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Husebø ALM, Søreide JA, Kørner H, Storm M, Wathne HB, Richardson A, Morken IM, Urstad KH, Nordfonn OK, Karlsen B. eHealth interventions to support colorectal cancer patients' self-management after discharge from surgery-an integrative literature review. Support Care Cancer 2023; 32:11. [PMID: 38055087 PMCID: PMC10700211 DOI: 10.1007/s00520-023-08191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) creates elevated self-management demands and unmet support needs post-discharge. Follow-up care through eHealth post-primary surgery may be an effective means of supporting patients' needs. This integrative review describes the evidence regarding eHealth interventions post-hospital discharge focusing on delivery mode, user-interface and content, patient intervention adherence, impact on patient-reported outcomes and experiences of eHealth. METHODS A university librarian performed literature searches in 2021 using four databases. After screening 1149 records, the authors read 30 full-text papers and included and extracted data from 26 papers. Two authors analysed the extracted data using the 'framework synthesis approach'. RESULTS The 26 papers were published between 2012 and 2022. The eHealth interventions were mainly delivered by telephone with the assistance of healthcare professionals, combined with text messages or video conferencing. The user interfaces included websites, applications and physical activity (PA) trackers. The interventions comprised the monitoring of symptoms or health behaviours, patient information, education and counselling. Evidence showed a better psychological state and improved PA. Patients reported high satisfaction with eHealth. However, patient adherence was inadequately reported. CONCLUSIONS eHealth interventions may positively impact CRC patients' anxiety and PA regardless of the user interface. Patients prefer technology combined with a human element.
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Affiliation(s)
- Anne Lunde Marie Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Hege Bjøkne Wathne
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Alison Richardson
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, Building 67, Highfield Campus, University Road, Southampton, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Mailpoint 11, Clinical Academic Facility (Room AA102), South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Ingvild Margreta Morken
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Kristin Hjorthaug Urstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Oda Karin Nordfonn
- Department of Health and Caring Science, Western Norway University of Applied Science, Stord, Norway
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Wang X, Sun J, Yin X, Zou C, Li H. Effects of behavioral change techniques on diet and physical activity in colorectal cancer patients: a systematic review and meta-analysis. Support Care Cancer 2022; 31:29. [PMID: 36515770 DOI: 10.1007/s00520-022-07511-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the effect of behavior change technology on diet, exercise, and sedentary behaviors in colorectal cancer over the last decade. METHODS This study systematically searched six English databases (Cochrane Library, EMBASE, APA PsycInfo, SCOPUS, PubMed, Web of Science) and three Chinese databases (CNKI, WanFang, and SINOMEd), searched for eligible clinical trials published between January 1, 2012, and December 31, 2021. Each database follows the principle of PICOS and adopts the method of subject words combined with free words to conduct literature retrieval, such as "colorectal cancer" and "behavior change intervention." Meta-analysis was performed using RevMan 5.3 software. Continuous data using the same measurement tools were analyzed using weighted mean difference (MD). Otherwise, standard mean difference (SMD) was used for analysis. The confidence interval is 95%. There was no significant statistical heterogeneity between the studies (P > 0.1, I2 < 50%), and fixed-effects model was used. There was statistical heterogeneity (P ≤ 0.1), I2 ≥ 50%), and the random effects model was used for analysis. The Cochrane risk of bias tool was used to assess the risk of bias in the included studies. RESULTS In total, 15 good-quality randomized controlled trials were identified. Six studies focused on eating habits. Twelve studies focused on physical activity. We found that behavior change techniques had significant effects on colorectal cancer survivors' eating behaviors such as frequency of fruit and vegetable intake and mastery of dietary knowledge (P < 0.05). The meta-analysis showed that the amount of physical activity in the intervention group increased by 71.76 min/w (16.27 to 127.24, P = 0.01) at 3 months after treatment compared with the control group. The meta-analysis showed that the amount of physical activity in the intervention group increased by 113.97 min/w (48.34 to 179.59, P < 0.001) at 6 months after treatment compared with the control group. The results revealed significant difference in the overall effect of the behavior change technique on the amount of exercise. Behavior change techniques were not found to have significant effects on body weight and BMI in colorectal cancer survivors, but it had a significant effect on sedentary behavior (P < 0.05). CONCLUSIONS The effects of behavioral change technique intervention on diet and physical activity may be more clinically significant at 6 months. This is the first systematic review and meta-analysis to summarize the effectiveness of a behavioral change techniques health behavior intervention in patients with colorectal cancer.
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Affiliation(s)
- Xiao Wang
- First Hospital of Jilin University, Changchun, China
| | - Jiao Sun
- Jilin University, Changchun, China
| | - Xin Yin
- First Hospital of Jilin University, Changchun, China
| | - Congcong Zou
- First Hospital of Jilin University, Changchun, China
| | - Hongyan Li
- First Hospital of Jilin University, Changchun, China.
