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Alfano CM, Cheville AL, Mustian K. Developing High-Quality Cancer Rehabilitation Programs: A Timely Need. Am Soc Clin Oncol Educ Book 2017; 35:241-9. [PMID: 27249704 DOI: 10.1200/edbk_156164] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The number of survivors of cancer in the United States, already 14.5 million, is growing with improved cancer treatment and aging of the population. Two-thirds of cancer survivors will be older than age 65 and are likely to enter cancer treatment already deconditioned and with multiple comorbidities. Survivors of cancer face numerous adverse consequences of cancer treatment that add to or exacerbate the effects of existing comorbidities and increase risk of functional decline. Many of these problems are amenable to rehabilitation interventions, but referral to cancer rehabilitation professionals is not a standard part of care. We present an expanded prospective model of surveillance, cancer rehabilitation assessment, and referral efforts using a multidisciplinary team approach. In this model, cancer rehabilitation begins at the time of cancer diagnosis and continues through and beyond cancer treatment. Physical impairments and psychosocial symptoms are assessed and treated, and lifestyle and exercise interventions are provided to optimize functioning, health, and quality of life. We present a stepped-care framework to guide decisions on when, how, and where to refer survivors to cancer rehabilitation specialists depending on safety requirements and needs. This model has the potential to result in early identification of symptoms and impairments, appropriate referral and timely treatment, and, in turn, will better address and minimize both acute and long-term cancer morbidity.
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Affiliation(s)
- Catherine M Alfano
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Andrea L Cheville
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Karen Mustian
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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302
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Spécificités et recherches méthodologiques pour l’évaluation en soins de support en oncologie. ONCOLOGIE 2017. [DOI: 10.1007/s10269-017-2686-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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303
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Lifestyle and Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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304
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Browall M, Mijwel S, Rundqvist H, Wengström Y. Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women's Experiences. Integr Cancer Ther 2016; 17:16-30. [PMID: 28008778 PMCID: PMC5950941 DOI: 10.1177/1534735416683807] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: In oncology, physical activity (PA) is recognized to
improve psychological and physiological functions. Motivating women with breast
cancer to sustain a physically active lifestyle is important for promoting
positive health after diagnosis. To review and synthesize what is known about
how women with breast cancer experience supervised and unsupervised PA during
and after adjuvant treatment. PubMed, PsycINFO, and CINAHL were searched,
yielding 994 citations. The final review included 17 articles published between
2004 and 2014 in English. The CASP (Critical Appraisal Skills Programme)
instrument was used to appraise quality. Results: Exercise is
experienced as a positive element with multiple benefits. However, maintaining a
physically active lifestyle during and after chemotherapy is sometimes
challenging. Reported benefits of PA include feeling empowered, and improving
and reclaiming health. Facilitators to PA comprised exercising with peers and
skilled instructors. Barriers included social factors and lack of information.
Conclusions: Findings highlight the importance of incorporating
PA programs from a patient experience perspective as routine treatment. Health
care professionals play a crucial “gateway” role in providing information on
implementation and benefits of PA. Providing support and educated advice about
how to safely start or continue regular PA to minimize symptoms, reduce
morbidity, and increase well-being during or after treatment is vital for women
with breast cancer. Implications for Practice: Health care
professionals need increased knowledge of the breast cancer patients’
perspectives on facilitators and barriers to PA during and after treatment, in
order to provide sufficient support for women to stay physically active during a
breast cancer illness.
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Affiliation(s)
- Maria Browall
- Karolinska Institute, Huddinge,
Sweden
- University of Skövde, Skövde,
Sweden
- Maria Browall, School of Health and
Education, University of Skövde, Box 408, 54128 Skövde, Sweden.
| | | | | | - Yvonne Wengström
- Karolinska Institute, Huddinge,
Sweden
- Karolinska University Hospital,
Stockholm, Sweden
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305
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Di Blasio A, Morano T, Napolitano G, Bucci I, Di Santo S, Gallina S, Cugusi L, Di Donato F, D'Arielli A, Cianchetti E. Nordic Walking and the Isa Method for Breast Cancer Survivors: Effects on Upper Limb Circumferences and Total Body Extracellular Water - a Pilot Study. Breast Care (Basel) 2016; 11:428-431. [PMID: 28228712 DOI: 10.1159/000453599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The negative side effects of breast cancer treatments can include upper limb lymphoedema. The growing literature indicates that Nordic walking is an effective discipline against several disease symptoms. The aim of this study was to determine whether introduction to Nordic walking alone is effective against total body extracellular water and upper limb circumferences in breast cancer survivors compared to its combination with a series of specifically created exercises (i.e. the Isa method). METHODS 16 breast cancer survivors (49.09 ± 2.24 years) were recruited and randomly assigned to 1 of 2 different training groups. RESULTS 10 lessons on Nordic walking technique plus the Isa method significantly reduced both extracellular body water and the extracellular-to-total body water ratio (p = 0.01 for both), and also the circumference of the upper limb, (both relaxed arm and forearm circumferences) (p = 0.01 for all), whereas Nordic walking alone did not. CONCLUSIONS Introduction to Nordic walking does not seem to affect lymphoedema in breast cancer survivors. This might be because novice Nordic Walkers do not adequately generate an effective muscular pump through coordination of the alternated bimanual open-close cycle. The Isa method appears to close this gap.
