oncology rehabilitation. DATA SOURCES Published articles and guidelines. CONCLUSION With improvements in cancer detection and the use of novel adjuvant therapies, an increasing number of individuals now survive a cancer diagnosis. However, for some the cost is high - many survivors are now at higher risk of death from cardiovascular disease than from recurrent cancer. Cardiovascular morbidity and mortality are common and associated with common cancer therapies serially administered in adult oncology care. IMPLICATIONS FOR NURSING PRACTICE Timely risk-reduction interventions hold promise in reducing cardiovascular morbidity and mortality. Oncology nurses are the key providers to identify baseline risks, perform necessary referrals, provide individualized teaching, and support the patient within the family and community.
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Affiliation(s)
- Edith Pituskin
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), Edmonton, AB, Canada.
| | - Amy A Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | | | - Rebecca Dimitry
- Medical Oncology, Alberta Health Services, Edmonton, AB, Canada
| | - John Dimitry
- Medical Oncology, Alberta Health Services, Edmonton, AB, Canada
| | - Ian Paterson
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Gabor T Gyenes
- Cardiac Rehabilitation, Division of Cardiology, University of Alberta, Edmonton, AB, Canada
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262
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Sanz-de la Garza M, Sitges M. Physical exercise: Another tool in the fight against cancer and its treatment side effects? Eur J Prev Cardiol 2019; 28:722-724. [PMID: 33611553 DOI: 10.1177/2047487319890173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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263
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Schmitz KH, Campbell AM, Stuiver MM, Pinto BM, Schwartz AL, Morris GS, Ligibel JA, Cheville A, Galvão DA, Alfano CM, Patel AV, Hue T, Gerber LH, Sallis R, Gusani NJ, Stout NL, Chan L, Flowers F, Doyle C, Helmrich S, Bain W, Sokolof J, Winters-Stone KM, Campbell KL, Matthews CE. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin 2019; 69:468-484. [PMID: 31617590 PMCID: PMC7896280 DOI: 10.3322/caac.21579] [Citation(s) in RCA: 380] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023] Open
Abstract
Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.
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Affiliation(s)
- Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Anna M Campbell
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Martijn M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, North Carolina
| | - Jennifer A Ligibel
- Division of Women's Cancers, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | | | - Alpa V Patel
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Trisha Hue
- Data and Information Management, University of California at San Francisco, San Francisco, California
| | - Lynn H Gerber
- Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Robert Sallis
- Family Medicine, Kaiser Permanente Southern California, Pasadena, California
| | - Niraj J Gusani
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Nicole L Stout
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Fiona Flowers
- Community Settings, Macmillan Cancer Support, London, United Kingdom
| | - Colleen Doyle
- Department of Cancer Control, American Cancer Society, Atlanta, Georgia
| | | | | | - Jonas Sokolof
- Physical Medicine and Rehabilitation, New York University Langone Medical Center, New York, New York
| | - Kerri M Winters-Stone
- Knight Cancer Institute, School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Kristin L Campbell
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Exercise training, circulating cytokine levels and immune function in cancer survivors: A meta-analysis. Brain Behav Immun 2019; 81:92-104. [PMID: 31454519 DOI: 10.1016/j.bbi.2019.08.187] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Anti-cancer therapies lead to chronic non-resolving inflammation and reduced immune function. One potential therapy is exercise training, but the effectiveness of these interventions to improve immune-related outcomes, the gaps in the literature, and recommendations to progress the field need to be determined. OBJECTIVES (1) to conduct separate meta-analyses in cancer survivors to determine the effects of exercise training on pro- and anti-inflammatory markers, and immune cell proportions and function; and (2) to perform subgroup analyses to determine whether exercise modality, cancer type, and specific markers help to explain heterogeneity in each meta-analysis. DATA SOURCES Electronic databases (PubMed/MEDLINE, EMBASE, CENTRAL, and CINAHL) from inception to March 2018. The reference lists of eligible articles and relevant reviews were also checked. STUDY SELECTION Inclusion criteria were adult cancer survivors from randomized controlled trials performing structured exercise intervention (aerobic, resistance or combined training or Tai Chi/yoga) compared to usual care control group and included pro-inflammatory, anti-inflammatory, and/or immune cell outcomes. APPRAISAL AND SYNTHESIS METHODS A total of 5349 potentially eligible articles were identified, of which 26 articles (27 trials) met the inclusion criteria. Effect sizes were calculated as standardized mean differences (SMD), where <0.2 was defined as trivial, 0.2-0.3 as small, 0.4-0.8 as moderate, and >0.8 as a large effect. RESULTS Exercise training decreased pro-inflammatory markers (SMD: -0.2, 95% CI: -0.4, -0.1, p < 0.001). Sub-group analysis for the pro-inflammatory markers indicated that combined aerobic and resistance training had the greatest effect (SMD: -0.3, 95% CI: -0.5, -1.9, p < 0.001), that prostate (SMD: -0.5, 95% CI: -0.8, 0.1, p = 0.004) and breast cancer populations were most responsive (SMD: -0.2, 95% CI: -0.3, -0.1, p = 0.001), and that C-reactive protein (SMD: -0.5, 95% CI: -0.9, -0.06, p = 0.025) and tumor necrosis factor (SMD: -0.3, 95% CI: -0.5, -0.06, p = 0.004) were the most sensitive to change. Exercise training tended to decrease anti-inflammatory markers (p = 0.072) but had no effect on natural killer or natural killer T cell proportions or cytotoxic activity. CONCLUSIONS Exercise training reduces pro-inflammatory markers in cancer survivors, with the strongest evidence for combined training and for prostate and breast cancer survivors. Further research is warranted to determine if these changes are clinically relevant or are associated with improvements in symptoms. To strengthen future research, focusing on novel immune populations that include functional parameters and standardized reporting of key immune outcomes is recommended.
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