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McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database Syst Rev 2020; 5:CD012864. [PMID: 32361988 PMCID: PMC7196359 DOI: 10.1002/14651858.cd012864.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colorectal cancer is the third most commonly diagnosed cancer worldwide. A diagnosis of colorectal cancer and subsequent treatment can adversely affect an individuals physical and mental health. Benefits of physical activity interventions in alleviating treatment side effects have been demonstrated in other cancer populations. Given that regular physical activity can decrease the risk of colorectal cancer, and cardiovascular fitness is a strong predictor of all-cause and cancer mortality risk, physical activity interventions may have a role to play in the colorectal cancer control continuum. Evidence of the efficacy of physical activity interventions in this population remains unclear. OBJECTIVES To assess the effectiveness and safety of physical activity interventions on the disease-related physical and mental health of individuals diagnosed with non-advanced colorectal cancer, staged as T1-4 N0-2 M0, treated surgically or with neoadjuvant or adjuvant therapy (i.e. chemotherapy, radiotherapy or chemoradiotherapy), or both. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 6), along with OVID MEDLINE, six other databases and four trial registries with no language or date restrictions. We screened reference lists of relevant publications and handsearched meeting abstracts and conference proceedings of relevant organisations for additional relevant studies. All searches were completed between 6 June and 14 June 2019. SELECTION CRITERIA We included randomised control trials (RCTs) and cluster-RCTs comparing physical activity interventions, to usual care or no physical activity intervention in adults with non-advanced colorectal cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, performed the data extraction, assessed the risk of bias and rated the quality of the studies using GRADE criteria. We pooled data for meta-analyses by length of follow-up, reported as mean differences (MDs) or standardised mean differences (SMDs) using random-effects wherever possible, or the fixed-effect model, where appropriate. If a meta-analysis was not possible, we synthesised studies narratively. MAIN RESULTS We identified 16 RCTs, involving 992 participants; 524 were allocated to a physical activity intervention group and 468 to a usual care control group. The mean age of participants ranged between 51 and 69 years. Ten studies included participants who had finished active treatment, two studies included participants who were receiving active treatment, two studies included both those receiving and finished active treatment. It was unclear whether participants were receiving or finished treatment in two studies. Type, setting and duration of physical activity intervention varied between trials. Three studies opted for supervised interventions, five for home-based self-directed interventions and seven studies opted for a combination of supervised and self-directed programmes. One study did not report the intervention setting. The most common intervention duration was 12 weeks (7 studies). Type of physical activity included walking, cycling, resistance exercise, yoga and core stabilisation exercise. Most of the uncertainty in judging study bias came from a lack of clarity around allocation concealment and blinding of outcome assessors. Blinding of participants and personnel was not possible. The quality of the evidence ranged from very low to moderate overall. We did not pool physical function results at immediate-term follow-up due to considerable variation in results and inconsistency of direction of effect. We are uncertain whether physical activity interventions improve physical function compared with usual care. We found no evidence of effect of physical activity interventions compared to usual care on disease-related mental health (anxiety: SMD -0.11, 95% confidence interval (CI) -0.40 to 0.18; 4 studies, 198 participants; I2 = 0%; and depression: SMD -0.21, 95% CI -0.50 to 0.08; 4 studies, 198 participants; I2 = 0%; moderate-quality evidence) at short- or medium-term follow-up. Seven studies reported on adverse events. We did not pool adverse events due to inconsistency in reporting and measurement. We found no evidence of serious adverse events in the intervention or usual care groups. Minor adverse events, such as neck, back and muscle pain were most commonly reported. No studies reported on overall survival or recurrence-free survival and no studies assessed outcomes at long-term follow-up We found evidence of positive effects of physical activity interventions on the aerobic fitness component of physical fitness (SMD 0.82, 95% CI 0.34 to 1.29; 7 studies, 295; I2 = 68%; low-quality evidence), cancer-related fatigue (MD 2.16, 95% CI 0.18 to 4.15; 6 studies, 230 participants; I2 = 18%; low-quality evidence) and health-related quality of life (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence) at immediate-term follow-up. These positive effects were also observed at short-term follow-up but not medium-term follow-up. Only three studies reported medium-term follow-up for cancer-related fatigue and health-related quality of life. AUTHORS' CONCLUSIONS The findings of this review should be interpreted with caution due to the low number of studies included and the quality of the evidence. We are uncertain whether physical activity interventions improve physical function. Physical activity interventions may have no effect on disease-related mental health. Physical activity interventions may be beneficial for aerobic fitness, cancer-related fatigue and health-related quality of life up to six months follow-up. Where reported, adverse events were generally minor. Adequately powered RCTs of high methodological quality with longer-term follow-up are required to assess the effect of physical activity interventions on the disease-related physical and mental health and on survival of people with non-advanced colorectal cancer. Adverse events should be adequately reported.