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Affiliation(s)
- Andrea Di Blasio
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
| | - Teresa Morano
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
| | - Ines Bucci
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
| | - Serena Di Santo
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
| | - Sabina Gallina
- Department of Neuroscience and Imaging, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
| | - Lucia Cugusi
- 'M. Aresu' Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Francesco Di Donato
- Dietamovimento.it Laboratories, Montesilvano, University of Chieti-Pescara, Chieti Scalo, Italy
| | | | - Ettore Cianchetti
- Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti Scalo, Italy
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306
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Do cancer survivors develop healthier lifestyle behaviors than the cancer-free population in the PLCO study? J Cancer Surviv 2016; 11:233-245. [PMID: 27837443 DOI: 10.1007/s11764-016-0581-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Current studies report mixed results in health status and health behaviors after a diagnosis of cancer. The aim of our study is to investigate potential differences in lifestyle factors among cancer survivors and cancer-free individuals in a prospective cohort study conducted in the United States. METHODS Using data from the Prostate, Lung, Colorectal and Ovarian (PLCO) Trial, 10,133 cancer survivors were identified and compared to 81,992 participants without cancer to evaluate differences in body mass index (BMI), smoking, NSAID use, and physical activity. RESULTS Cancer survivors, compared to the cancer-free, were significantly less likely to engage in physical activity (odds ratio (OR) = 0.82, 95% CI = 0.77-0.88). Compared to those who were obese at baseline, cancer survivors were more likely to be at normal BMI at follow-up compared to the cancer-free (OR = 1.90, 95% CI = 1.42-2.54). Cancer survivors were less likely to report regular aspirin use as compared to the cancer-free population (OR = 0.86, 95 % CI = 0.82-0.92). Of the current smokers, cancer survivors were more likely to be former smokers at follow-up compared to the cancer-free (OR = 1.50, 95% CI = 1.30-1.74). CONCLUSION Upon stratification by baseline health markers, cancer survivors practice healthier lifestyle habits such as smoking cessation and maintenance of a healthy weight. However, cancer survivors are less likely to be physically active as compared to cancer-free individuals, regardless of baseline practices. IMPLICATIONS FOR CANCER SURVIVORS For cancer survivors who reported poor health status and behaviors at baseline, a cancer diagnosis may encourage the practice of healthier lifestyle behaviors.
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307
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Di Blasio A, Morano T, Bucci I, Di Santo S, D'Arielli A, Castro CG, Cugusi L, Cianchetti E, Napolitano G. Physical exercises for breast cancer survivors: effects of 10 weeks of training on upper limb circumferences. J Phys Ther Sci 2016; 28:2778-2784. [PMID: 27821934 PMCID: PMC5088125 DOI: 10.1589/jpts.28.2778] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/16/2016] [Indexed: 01/12/2023] Open
Abstract
[Purpose] The aims of this study were to verify the effects on upper limb circumferences
and total body extracellular water of 10 weeks of Nordic Walking (NW) and Walking (W),
both alone and combined with a series of exercises created for breast cancer survivors,
the ISA method. [Subjects and Methods] Twenty breast cancer survivors were randomly
assigned to 4 different training groups and evaluated for upper limb circumferences, total
body and extracellular water. [Results] The breast cancer survivors who performed NW,
alone and combined with the ISA method, and Walking combined with the ISA method (but not
alone) showed significantly reduced arm and forearm circumferences homolateral to the
surgical intervention. [Conclusion] For breast cancer survivors, NW, alone and combined
with the ISA method, and Walking combined with the ISA method should be prescribed to
prevent the onset and to treat light forms of upper limb lymphedema because Walking
training practiced alone had no significant effect on upper limb circumference
reduction.
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Affiliation(s)
- Andrea Di Blasio
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Teresa Morano
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Ines Bucci
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Serena Di Santo
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | | | | | - Lucia Cugusi
- Department of Medical Sciences 'M. Aresu', University of Cagliari, Italy
| | - Ettore Cianchetti
- Department of Medical, Oral and Biotechnological Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
| | - Giorgio Napolitano
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Italy
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308
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Reeves MM, Terranova CO, Erickson JM, Job JR, Brookes DSK, McCarthy N, Hickman IJ, Lawler SP, Fjeldsoe BS, Healy GN, Winkler EAH, Janda M, Veerman JL, Ware RS, Prins JB, Vos T, Demark-Wahnefried W, Eakin EG. Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer. BMC Cancer 2016; 16:830. [PMID: 27793125 PMCID: PMC5086071 DOI: 10.1186/s12885-016-2858-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity, physical inactivity and poor diet quality have been associated with increased risk of breast cancer-specific and all-cause mortality as well as treatment-related side-effects in breast cancer survivors. Weight loss intervention trials in breast cancer survivors have shown that weight loss is safe and achievable; however, few studies have examined the benefits of such interventions on a broad range of outcomes and few have examined factors important to translation (e.g. feasible delivery method for scaling up, assessment of sustained changes, cost-effectiveness). The Living Well after Breast Cancer randomized controlled trial aims to evaluate a 12-month telephone-delivered weight loss intervention (versus usual care) on weight change and a range of secondary outcomes including cost-effectiveness. METHODS/DESIGN Women (18-75 years; body mass index 25-45 kg/m2) diagnosed with stage I-III breast cancer in the previous 2 years are recruited from public and private hospitals and through the state-based cancer registry (target n = 156). Following baseline assessment, participants are randomized 1:1 to either a 12-month telephone-delivered weight loss intervention (targeting diet and physical activity) or usual care. Data are collected at baseline, 6-months (mid-intervention), 12-months (end-of-intervention) and 18-months (maintenance). The primary outcome is change in weight at 12-months. Secondary outcomes are changes in body composition, bone mineral density, cardio-metabolic and cancer-related biomarkers, metabolic health and chronic disease risk, physical function, patient-reported outcomes (quality of life, fatigue, menopausal symptoms, body image, fear of cancer recurrence) and behaviors (dietary intake, physical activity, sitting time). Data collected at 18-months will be used to assess whether outcomes achieved at end-of-intervention are sustained six months after intervention completion. Cost-effectiveness will be assessed, as will mediators and moderators of intervention effects. DISCUSSION This trial will provide evidence needed to inform the wide-scale provision of weight loss, physical activity and dietary interventions as part of routine survivorship care for breast cancer survivors. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ANZCTR) - ACTRN12612000997853 (Registered 18 September 2012).