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Affiliation(s)
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Marie M Cantwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
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Sweeney‐Magee M, Moustaqim‐Barrette A, Gotay C, Dummer T. A systematic mixed studies review of health behaviour change interventions in colorectal cancer survivors. J Adv Nurs 2020. [DOI: 10.1111/jan.14389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Molly Sweeney‐Magee
- School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
| | - Amina Moustaqim‐Barrette
- School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
| | - Carolyn Gotay
- School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
| | - Trevor Dummer
- School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
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Burden S, Jones DJ, Sremanakova J, Sowerbutts AM, Lal S, Pilling M, Todd C. Dietary interventions for adult cancer survivors. Cochrane Database Syst Rev 2019; 2019:CD011287. [PMID: 31755089 PMCID: PMC6872979 DOI: 10.1002/14651858.cd011287.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND International dietary recommendations include guidance on healthy eating and weight management for people who have survived cancer; however dietary interventions are not provided routinely for people living beyond cancer. OBJECTIVES To assess the effects of dietary interventions for adult cancer survivors on morbidity and mortality, changes in dietary behaviour, body composition, health-related quality of life, and clinical measurements. SEARCH METHODS We ran searches on 18 September 2019 and searched the Cochrane Central Register of Controlled trials (CENTRAL), in the Cochrane Library; MEDLINE via Ovid; Embase via Ovid; the Allied and Complementary Medicine Database (AMED); the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and the Database of Abstracts of Reviews of Effects (DARE). We searched other resources including reference lists of retrieved articles, other reviews on the topic, the International Trials Registry for ongoing trials, metaRegister, Physicians Data Query, and appropriate websites for ongoing trials. We searched conference abstracts and WorldCat for dissertations. SELECTION CRITERIA We included randomised controlled trials (RCTs) that recruited people following a cancer diagnosis. The intervention was any dietary advice provided by any method including group sessions, telephone instruction, written materials, or a web-based approach. We included comparisons that could be usual care or written information, and outcomes measured included overall survival, morbidities, secondary malignancies, dietary changes, anthropometry, quality of life (QoL), and biochemistry. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Two people independently assessed titles and full-text articles, extracted data, and assessed risk of bias. For analysis, we used a random-effects statistical model for all meta-analyses, and the GRADE approach to rate the certainty of evidence, considering limitations, indirectness, inconsistencies, imprecision, and bias. MAIN RESULTS We included 25 RCTs involving 7259 participants including 977 (13.5%) men and 6282 (86.5%) women. Mean age reported ranged from 52.6 to 71 years, and range of age of included participants was 23 to 85 years. The trials reported 27 comparisons and included participants who had survived breast cancer (17 trials), colorectal cancer (2 trials), gynaecological cancer (1 trial), and cancer at mixed sites (5 trials). For overall survival, dietary intervention and control groups showed little or no difference in risk of mortality (hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.77 to 1.23; 1 study; 3107 participants; low-certainty evidence). For secondary malignancies, dietary interventions versus control trials reported little or no difference (risk ratio (RR) 0.99, 95% CI 0.84 to 1.15; 1 study; 3107 participants; low-certainty evidence). Co-morbidities were not measured in any included trials. Subsequent outcomes reported after 12 months found that dietary interventions versus control probably make little or no difference in energy intake at 12 months (mean difference (MD) -59.13 kcal, 95% CI -159.05 to 37.79; 5 studies; 3283 participants; moderate-certainty evidence). Dietary interventions versus control probably led to slight increases in fruit and vegetable servings (MD 0.41 servings, 95% CI 0.10 to 0.71; 5 studies; 834 participants; moderate-certainty evidence); mixed results for fibre intake overall (MD 5.12 g, 95% CI 0.66 to 10.9; 2 studies; 3127 participants; very low-certainty evidence); and likely improvement in Diet Quality Index (MD 3.46, 95% CI 1.54 to 5.38; 747 participants; moderate-certainty evidence). For anthropometry, dietary intervention versus control probably led to a slightly decreased body mass index (BMI) (MD -0.79 kg/m², 95% CI -1.50 to -0.07; 4 studies; 777 participants; moderate-certainty evidence). Dietary interventions versus control probably had little or no effect on waist-to-hip ratio (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; 106 participants; low-certainty evidence). For QoL, there were mixed results; several different quality assessment tools were used and evidence was of low to very low-certainty. No adverse events were reported in any of the included studies. AUTHORS' CONCLUSIONS Evidence demonstrated little effects of dietary interventions on overall mortality and secondary cancers. For comorbidities, no evidence was identified. For nutritional outcomes, there was probably little or no effect on energy intake, although probably a slight increase in fruit and vegetable intake and Diet Quality Index. Results were mixed for fibre. For anthropometry, there was probably a slight decrease in body mass index (BMI) but probably little or no effect on waist-to-hip ratio. For QoL, results were highly varied. Additional high-quality research is needed to examine the effects of dietary interventions for different cancer sites, and to evaluate important outcomes including comorbidities and body composition. Evidence on new technologies used to deliver dietary interventions was limited.
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Affiliation(s)
- Sorrel Burden
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Debra J Jones
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Jana Sremanakova
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Anne Marie Sowerbutts
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
| | - Simon Lal
- Salford Royal Foundation TrustIntestinal Failure UnitSalfordUKM6 8HD
| | - Mark Pilling
- University of CambridgeDepartment of Public and Health and Primary CareCambridgeUKCB2 0SR
| | - Chris Todd
- The University of Manchester, and Manchester Academic Health Science CentreSchool of Health SciencesManchesterUKM13 9PL
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Lynch BM, Nguyen NH, Moore MM, Reeves MM, Rosenberg DE, Boyle T, Vallance JK, Milton S, Friedenreich CM, English DR. A randomized controlled trial of a wearable technology-based intervention for increasing moderate to vigorous physical activity and reducing sedentary behavior in breast cancer survivors: The ACTIVATE Trial. Cancer 2019; 125:2846-2855. [PMID: 31012970 DOI: 10.1002/cncr.32143] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial examined the efficacy of an intervention (use of the Garmin Vivofit 2 activity monitor coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions) to increase moderate to vigorous physical activity (MVPA) and reduce sedentary behavior in breast cancer survivors. METHODS This randomized controlled trial recruited 83 inactive, postmenopausal women diagnosed with stage I-III breast cancer who had completed primary treatment. Participants were randomly assigned to the intervention group or to the control group, and the intervention was delivered over a 12-week period. MVPA and sedentary behavior were measured with Actigraph and activPAL accelerometers at baseline (T1) and at the end of the intervention (T2). RESULTS Retention in the trial was high, with 80 (96%) of participants completing T2 data collection. At T2, there was a significant between-group difference in MVPA (69 min/wk; 95% CI = 22-116) favoring the intervention group. The trial resulted in a statistically significant decrease in both total sitting time and prolonged bouts (≥20 min) of sitting, with between-group reductions of 37 min/d (95% CI = -72 to -2) and 42 min/d (95% CI = -83 to -2), respectively, favoring the intervention group. CONCLUSION Results from the ACTIVATE Trial suggest that the use of wearable technology presents an inexpensive and scalable opportunity to facilitate more active lifestyles for cancer survivors. Whether or not such wearable technology-based interventions can create sustainable behavioral change should be the subject of future research.