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Affiliation(s)
- Marina M. Reeves
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Jane M. Erickson
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jennifer R. Job
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Denise S. K. Brookes
- School of Public Health, The University of Queensland, Brisbane, Australia
- School of Medicine, Children’s Nutrition Research Centre, The University of Queensland, Brisbane, Australia
| | - Nicole McCarthy
- Icon Cancer Care, Wesley Medical Centre, Brisbane, Australia
| | - Ingrid J. Hickman
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Sheleigh P. Lawler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Genevieve N. Healy
- School of Public Health, The University of Queensland, Brisbane, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- School of Physiotherapy, Curtin University, Perth, Australia
| | | | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - J. Lennert Veerman
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Robert S. Ware
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Johannes B. Prins
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | | | - Elizabeth G. Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia
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309
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Comprendre la non-adhésion à l’activité physique après un diagnostic de cancer pour mieux accompagner les patients—Partie I : Comprendre la non-adhésion à une pratique régulière d’activité physique. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0582-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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310
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Niravath P. Aromatase Inhibitor-Associated Arthralgia: How Big Is the Problem and What Can Be Done? CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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311
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How Receptive Are Patients With Late Stage Cancer to Rehabilitation Services and What Are the Sources of Their Resistance? Arch Phys Med Rehabil 2016; 98:203-210. [PMID: 27592401 DOI: 10.1016/j.apmr.2016.08.459] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, and the rationale for their level of interest. DESIGN Prospective mixed-methods study. SETTING Comprehensive cancer center in a quaternary medical center. PARTICIPANTS Adults with stage IIIC or IV non-small cell or extensive stage small cell lung cancer (N=311). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Telephone-acquired responses to the administration of (1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); (2) numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; (3) a query regarding receptivity to receipt of rehabilitation services, and (4) a query about rationale for nonreceptivity. RESULTS Overall, 99 (31.8%) of the study's 311 participants expressed interest in receiving rehabilitation services: 38 at the time of enrollment and an additional 61 during at least 1 subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs 9.91%, P=.04) and a musculoskeletal comorbidity (42.4% vs 31.6%, P=.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns. CONCLUSIONS One-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.
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312
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Lee HY, Kim J, Merighi JR. Physical Activity and Self-Rated Health Status Among Older Adult Cancer Survivors: Does Intensity of Activity Play a Role? Oncol Nurs Forum 2016; 42:614-24. [PMID: 26488831 DOI: 10.1188/15.onf.614-624] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the association between routine physical activity and self-rated health status in older adults with cancer.. DESIGN Cross-sectional. SETTING Community-dwelling older adult survivors who completed a screening tool and subsequent detailed interview from the 2004 wave of the National Long-Term Care Survey, a nationally representative study of Medicare beneficiaries aged 65 years or older.
SAMPLE 251 older adult cancer survivors who regularly engaged in routine physical activity. METHODS Participants were asked about chronic health conditions, depression, activities of daily living, participation in physical activities, self-rated health status, and sociodemographic characteristics. A weighted ordered probit model was used to estimate variables that predict self-reported health status. MAIN RESEARCH VARIABLES Self-rated health status and participation in physical activity.
FINDINGS Age and higher education level were found to be significant correlates of health status (p < 0.05) in the first model. Although education was not significant in subsequent models, age, functional disability, and depression all were identified as significant correlates of health status (p < 0.01). In the final model, in which moderate and vigorous activity participation were entered, older adult survivors who engaged in vigorous physical activity showed higher levels of health status than those who engaged in light physical activity (p < 0.05), but number of chronic health conditions was not significantly associated with health status. CONCLUSIONS The association between vigorous activity and health status points to the primacy of physical activity within a post-cancer treatment health regimen.
. IMPLICATIONS FOR NURSING Health programs and policies need to address physical activity to improve the overall well-being of older adult cancer survivors.
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313
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Jones LW, Habel LA, Weltzien E, Castillo A, Gupta D, Kroenke CH, Kwan ML, Quesenberry CP, Scott J, Sternfeld B, Yu A, Kushi LH, Caan BJ. Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer. J Clin Oncol 2016; 34:2743-9. [PMID: 27217451 PMCID: PMC5019746 DOI: 10.1200/jco.2015.65.6603] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Cardiovascular disease (CVD) is a leading cause of death among women with nonmetastatic breast cancer. Whether exercise is associated with reductions in CVD risk in patients with breast cancer with an elevated CVD risk phenotype is not known. METHODS Using a prospective design, women (n = 2,973; mean age, 57 years) diagnosed with nonmetastatic breast cancer participating in two registry-based, regional cohort studies, completed a questionnaire that assessed leisure-time recreational physical activity (metabolic equivalent task [MET]-h/wk). The primary end point was the first occurrence of any of the following: new diagnosis of coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, occurring after study enrollment. RESULTS Median follow-up was 8.6 years (range, 0.2 to 14.8 years). In multivariable analysis, the incidence of cardiovascular events decreased across increasing total MET-h/wk categories (Ptrend < .001). Compared with < 2 MET-h/wk, the adjusted hazard ratio was 0.91 (95% CI, 0.76 to 1.09) for 2 to 10.9 MET-h/wk, 0.79 (95% CI, 0.66 to 0.96) for 11 to 24.5 MET-h/wk, and 0.65 (95% CI, 0.53 to 0.80) for ≥ 24.5 MET-h/wk. Similar trends were observed for the incidence of coronary artery disease and heart failure (P values < .05). Adherence to national exercise guidelines for adult patients with cancer (ie, ≥ 9 MET-h/wk) was associated with an adjusted 23% reduction in the risk of cardiovascular events in comparison with not meeting the guidelines (< 9 MET-h/wk; P < .001). The association with exercise did not differ according to age, CVD risk factors, menopausal status, or anticancer treatment. CONCLUSION Exercise is associated with substantial, graded reductions in the incidence of cardiovascular events in women with nonmetastatic breast cancer.
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Affiliation(s)
- Lee W Jones
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX.
| | - Laurel A Habel
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Erin Weltzien
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Adrienne Castillo
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Dipti Gupta
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Candyce H Kroenke
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Marilyn L Kwan
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Charles P Quesenberry
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Jessica Scott
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Barbara Sternfeld
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Anthony Yu
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Lawrence H Kushi
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
| | - Bette J Caan
- Lee W. Jones, Dipti Gupta, and Anthony Yu, Memorial Sloan Kettering Cancer Center, New York, NY; Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Barbara Sternfeld, Lawrence H. Kushi, and Bette J. Caan, Kaiser Permanente, Oakland, CA; and Jessica Scott, NASA Johnson Space Center, Houston, TX
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Courneya KS, McNeely ML, Culos-Reed SN, Vallance JK, Bell GJ, Mackey JR, Matthews CE, Morielli AR, Cook D, MacLaughlin S, Farris MS, Voaklander S, O'Reilly R, Friedenreich CM. The Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study: Recruitment, Baseline Assessment, and Description of the First 500 Participants. BMC Cancer 2016; 16:481. [PMID: 27416835 PMCID: PMC4946114 DOI: 10.1186/s12885-016-2534-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To our knowledge, the Alberta Moving Beyond Breast Cancer (AMBER) Study is the first and only prospective cohort study of breast cancer survivors that includes objectively-measured physical activity (PA), sedentary behavior, health-related fitness (HRF), and biologic mechanisms focused on understanding breast cancer outcomes. The purpose of the present study was to report on the feasibility of recruitment, baseline measurement completion, and the representativeness of the first 500 participants. METHODS AMBER is enrolling newly diagnosed stage I (≥T1c) to IIIc breast cancer survivors in Alberta, Canada. Baseline assessments are completed soon after diagnosis and include cardiorespiratory fitness, musculoskeletal fitness, body composition, objective and self-reported PA and sedentary behavior, lymphedema, and blood collection. RESULTS Between July 2012 and November 2014, AMBER recruited its first 500 participants from a pool of 1,447 (35 %) eligible breast cancer survivors. Baseline HRF assessments were completed on ≥85 % of participants with the exception of upper body strength. Collection of ≥4 days/week of monitoring for the Actigraph GT3X® and ActivPAL® were obtained from 90 % of participants. Completion rates were also high for blood (99 %), lymphedema (98 %), and questionnaires (95 %) including patient-reported outcomes and correlates of exercise. The first 500 participants in AMBER are an average age of 56 years, 60 % are overweight or obese, and 58 % have disease stage II or III. CONCLUSION Despite the modest recruitment rate and younger age, AMBER has demonstrated that many newly diagnosed breast cancer survivors are willing and able to complete a wide array of sophisticated and physically demanding HRF and PA assessments soon after diagnosis. AMBER is a unique breast cancer survivor cohort that may inform future randomized controlled trials on lifestyle and breast cancer outcomes as well as PA behavior change in breast cancer survivors. Moreover, AMBER may also inform guidelines on PA, sedentary behavior, and HRF for improving breast cancer outcomes and survivorship.
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Affiliation(s)
- Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada.
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Gordon J Bell
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - John R Mackey
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, USA
| | - Andria R Morielli
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Diane Cook
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Sarah MacLaughlin
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Megan S Farris
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Stephanie Voaklander
- Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Rachel O'Reilly
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
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315
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Dieli-Conwright CM, Lee K, Kiwata JL. Reducing the Risk of Breast Cancer Recurrence: an Evaluation of the Effects and Mechanisms of Diet and Exercise. CURRENT BREAST CANCER REPORTS 2016; 8:139-150. [PMID: 27909546 PMCID: PMC5112289 DOI: 10.1007/s12609-016-0218-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With recent medical advances in diagnosis and treatment, the increasing numbers of long-term survivors of breast cancer is considerable and has resulted in the expansion of scientific research to include examination of lifestyle modifications as means of prevention of recurrence, new breast cancer events, and mortality. The objective of this report is to review randomized controlled trials (RCTs) including diet and/or exercise interventions on breast cancer recurrence in women with a history of breast cancer as well as pertinent recent epidemiologic evidence. Implicated biologic mechanisms are discussed to elucidate the impact of diet and exercise on disease recurrence.