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Affiliation(s)
- Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nga H Nguyen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melissa M Moore
- Medical Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marina M Reeves
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Shakira Milton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJC, Rosario DJ, Thaha MA, Bourke L. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2018; 9:CD010192. [PMID: 30229557 PMCID: PMC6513653 DOI: 10.1002/14651858.cd010192.pub3] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in the Cochrane Library 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. OBJECTIVES To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? SEARCH METHODS We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. MAIN RESULTS We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week).Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). AUTHORS' CONCLUSIONS Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population.
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Affiliation(s)
- Rebecca R Turner
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Liz Steed
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public HealthBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Helen Quirk
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Rosa U Greasley
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - John M Saxton
- Northumbria UniversityDepartment of Sport, Exercise, and RehabilitationNewcastle‐upon‐TyneUKNE1 8ST
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
| | - Derek J Rosario
- University of SheffieldDepartment of OncologyBeech Hill RoadRoyal Hallamshire HospitalSheffieldUKS010 2RX
| | - Mohamed A Thaha
- Barts & The London School of Medicine & Dentistry, Queen Mary University LondonAcademic Surgical Unit, National Centre for Bowel Research & Surgical Innovation, Centre for Digestive Diseases, Blizard Institute1st Floor, Abernethy Building, 2 Newark StreetThe Royal London Hospital, WhitechapelLondonEnglandUKE1 2AT
| | - Liam Bourke
- Sheffield Hallam UniversityHealth and Wellbeing Research InstituteSheffieldUKS10 2BP
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Predictors of sedentary behavior among colorectal survivors. Support Care Cancer 2018; 27:2049-2056. [DOI: 10.1007/s00520-018-4452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/30/2018] [Indexed: 01/23/2023]
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9
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Abstract
Mortality from colorectal cancer has been declining over the past 20 years due to improvements in screening and treatment. Physical activity improves patient quality of life, slows functional decline, and reduces all-cause mortality. Although some patients may have difficulty participating in physical activity, clinicians should always try to incorporate exercise into a management plan for patients who have survived colorectal cancer.
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10
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Sampayo V, Tofthagen C. Hyperglycemia and Cancer: An Algorithm to Guide Oncology Nurses
. Clin J Oncol Nurs 2018; 21:345-352. [PMID: 28524903 DOI: 10.1188/17.cjon.345-352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A dual diagnosis of cancer and hyperglycemia has demonstrated untoward effects on patients' cancer treatment, prognosis, and survival.
. OBJECTIVES The purpose of this evidence-based project is to improve knowledge and awareness of the consequences of hyperglycemia in patients with cancer, increasing nurses' capability to effectively intervene. In addition, a clinical algorithm based on current evidence was developed and is presented.
. METHODS An educational program was developed and pilot tested. The program addressed the etiology of hyperglycemia and its effects on patients with cancer. Knowledge of hyperglycemia in patients with cancer was assessed with a pre- and post-test.
. FINDINGS All participants found the educational program effective and deemed the clinical algorithm useful. Results improved significantly after participation in the educational intervention.
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11
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Tsai E, Robertson MC, Lyons EJ, Swartz MC, Basen-Engquist K. Physical activity and exercise self-regulation in cancer survivors: A qualitative study. Psychooncology 2017; 27:563-568. [PMID: 28763133 DOI: 10.1002/pon.4519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/12/2017] [Accepted: 07/26/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite the benefits of physical activity, many cancer survivors do not adhere to clinically recommended levels. This qualitative study investigated factors of self-regulation contributing to survivor physical activity patterns. METHODS Participants attended focus groups with prompts on exercise habits and self-regulation on the basis of social cognitive theory, self-determination theory, and self-regulation theory. Content analysis with a priori codes was conducted to identify emergent themes. RESULTS Participants (n = 35) were predominately older (63.7 y ± 10.8), female (69%), white (71%), and breast cancer (60%) survivors, with 41% not meeting activity guidelines. Emergent themes included exercise goal development, selection, and attainment; exercise planning; and self-reward. Participants tended to develop values-based, general goals rather than action-based, measurable goals. Goal attainment success emerged as a facilitator of future goal performance; completing a current goal facilitated subsequent goal attainment, while failure hindered future goal completion. Rather than having deliberate intentions to schedule exercise, participants exercised if expedient in the context of normal daily activities. Food consumption emerged as a major mechanism for self-reward. CONCLUSIONS Our findings suggest that values-based goals, unplanned activity, influence from previous goal attempts, and self-reward were important factors related to self-regulation. Interventions designed to improve self-regulation may consider facilitating development of autonomous, value-based goals, assisting in development of strategies for future goals if current goals are not met, endorsing exercise as a scheduled activity, and introducing healthy self-reward alternatives.