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Affiliation(s)
- Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St., CHP-155, Los Angeles, CA 90033 USA
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St., CHP-155, Los Angeles, CA 90033 USA
| | - Jacqueline L Kiwata
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St., CHP-155, Los Angeles, CA 90033 USA
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316
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Puszkiewicz P, Roberts AL, Smith L, Wardle J, Fisher A. Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application. JMIR Cancer 2016; 2:e7. [PMID: 28410168 PMCID: PMC5369632 DOI: 10.2196/cancer.5380] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/24/2016] [Accepted: 04/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population.
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Affiliation(s)
- Patrycja Puszkiewicz
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Anna L Roberts
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Lee Smith
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom.,The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
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317
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Leithner D, Baltzer PA, Magometschnigg HF, Wengert GJ, Karanikas G, Helbich TH, Weber M, Wadsak W, Pinker K. Quantitative Assessment of Breast Parenchymal Uptake on 18F-FDG PET/CT: Correlation with Age, Background Parenchymal Enhancement, and Amount of Fibroglandular Tissue on MRI. J Nucl Med 2016; 57:1518-1522. [PMID: 27230924 DOI: 10.2967/jnumed.116.174904] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/12/2016] [Indexed: 01/26/2023] Open
Abstract
Background parenchymal enhancement (BPE), and the amount of fibroglandular tissue (FGT) assessed with MRI have been implicated as sensitive imaging biomarkers for breast cancer. The purpose of this study was to quantitatively assess breast parenchymal uptake (BPU) on 18F-FDG PET/CT as another valuable imaging biomarker and examine its correlation with BPE, FGT, and age. METHODS This study included 129 patients with suspected breast cancer and normal imaging findings in one breast (BI-RADS 1), whose cases were retrospectively analyzed. All patients underwent prone 18F-FDG PET/CT and 3-T contrast-enhanced MRI of the breast. In all patients, interpreter 1 assessed BPU quantitatively using SUVmax Interpreters 1 and 2 assessed amount of FGT and BPE in the normal contralateral breast by subjective visual estimation, as recommended by BI-RADS. Interpreter 1 reassessed all cases and repeated the BPU measurements. Statistical tests were used to assess correlations between BPU, BPE, FGT, and age, as well as inter- and intrainterpreter agreement. RESULTS BPU on 18F-FDG PET/CT varied among patients. The mean BPU SUVmax ± SD was 1.57 ± 0.6 for patients with minimal BPE, 1.93 ± 0.6 for mild BPE, 2.42 ± 0.5 for moderate BPE, and 1.45 ± 0.3 for marked BPE. There were significant (P < 0.001) moderate to strong correlations among BPU, BPE, and FGT. BPU directly correlated with both BPE and FGT on MRI. Patient age showed a moderate to strong indirect correlation with all 3 imaging-derived tissue biomarkers. The coefficient of variation for quantitative BPU measurements with SUVmax was 5.6%, indicating a high reproducibility. Interinterpreter and intrainterpreter agreement for BPE and FGT was almost perfect, with a κ-value of 0.860 and 0.822, respectively. CONCLUSION The results of our study demonstrate that BPU varied among patients. BPU directly correlated with both BPE and FGT on MRI, and BPU measurements were highly reproducible. Patient age showed a strong inverse correlation with all 3 imaging-derived tissue biomarkers. These findings indicate that BPU may serve as a sensitive imaging biomarker for breast cancer prediction, prognosis, and risk assessment.
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Affiliation(s)
- Doris Leithner
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany; and
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Heinrich F Magometschnigg
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Georg J Wengert
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Georgios Karanikas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
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318
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Van Moll CCA, Schep G, Vreugdenhil A, Savelberg HHCM, Husson O. The effect of training during treatment with chemotherapy on muscle strength and endurance capacity: A systematic review. Acta Oncol 2016; 55:539-46. [PMID: 26755191 DOI: 10.3109/0284186x.2015.1127414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Treatment of cancer with chemotherapy decreases endurance capacity and muscle strength. Training during chemotherapy might prevent this. There are no clear guidelines concerning which type of training and which training dose are effective. This review aims to gain insight into the different training modalities during chemotherapy and the effects of such training to improve endurance capacity and muscle strength in order to obtain the knowledge to compose a future training program which trains cancer patients in the most effective way. Material and methods A systematic search of PubMed was carried out. In total, 809 studies of randomized controlled trials studying the effects of training during chemotherapy on endurance capacity and muscle strength were considered. Only 14 studies met all the inclusion criteria. The studies were assessed on methodological quality by using Cochrane criteria for randomized controlled trials. Results The quality of the studies was generally poor and the study populations varied considerably as the training programs were very heterogeneous. Variables of endurance capacity reported beneficial effects in 10 groups (59%). Increases due to training ranged from 8% to 31%. Endurance capacity decreased in nine of 13 control groups (69%), which ranged from 1% to 32%. Muscle strength improved significantly in 17 of 18 intervention groups (94%), ranging from 2% to 38%. Muscle strength also improved in 11 of 14 control groups (79%), but this increase was only minimal, ranging from 1.3% to 6.5%. Conclusions This review indicates that training during chemotherapy may help in preventing the decrease in muscle strength and endurance capacity. It is important to know which training intensity and duration is the most effective in training cancer patients, to provide a training program suitable for every cancer patient. Training should be based on good research and should be implemented into international guidelines and daily practice. More research is needed.