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Affiliation(s)
- Edward Tsai
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA.,Center for Energy Balance in Cancer Prevention and Survivorship, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael C Robertson
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA.,Center for Energy Balance in Cancer Prevention and Survivorship, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria C Swartz
- Division of Rehabilitation Sciences Center for Recovery, Physical Activity, and Nutrition, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen Basen-Engquist
- Center for Energy Balance in Cancer Prevention and Survivorship, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Barakat S, Boehmer K, Abdelrahim M, Ahn S, Al-Khateeb AA, Villalobos NÁ, Prokop L, Erwin PJ, Fleming K, Serrano V, Spencer-Bonilla G, Murad MH. Does Health Coaching Grow Capacity in Cancer Survivors? A Systematic Review. Popul Health Manag 2017. [PMID: 28636526 DOI: 10.1089/pop.2017.0040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Interventions that grow patient capacity to do the work of health care and life are needed to support the health of cancer survivors. Health coaching may grow capacity. This systematic review of health coaching interventions explored coaching's ability to grow capacity of cancer survivors. The authors included randomized trials or quasi-experimental studies comparing coaching to alternative interventions, and adhered to PRISMA reporting guidelines. Data were analyzed using the Theory of Patient Capacity (BREWS: Capacity is affected by factors that influence ability to reframe Biography ["B"], mobilize or recruit Resources ["R"], interact with the Environment of care ["E"], accomplish Work ["W"]), and function Socially ["S"]). The authors reviewed 2210 references and selected 12 studies (6 randomized trials and 6 pre-post). These studies included 1038 cancer survivors, mean age 57.2 years, with various type of cancers: breast, colorectal, prostate, and lung. Health coaching was associated with improved quality of life, mood, and physical activity but not self-efficacy. Classified by potential to support growth in patient capacity, 67% of included studies reported statistically significant outcomes that support "B" (quality of life, acceptance, spirituality), 75% "R" (decreased fatigue, pain), 67% "W" (increased physical activity), and 33% "S" (social deprivation index). None addressed changing the patient's environment of care. In cancer survivors, health coaching improved quality of life and supported patient capacity by several mechanisms, suggesting an important role for "Capacity Coaching." Future interventions that improve self-efficacy and patients' environments of care are needed. Capacity Coaching may improve health and quality of life of cancer survivors.
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Affiliation(s)
| | | | | | - Sangwoo Ahn
- 2 University of Minnesota , Minneapolis, Minnesota
| | | | - Neri Álvarez Villalobos
- 1 Mayo Clinic , Rochester, Minnesota.,4 Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José E. González," Monterrey, México
| | | | | | | | - Valentina Serrano
- 1 Mayo Clinic , Rochester, Minnesota.,5 Pontificia Universidad Católica de Chile , Escuela de Medicina, Alameda, Chile
| | - Gabriela Spencer-Bonilla
- 1 Mayo Clinic , Rochester, Minnesota.,6 University of Puerto Rico Medical Sciences Campus , San Juan, Puerto Rico
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13
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Moug SJ, Bryce A, Mutrie N, Anderson AS. Lifestyle interventions are feasible in patients with colorectal cancer with potential short-term health benefits: a systematic review. Int J Colorectal Dis 2017; 32:765-775. [PMID: 28374148 PMCID: PMC5432596 DOI: 10.1007/s00384-017-2797-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Lifestyle interventions have been proposed to improve cancer survivorship in patients with colorectal cancer (CRC), but with treatment pathways becoming increasingly multi-modal and prolonged, opportunities for interventions may be limited. This systematic review assessed the evidence for the feasibility of performing lifestyle interventions in CRC patients and evaluated any short- and long-term health benefits. METHODS Using PRISMA Guidelines, selected keywords identified randomised controlled studies (RCTs) of lifestyle interventions [smoking, alcohol, physical activity (PA) and diet/excess body weight] in CRC patients. These electronic databases were searched in June 2015: Dynamed, Cochrane Database, OVID MEDLINE, OVID EMBASE, and PEDro. RESULTS Fourteen RCTs were identified: PA RCTs (n = 10) consisted mainly of telephone-prompted walking or cycling interventions of varied durations, predominately in adjuvant setting; dietary/excess weight interventions RCTs (n = 4) focused on low-fat and/or high-fibre diets within a multi-modal lifestyle intervention. There were no reported RCTs in smoking or alcohol cessation/reduction. PA and/or dietary/excess weight interventions reported variable recruitment rates, but good adherence and retention/follow-up rates, leading to short-term improvements in dietary quality, physical, psychological and quality-of-life parameters. Only one study assessed long-term follow-up, finding significantly improved cancer-specific survival after dietary intervention. CONCLUSIONS This is the first systematic review on lifestyle interventions in patients with CRC finding these interventions to be feasible with improvements in short-term health. Future work should focus on defining the optimal type of intervention (type, duration, timing and intensity) that not only leads to improved short-term outcomes but also assesses long-term survival.
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Affiliation(s)
- Susan J Moug
- The University of Glasgow, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK.
| | - Adam Bryce
- The University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, Moray House School of Education, The University of Edinburgh, St. Leonard's Land, Holyrood Road, Edinburgh, EH8 8AQ, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Ninewells Medical School, Level 7, Mailbox 7, Dundee, DD1 9SY, UK
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14
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Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act 2017. [PMID: 28351367 DOI: 10.1186/s12966–017–0494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. METHODS The inclusion criteria specified RCTs with ≥ 12 weeks' duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. RESULTS We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. CONCLUSION There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. TRIAL REGISTRATION PROSPERO CRD42015020624.