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Affiliation(s)
| | - Goof Schep
- Department of Sports Medicine, SportMáx, Máxima Medical Centre, Eindhoven and Veldhoven, The Netherlands
| | - Art Vreugdenhil
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven and Veldhoven, The Netherlands
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
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319
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Scott JM, Adams SC, Koelwyn GJ, Jones LW. Cardiovascular Late Effects and Exercise Treatment in Breast Cancer: Current Evidence and Future Directions. Can J Cardiol 2016; 32:881-90. [PMID: 27343744 DOI: 10.1016/j.cjca.2016.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/17/2016] [Accepted: 03/25/2016] [Indexed: 01/10/2023] Open
Abstract
Advances in detection and supportive care strategies have led to improvements in cancer-specific and overall survival after a diagnosis of early-stage breast cancer. These improvements, however, are associated with an increase in competing forms of morbidity and mortality, particularly cardiovascular disease (CVD). Indeed, in certain subpopulations of patients, CVD is the leading cause of mortality after early breast cancer, and these women also have an increased risk of CVD-specific morbidity, including an elevated incidence of coronary artery disease and heart failure compared with their sex- and age-matched counterparts. Exercise treatment is established as the cornerstone of primary and secondary prevention of CVD in multiple clinical populations. The potential benefits of exercise treatment to modulate CVD or CVD risk factors before, immediately after, or in the months/years after adjuvant therapy for early-stage breast cancer have received limited attention. We discuss the risk and extent of CVD in patients with breast cancer, review the pathogenesis of CVD, and highlight existing evidence from select clinical trials investigating the efficacy of structured exercise treatment across the CVD continuum in early breast cancer.
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Affiliation(s)
- Jessica M Scott
- Universities Space Research Association, NASA Johnson Space Center, Houston, Texas, USA
| | | | - Graeme J Koelwyn
- New York University Langone Medical Center, New York, New York, USA
| | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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320
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Lahart IM, Metsios GS, Nevill AM, Kitas GD, Carmichael AR. Randomised controlled trial of a home-based physical activity intervention in breast cancer survivors. BMC Cancer 2016; 16:234. [PMID: 26988367 PMCID: PMC4797234 DOI: 10.1186/s12885-016-2258-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/08/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To improve adherence to physical activity (PA), behavioural support in the form of behavioural change counselling may be necessary. However, limited evidence of the effectiveness of home-based PA combined with counselling in breast cancer patients exists. The aim of this current randomised controlled trial with a parallel group design was to evaluate the effectiveness of a home-based PA intervention on PA levels, anthropometric measures, health-related quality of life (HRQoL), and blood biomarkers in breast cancer survivors. METHODS Eighty post-adjuvant therapy invasive breast cancer patients (age = 53.6 ± 9.4 years; height = 161.2 ± 6.8 cm; mass = 68.7 ± 10.5 kg) were randomly allocated to a 6-month home-based PA intervention or usual care. The intervention group received face-to-face and telephone PA counselling aimed at encouraging the achievement of current recommended PA guidelines. All patients were evaluated for our primary outcome, PA (International PA Questionnaire) and secondary outcomes, mass, BMI, body fat %, HRQoL (Functional assessment of Cancer Therapy-Breast), insulin resistance, triglycerides (TG) and total (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol were assessed at baseline and at 6-months. RESULTS On the basis of linear mixed-model analyses adjusted for baseline values performed on 40 patients in each group, total, leisure and vigorous PA significantly increased from baseline to post-intervention in the intervention compared to usual care (between-group differences, 578.5 MET-min∙wk(-1), p = .024, 382.2 MET-min∙wk(-1), p = .010, and 264.1 MET-min∙wk(-1), p = .007, respectively). Both body mass and BMI decreased significantly in the intervention compared to usual care (between-group differences, -1.6 kg, p = .040, and -.6 kg/m(2), p = .020, respectively). Of the HRQoL variables, FACT-Breast, Trial Outcome Index, functional wellbeing, and breast cancer subscale improved significantly in the PA group compared to the usual care group (between-group differences, 5.1, p = .024; 5.6, p = .001; 1.9 p = .025; and 2.8, p = .007, respectively). Finally, TC and LDL-C was significantly reduced in the PA group compared to the usual care group (between-group differences, -.38 mmol∙L(-1), p = .001; and -.3 mmol∙L(-1), p = .023, respectively). CONCLUSIONS We found that home-based PA resulted in significant albeit small to moderate improvements in self-reported PA, mass, BMI, breast cancer specific HRQoL, and TC and LDL-C compared with usual care. CLINICALTRIALS. GOV IDENTIFIER NCT02408107 (March 25, 2015).