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Affiliation(s)
- Gro Beate Samdal
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tom Barth
- Member of Motivational Interviewing Network of Trainers (MINT), Allasso, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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15
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Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act 2017; 14:42. [PMID: 28351367 PMCID: PMC5370453 DOI: 10.1186/s12966-017-0494-y] [Citation(s) in RCA: 400] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/13/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. Methods The inclusion criteria specified RCTs with ≥ 12 weeks’ duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. Results We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. Conclusion There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. Trial Registration PROSPERO CRD42015020624 Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0494-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gro Beate Samdal
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tom Barth
- Member of Motivational Interviewing Network of Trainers (MINT), Allasso, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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16
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Namasivayam V, Lim S. Recent advances in the link between physical activity, sedentary behavior, physical fitness, and colorectal cancer. F1000Res 2017; 6:199. [PMID: 28344777 PMCID: PMC5333603 DOI: 10.12688/f1000research.9795.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/13/2022] Open
Abstract
Physical inactivity is a well-established risk factor for colorectal cancer (CRC). Recent studies have characterized physical activity (PA), sedentary behavior, and cardiorespiratory fitness as distinct, interrelated constructs that influence the risk of CRC and related outcomes. PA levels required to confer protection against CRC may be higher than previously thought. Sedentary behavior, defined as time spent sitting, increases CRC risk independent of PA and may require novel interventions distinct from those targeting PA. Finally, cardiorespiratory fitness is inversely associated with CRC risk and mortality and may provide a potential tool for risk stratification and intervention.
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Affiliation(s)
- Vikneswaran Namasivayam
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore; Duke NUS Medical School, Singapore, Singapore
| | - Sam Lim
- Respiratory Inflammation and General Medicine of AstraZeneca Global Medicine Development Centre, Shanghai, China; Office of Clinical Science, Duke-NUS Medical School, Singapore, Singapore
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17
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Henriksen HB, Ræder H, Bøhn SK, Paur I, Kværner AS, Billington SÅ, Eriksen MT, Wiedsvang G, Erlund I, Færden A, Veierød MB, Zucknick M, Smeland S, Blomhoff R. The Norwegian dietary guidelines and colorectal cancer survival (CRC-NORDIET) study: a food-based multicentre randomized controlled trial. BMC Cancer 2017; 17:83. [PMID: 28137255 PMCID: PMC5282711 DOI: 10.1186/s12885-017-3072-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/18/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Colorectal cancer survivors are not only at risk for recurrent disease but also at increased risk of comorbidities such as other cancers, cardiovascular disease, diabetes, hypertension and functional decline. In this trial, we aim at investigating whether a diet in accordance with the Norwegian food-based dietary guidelines and focusing at dampening inflammation and oxidative stress will improve long-term disease outcomes and survival in colorectal cancer patients. METHODS/DESIGN This paper presents the study protocol of the Norwegian Dietary Guidelines and Colorectal Cancer Survival study. Men and women aged 50-80 years diagnosed with primary invasive colorectal cancer (Stage I-III) are invited to this randomized controlled, parallel two-arm trial 2-9 months after curative surgery. The intervention group (n = 250) receives an intensive dietary intervention lasting for 12 months and a subsequent maintenance intervention for 14 years. The control group (n = 250) receives no dietary intervention other than standard clinical care. Both groups are offered equal general advice of physical activity. Patients are followed-up at 6 months and 1, 3, 5, 7, 10 and 15 years after baseline. The study center is located at the Department of Nutrition, University of Oslo, and patients are recruited from two hospitals within the South-Eastern Norway Regional Health Authority. Primary outcomes are disease-free survival and overall survival. Secondary outcomes are time to recurrence, cardiovascular disease-free survival, compliance to the dietary recommendations and the effects of the intervention on new comorbidities, intermediate biomarkers, nutrition status, physical activity, physical function and quality of life. DISCUSSION The current study is designed to gain a better understanding of the role of a healthy diet aimed at dampening inflammation and oxidative stress on long-term disease outcomes and survival in colorectal cancer patients. Since previous research on the role of diet for colorectal cancer survivors is limited, the study may be of great importance for this cancer population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01570010 .