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Affiliation(s)
- Ian M Lahart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK.
| | - George S Metsios
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Alan M Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - George D Kitas
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK.,Department of Research and Development, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, DY1 2HQ, West Midlands, UK
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321
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Iyer NS, Osann K, Hsieh S, Tucker JA, Monk BJ, Nelson EL, Wenzel L. Health Behaviors in Cervical Cancer Survivors and Associations with Quality of Life. Clin Ther 2016; 38:467-75. [PMID: 26926320 PMCID: PMC4799758 DOI: 10.1016/j.clinthera.2016.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/01/2016] [Accepted: 02/06/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Improvement in health behaviors following cancer diagnosis may contribute to better prognosis and well-being. This study examines the prevalence of health behaviors in cervical cancer survivors who have completed treatment, and associations between health behaviors and quality of life (QOL). METHODS We recruited 204 women who had completed treatment for cervical cancer to participate in a randomized counseling intervention. Participants provided information on health behaviors (smoking, physical activity, and alcohol consumption); QOL (Functional Assessment of Cancer Therapy-Cervical questionnaire); and depression (Patient-Reported Outcomes Measurement Information System), anxiety (Patient-Reported Outcomes Measurement Information System), and distress (Brief Symptom Inventory) at baseline (9-30 months after diagnosis) and subsequent to the intervention. Data were analyzed using multivariate general linear models. FINDINGS Participants ranged in age from 20 to 72 years at diagnosis (mean = 43 years), 41% were Hispanic, and 52% were non-Hispanic white. Three-fourths were stage 1 at diagnosis and 51% were treated with radiation with or without chemotherapy. At baseline, 15% of patients were current smokers, 4% reported alcohol consumption of >10 drinks per week, and 63% reported exercising <3 hours per week. Overall, 67.4% of cervical cancer survivors did not meet recommended national guidelines for at least 1 of these health behaviors. QOL scores were significantly higher for patients with greater physical activity (128 vs 118; P = 0.002) and increased with the number of recommended guidelines met (P for trend = 0.030). Associations between patient-reported outcomes and smoking and alcohol consumption did not reach statistical significance. Participants who met guidelines for all health behaviors also had less depression (P = 0.008), anxiety (P = 0.051), and distress (P = 0.142). Participants who improved their aggregate health behaviors during the 4-month follow-up experienced a greater improvement in QOL than those who did not improve their health behaviors (10.8 vs 4.5; P = 0.026). IMPLICATIONS Results indicate that two-thirds of cervical cancer survivors are not meeting national guidelines for smoking, physical activity, and alcohol consumption following completion of definitive treatment. These adverse health behaviors were associated with impaired QOL and higher levels of depression and distress. Positive changes in health behaviors are associated with significant improvement in QOL.
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Affiliation(s)
- Neel S Iyer
- Program in Public Health, University of California Irvine, Irvine, California
| | - Kathryn Osann
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California.
| | - Susie Hsieh
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California; Department of Medicine, General Internal Medicine, University of California Irvine, Irvine, California
| | - Jo A Tucker
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Irvine, California
| | - Bradley J Monk
- Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Edward L Nelson
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California; Institute for Immunology, University of California Irvine, Irvine, California
| | - Lari Wenzel
- Program in Public Health, University of California Irvine, Irvine, California; Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California; Department of Medicine, General Internal Medicine, University of California Irvine, Irvine, California
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Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 2016; 34:611-35. [PMID: 26644543 DOI: 10.1200/jco.2015.64.3809] [Citation(s) in RCA: 542] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.
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Affiliation(s)
- Carolyn D. Runowicz
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Corinne R. Leach
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - N. Lynn Henry
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Karen S. Henry
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Heather T. Mackey
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Rebecca L. Cowens-Alvarado
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Rachel S. Cannady
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Mandi L. Pratt-Chapman
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Stephen B. Edge
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Linda A. Jacobs
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Arti Hurria
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Lawrence B. Marks
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Samuel J. LaMonte
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Ellen Warner
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Gary H. Lyman
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
| | - Patricia A. Ganz
- Carolyn D. Runowicz, Herbert Wertheim College of Medicine, Florida International University; Karen S. Henry, Sylvester Cancer Center at the University of Miami, Miami, FL; Corinne R. Leach, Rebecca L. Cowens-Alvarado, Rachel S. Cannady, and Samuel J. LaMonte, American Cancer Society, Atlanta, GA; N. Lynn Henry, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI; Heather T. Mackey, Oncology Nursing Society, Pittsburgh; Linda A. Jacobs, Abramson Cancer Center, University of Pennsylvania,
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Brédart A, Untas A, Copel L, Leufroy M, Mino JC, Boiron C, Dolbeault S, Kop JL. Breast Cancer Survivors' Supportive Care Needs, Posttraumatic Growth and Satisfaction with Doctors' Interpersonal Skills in Relation to Physical Activity 8 Months after the End of Treatment: A Prospective Exploratory Study. Oncology 2016; 90:151-9. [PMID: 26882537 DOI: 10.1159/000443766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We assessed whether breast cancer survivors' (BCSs) supportive care needs, posttraumatic growth (positive psychological changes) and satisfaction with doctors' interpersonal skills could be related to physical activity (PA). METHODS A total of 426 BCSs were approached during the last week of treatment. Eight months later, 278 (65%) provided information on their PA levels. Ordinal logistic multiple regressions were performed. RESULTS PA levels included no PA (n = 68), some PA (n = 83), high PA levels more than twice or more than 2 h per week (n = 127). The multivariate model significantly explained 13% of PA variance (p = 0.001). An increase in posttraumatic growth total scores (proportional OR = 1.310; p < 0.05) and a decrease in physical and daily living supportive care needs subscale scores (proportional OR = 0.980; p < 0.001) and in satisfaction with doctors' interpersonal skill scores (proportional OR = 0.898; p < 0.05) were significantly associated with an increase in the likelihood of performing higher levels of PA. A lower educational level was associated with a decrease in the likelihood of performing PA. CONCLUSION The prevalence of PA in BCSs should be improved. Positive psychological changes after a breast cancer experience might contribute to performing PA. Encouraging PA needs to be accompanied by the alleviation of physical symptoms.
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Affiliation(s)
- Anne Brédart
- Psychology Institute, LPPS EA 4057, University Paris Descartes, Sorbonne Paris Citx00E9;, Boulogne-Billancourt, France
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Lee CE, Ah D, Szuck B, Lau YKJ. Determinants of Physical Activity Maintenance in Breast Cancer Survivors After a Community-Based Intervention. Oncol Nurs Forum 2016; 43:93-102. [DOI: 10.1188/16.onf.43-01ap] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mino JC, Lefève C. Mieux comprendre l’expérience de l’activité physique après un cancer grâce à la philosophie de la santé. SANTE PUBLIQUE 2016. [DOI: 10.3917/spub.160.0101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin 2016; 66:43-73. [PMID: 26641959 DOI: 10.3322/caac.21319] [Citation(s) in RCA: 430] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.
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Affiliation(s)
- Carolyn D Runowicz
- Executive Associate Dean for Academic Affairs and Professor, Department of Obstetrics and Gynecology, Herbert Wertheim College of Medicine Florida International University, Miami, FL
| | - Corinne R Leach
- Director, Cancer and Aging Research, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - N Lynn Henry
- Associate Professor, Division of Hematology/Oncology, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI
| | - Karen S Henry
- Nurse Practitioner, Oncology/Hematology Sylvester Cancer Center at the University of Miami, Miami, FL
| | | | | | - Rachel S Cannady
- Behavioral Scientist, Behavioral Research Center/National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | | | | | - Linda A Jacobs
- Clinical Professor of Nursing, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Arti Hurria
- Associate Professor and Director, Cancer and Aging Research Program, City of Hope, Duarte, CA
| | - Lawrence B Marks
- Sidney K. Simon Distinguished Professor of Oncology Research and Chairman, Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Samuel J LaMonte
- Retired Head and Neck Surgeon, Survivorship Workgroup Member and Volunteer, American Cancer Society, Atlanta, GA
| | - Ellen Warner
- Professor of Medicine, University of Toronto, Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - Gary H Lyman
- Co-Director Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Patricia A Ganz
- Distinguished Professor of Medicine and Health Policy & Management, Schools of Medicine and Public Health, University of California, Los Angeles, CA
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Coughlin SS, Yoo W, Whitehead MS, Smith SA. Advancing breast cancer survivorship among African-American women. Breast Cancer Res Treat 2015; 153:253-61. [PMID: 26303657 DOI: 10.1007/s10549-015-3548-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022]
Abstract
Advances have occurred in breast cancer survivorship but, for many African-American women, challenges and gaps in relevant information remain. This article identifies opportunities to address disparities in breast cancer survival and quality of life, and thereby to increase breast cancer survivorship among African-American women. For breast cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, difficulty sleeping, and sexual dysfunction. For addressing physical and mental health concerns, a variety of interventions have been evaluated, including exercise and weight training, dietary interventions, yoga and mindfulness-based stress reduction, and support groups or group therapy. Obesity has been associated with breast cancer recurrence and poorer survival. Relative to white survivors, African-American breast cancer survivors are more likely to be obese and less likely to engage in physical activity, although exercise improves overall quality of life and cancer-related fatigue. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among breast cancer survivors, but few studies have focused specifically on African-American women with a breast cancer diagnosis. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to a breast cancer diagnosis. There is a need for a better understanding of breast cancer survivorship among African-American women. Additional evaluations of interventions for improving the quality of life and survival of African-American breast cancer survivors are desirable.
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Affiliation(s)
- Steven S Coughlin
- Department of Community Health and Sustainability, Division of Public Health, University of Massachusetts, Lowell, MA, USA,
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Coughlin SS, Smith SA. The Insulin-like Growth Factor Axis, Adipokines, Physical Activity, and Obesity in Relation to Breast Cancer Incidence and Recurrence. ACTA ACUST UNITED AC 2015; 4:24-31. [PMID: 26251693 PMCID: PMC4524449 DOI: 10.5539/cco.v4n2p24] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Obesity, a risk factor for the development of postmenopausal breast cancer and certain other cancer types, has also been associated with poorer response to cancer therapy and cancer recurrence. The insulin-like growth factor (IGF) axis also influences cancer risk. Methods In this commentary, we consider the literature on IGF and its binding proteins and the risk of breast cancer, along with effects of obesity, adipokines, and insulin resistance on breast cancer, and the potential for lifestyle interventions to address weight gain and physical inactivity among at-risk women. Results Greater body fatness is associated with a higher risk of postmenopausal breast cancer. The association may be explained, in part, by hyperinsulinemia and alterations in adipokines and estrogens. Nutrition, energy balance, and levels of physical activity are determinants of IGF bioactivity. Alterations in the IGF axis can increase cancer risk and progression. Results from epidemiologic studies indicate that higher circulating levels of IGF-I are associated with an increased risk of breast cancer. Conclusions Intervention studies are needed to determine how to sustain the positive effects of exercise over time and to identify the optimal mode, intensity, frequency, duration, and timing of exercise for breast cancer survivors, including important subgroups of survivors such as African American and Hispanic women. Future epidemiologic studies of the relationships between the IGF axis and breast cancer should include adequate numbers of African American women, Hispanic women, and other minority women who have been underrepresented in studies completed to date.
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Affiliation(s)
- Steven S Coughlin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Selina A Smith
- Institute of Public and Preventive Health, and Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
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