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Affiliation(s)
- Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hanna Ræder
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Siv Kjølsrud Bøhn
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ane Sørlie Kværner
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Siv Åshild Billington
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Morten Tandberg Eriksen
- Department of Gastroenterological Surgery, Oslo University Hospital, Ullevål, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gro Wiedsvang
- Department of Gastroenterological Surgery, Oslo University Hospital, Ullevål, Norway
| | - Iris Erlund
- National Institute for Health and Welfare, Helsinki, Finland
| | - Arne Færden
- Department of Digestive and Paediatric Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Marit Bragelien Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Manuela Zucknick
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. .,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
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18
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Vitamin D and Physical Activity in Patients With Colorectal Cancer: Epidemiological Evidence and Therapeutic Implications. Cancer J 2017; 22:223-31. [PMID: 27341603 DOI: 10.1097/ppo.0000000000000197] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality in the United States. Notwithstanding major improvements in the early detection and treatment of CRC, an important proportion of patients who received a diagnosis of localized disease ultimately have a recurrence and die, underscoring the need of new therapeutic approaches. Vitamin D and physical activity (PA) have emerged as 2 potential interventions for both prevention and treatment of CRC. Plausible biological mechanisms have been described for the antineoplastic effects of vitamin D and PA, and a wealth of epidemiological evidence indicates that 25(OH)D (the main circulating form of vitamin D) and PA levels are inversely associated with CRC risk. Recent efforts have now focused on the role of vitamin D and PA as adjunct treatments after a CRC diagnosis. Observational studies evaluating prediagnosis and postdiagnosis circulating 25(OH)D levels among patients with CRC of all stages have found that subjects with levels in the highest quantiles have improved overall and CRC-specific survival compared with those with levels in the lowest quantiles. Similarly, prospective studies of PA have found that higher levels of postdiagnosis PA are associated with lower overall and CRC-specific mortality in patients with nonmetastatic CRC. Meta-analyses of the observational studies of 25(OH)D and postdiagnosis PA have confirmed significant protective associations against overall and CRC-specific mortality, as well as significant dose-response relationships. No randomized controlled trial of vitamin D or PA using survival outcomes as endpoints has been completed to date. Two randomized, placebo-controlled trials of vitamin D in patients with metastatic CRC assessing patient survival as an endpoint are underway: the first is a phase II trial comparing high-dose vitamin D3 (8000 IU/d for 2 weeks followed by 4000 IU/d) versus standard dose (400 IU/d), and the second is a phase I-II trial comparing customized oral doses of vitamin D3 titrated to raise serum 25(OH)D levels to 80 to 100 ng/mL versus 2000 IU/d. For PA, the ongoing phase III CHALLENGE (Colon Health and Life-Long Exercise Change) study is the first randomized controlled trial using survival as an endpoint among patients with stage II-III colon cancer. The results of these trials will pave the way to more conclusive phase III trials that will provide more definitive answers about the role of these interventions in the treatment of CRC. Lastly, the advent of genomic technologies will allow identifying molecular signatures in CRC associated with improved response to vitamin D and PA and will usher in a precision medicine approach to these therapies.
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Abstract
PURPOSE OF REVIEW The gastroenterology literature emphasizes factors that increase colorectal cancer (CRC) incidence but presents little about management after initial CRC treatments. The purpose of this review is to describe the remarkably increasing numbers of CRC survivors in whom surveillance guidelines are often not followed and patient care is fragmented. The gastroenterologist can play an important role in this care to improve prognosis and overall health. RECENT FINDINGS Existing surveillance recommendations by specialty societies for CRC survivors are fairly consistent but implementation occurs in less than half. The gastroenterologist can help to coordinate care to ensure appropriate surveillance and also can help to diagnose and treat chemotherapy and radiotherapy complications in survivors which can affect the quality of life long after the initial treatment. The gastroenterologist also can focus on host factors, including management of obesity, exercise programs, and the diet and can introduce potential chemopreventive agents such as nonsteroidal anti-inflammatory drugs when positive prospective studies are forthcoming. Interested gastroenterologists also have a role in participating in such prospective studies. SUMMARY The gastroenterologist should enhance her/his role for coordinated management of CRC survivors to improve patient surveillance care, to treat posttherapy complications and encourage preventive measures to improve prognosis and quality of life.
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20
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Walker RK, Hickey AM, Freedson PS. Advantages and Limitations of Wearable Activity Trackers: Considerations for Patients and Clinicians. Clin J Oncol Nurs 2016; 20:606-610. [PMID: 27857250 DOI: 10.1188/16.cjon.606-610] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Pinto B, Dunsiger S, Stein K. Does a peer-led exercise intervention affect sedentary behavior among breast cancer survivors? Psychooncology 2016; 26:1907-1913. [PMID: 27531024 DOI: 10.1002/pon.4255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/21/2016] [Accepted: 08/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Sedentary behavior is recognized as an independent risk factor for chronic diseases. Cancer survivors report high levels of sedentary behavior. In secondary analyses, we examined the effects of an exercise intervention on sedentary behavior (sitting time) among breast cancer survivors. METHODS Seventy-six breast cancer survivors (mean age = 55.62 y, mean 1.1 y since diagnosis) were randomized to receive either a 12-week telephone-delivered exercise intervention from peer volunteers or a contact control condition. The intervention did not specifically address sitting time. Participants' sedentary behavior was assessed for 7 days at baseline, 12 weeks, and 24 weeks via self-report and objective measurement (accelerometer). RESULTS At baseline, our sample reported sitting for 7.75 hours/day (10.98 h/d by accelerometer data). Spearman rank correlations showed significant positive correlations at baseline between sitting time measured by self-report and accelerometer (ρ = 0.37; P = .002) in the entire sample. There were no significant changes over time within group nor were there any significant intervention effects on sitting time (self-report and objective) at 12 and 24 weeks (all P's > .05). CONCLUSIONS An exercise intervention that did not focus specifically on sitting time did not affect sedentary behavior among breast cancer survivors. Intervention components that specifically target sitting behavior are needed to reduce this risk behavior among survivors.
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Affiliation(s)
- Bernardine Pinto
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Shira Dunsiger
- Miriam Hospital and W. Alpert Medical School of Brown University, Providence, RI, USA
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22
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Eakin EG, Hayes SC, Haas MR, Reeves MM, Vardy JL, Boyle F, Hiller JE, Mishra GD, Goode AD, Jefford M, Koczwara B, Saunders CM, Demark-Wahnefried W, Courneya KS, Schmitz KH, Girgis A, White K, Chapman K, Boltong AG, Lane K, McKiernan S, Millar L, O'Brien L, Sharplin G, Baldwin P, Robson EL. Healthy Living after Cancer: a dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors. BMC Cancer 2015; 15:992. [PMID: 26690258 PMCID: PMC4687340 DOI: 10.1186/s12885-015-2003-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Given evidence shows physical activity, a healthful diet and weight management can improve cancer outcomes and reduce chronic disease risk, the major cancer organisations and health authorities have endorsed related guidelines for cancer survivors. Despite these, and a growing evidence base on effective lifestyle interventions, there is limited uptake into survivorship care. METHODS/DESIGN Healthy Living after Cancer (HLaC) is a national dissemination and implementation study that will evaluate the integration of an evidence-based lifestyle intervention for cancer survivors into an existing telephone cancer information and support service delivered by Australian state-based Cancer Councils. Eligible participants (adults having completed cancer treatment with curative intent) will receive 12 health coaching calls over 6 months from Cancer Council nurses/allied health professionals targeting national guidelines for physical activity, healthy eating and weight control. Using the RE-AIM evaluation framework, primary outcomes are service-level indicators of program reach, adoption, implementation/costs and maintenance, with secondary (effectiveness) outcomes of patient-reported anthropometric, behavioural and psychosocial variables collected at pre- and post-program completion. The total participant accrual target across four participating Cancer Councils is 900 over 3 years. DISCUSSION The national scope of the project and broad inclusion of cancer survivors, alongside evaluation of service-level indicators, associated costs and patient-reported outcomes, will provide the necessary practice-based evidence needed to inform future allocation of resources to support healthy living among cancer survivors. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR)--ACTRN12615000882527 (registered on 24/08/2015).
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Affiliation(s)
- Elizabeth G Eakin
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Sandra C Hayes
- Queensland University of Technology, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Brisbane, Australia.
| | - Marion R Haas
- University of Technology Sydney, Centre for Health Economics Research and Evaluation, Sydney, Australia.
| | - Marina M Reeves
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Janette L Vardy
- The University of Sydney, Concord Clinical School, Sydney, Australia.
| | - Frances Boyle
- Mater Hospital Sydney, The Patricia Ritchie Centre for Cancer Care and Research, Sydney, Australia.
| | - Janet E Hiller
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia.
| | - Gita D Mishra
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Ana D Goode
- The University of Queensland, School of Public Health, Brisbane, Australia.
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Department of Cancer Experiences Research, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Bogda Koczwara
- Flinders Medical Centre, Department of Medical Oncology, Bedford Park, Australia.
| | | | | | - Kerry S Courneya
- University of Alberta, Faculty of Physical Education and Recreation, Edmonton, Canada.
| | - Kathryn H Schmitz
- University of Pennsylvania, Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, USA.
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia.
| | - Kate White
- University of Sydney, Sydney Nursing School, Sydney, Australia.
| | | | - Anna G Boltong
- Cancer Council Victoria, Melbourne, Australia.
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | | | | | | | | | - Greg Sharplin
- Cancer Council South Australia, Adelaide, Australia.
| | - Polly Baldwin
- Cancer Council South Australia, Adelaide, Australia.
| | - Erin L Robson
- The University of Queensland, School of Public Health, Brisbane, Australia.
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Patterns and correlates of accelerometer-assessed physical activity and sedentary time among colon cancer survivors. Cancer Causes Control 2015; 27:59-68. [DOI: 10.1007/s10552-015-0683-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/13/2015] [Indexed: 12/28/2022]
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24
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Clinical characteristics of patients with cancer referred for outpatient physical therapy. Phys Ther 2015; 95:526-38. [PMID: 25504482 PMCID: PMC4384050 DOI: 10.2522/ptj.20140106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 11/25/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cancer rehabilitation is a developing area, with an increasing number of survivors of cancer in the United States. The increase in survivorship occurs alongside impairments arising directly from cancer or from treatment-related side effects. OBJECTIVE This study described clinical characteristics of patients with cancer referred for outpatient physical therapy and explored patterns in frequency of impairments between type of cancer and mode of cancer treatment. DESIGN This was a retrospective chart review of patients with cancer referred to a tertiary care physical therapy clinic over a 2-year period. METHODS Characteristics such as age, sex, cancer type, mode of treatment, and neuromusculoskeletal impairments were identified. Impairment frequencies were computed based on cancer type and mode of treatment. RESULTS Data from 418 patients (mean age=57.9 years, SD=14.3; 41.1% female) were examined. Genitourinary cancer (n=169) and breast cancer (n=90) were the most prevalent types of cancer reported in this sample. Impairments in strength (83.6%) and soft tissue (71.3%) were the most common examination findings. Lymphedema was most common in patients with breast cancer, and incontinence was most common in patients with genitourinary cancer. LIMITATIONS The types of cancer identified in this study may be reflective of this tertiary center and may not generalize to other facilities. Impairment identification during the initial physical therapist evaluation was not performed systematically. CONCLUSION These data reinforce that physical therapists should screen for lymphedema in patients with breast cancer and incontinence in urogenital cancers. Strength and soft tissue integrity should be evaluated in most patients with cancer. Assessing pain and fatigue levels is recommended for patients who have had radiation therapy.
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