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Bouwman E, Stollman I, Wilbers J, Claessens JJM, van Spronsen DJ, Bongaerts A, Breij D, Blijlevens NMA, Knoop H, Hermens RPMG, Loonen JJ. Feasibility and potential effectiveness of nurse-led video-coaching interventions for childhood, adolescent, and young adult cancer survivors: the REVIVER study. BMC Cancer 2024; 24:722. [PMID: 38862904 PMCID: PMC11167751 DOI: 10.1186/s12885-024-12430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Childhood, adolescent, and young adult (CAYA) cancer survivors, at risk for late effects, including cancer-related fatigue, cardiovascular issues, and psychosocial challenges, may benefit from interventions stimulating behaviour adjustments. Three nurse-led eHealth interventions (REVIVER) delivered via video calls and elaborating on person-centred care, cognitive behaviour therapy and/or motivational interviewing were developed. These interventions target: 1) fatigue management, 2) healthier lifestyle behaviours, and 3) self-efficacy and self-management. This study aimed to assess the feasibility and potential effectiveness of the REVIVER interventions for CAYA cancer survivors and healthcare professionals. METHODS In a single-group mixed methods design, CAYA cancer survivors aged 16-54, more than five years post-treatment, were enrolled. Feasibility, assessed via Bowen's outcomes for feasibility studies, included acceptability, practicality, integration and implementation, demand and adherence. Qualitative data from semi-structured interviews and a focus group interview with survivors and healthcare professionals supplemented the evaluation. Paired sample t-tests assessed changes in self-reported quality of life, fatigue, lifestyle, self-management, and self-efficacy at baseline (T0), post-intervention (T1), and 6-month follow-up (T2). RESULTS The interventions and video consults were generally acceptable, practical, and successfully integrated and implemented. Success factors included the nurse consultant (i.e., communication, approach, and attitude) and the personalised approach. Barriers included sustainability concerns, technical issues, and short intervention duration. Regarding demand, 71.4%, 65.4%, and 100% of eligible CAYA cancer survivors engaged in the fatigue (N = 15), lifestyle (N = 17) and empowerment (N = 3) intervention, respectively, with 5, 5 and 2 participants interviewed, correspondingly. Low interest (demand) in the empowerment intervention (N = 3) and dropout rates of one-third for both fatigue and empowerment interventions were noted (adherence). Improvements in quality of life, fatigue (fatigue intervention), lifestyle (lifestyle intervention), self-efficacy, and self-management were evident among survivors who completed the fatigue and lifestyle interventions, with medium and large effect sizes observed immediately after the intervention and six months post-intervention. CONCLUSIONS Our study demonstrates the feasibility of nurse-led video coaching (REVIVER interventions) despite lower demand for the empowerment intervention and lower adherence to the fatigue and empowerment interventions. The medium and high effect sizes found for those who completed the interventions hold potential clinical significance for future studies investigating the effectiveness of the REVIVER interventions.
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Affiliation(s)
- Eline Bouwman
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Iridi Stollman
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Joyce Wilbers
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Joyce J M Claessens
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Dick Johan van Spronsen
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Annet Bongaerts
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Dionne Breij
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
| | - Nicole M A Blijlevens
- Department of Haematology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Centre, IQ Health, Kapittelweg 54 (route 160, post 160), Nijmegen, HB, 6500, the Netherlands.
| | - Jacqueline J Loonen
- Department of Haematology, Centre of Expertise for Cancer Survivorship, Radboud university medical centre, Nijmegen, the Netherlands
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Sequeira M, Pereira C, Alvarez MJ. Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level. Int J Behav Med 2023; 30:777-789. [PMID: 36352277 DOI: 10.1007/s12529-022-10140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer. METHOD PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported). RESULTS A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break. CONCLUSION Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.
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Affiliation(s)
- Margarida Sequeira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.
- CIIAS, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal.
| | - Cícero Pereira
- ICS, Instituto de Ciências Sociais da Universidade de Lisboa, Lisbon, Portugal
| | - Maria-João Alvarez
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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Martínez-Vizcaíno V, Cavero-Redondo I, Reina-Gutiérrez S, Gracia-Marco L, Gil-Cosano JJ, Bizzozero-Peroni B, Rodriguez-Artalejo F, Ubago-Guisado E. Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:726-738. [PMID: 36736726 PMCID: PMC10658325 DOI: 10.1016/j.jshs.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/22/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment. METHODS MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains. RESULTS In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires. CONCLUSION Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.
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Affiliation(s)
- Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile.
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain
| | - Luis Gracia-Marco
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18012, Spain
| | - José J Gil-Cosano
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18012, Spain
| | - Bruno Bizzozero-Peroni
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain; Higher Institute for Physical Education, Universidad de la República, Rivera 40000, Uruguay
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid 28029, Spain; Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain
| | - Esther Ubago-Guisado
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain; Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada 18011, Spain; Cancer Epidemiology Group, Instituto de Investigación Biosanitaria, Granada 18012, Spain
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Schlecht S, Neubert S, Meng K, Rabe A, Jentschke E. Changes of Symptoms of Anxiety, Depression, and Fatigue in Cancer Patients 3 Months after a Video-Based Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6933. [PMID: 37887671 PMCID: PMC10606592 DOI: 10.3390/ijerph20206933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
During the COVID-19 pandemic, social distancing restricted psycho-oncological care. Therefore, this secondary analysis examines the changes in anxiety, fear of progression, fatigue, and depression in cancer patients after a video-based eHealth intervention. We used a prospective observational design with 155 cancer patients with mixed tumor entities. Data were assessed before and after the intervention and at a three-month follow-up using self-reported questionnaires (GAD-7, FOP-Q-SF, PHQ-8, and EORTC QLQ-FA12). The eight videos included psychoeducation, Acceptance and Commitment Therapy elements, and yoga and qigong exercises. The results showed that three months after finishing the video-based intervention, participants showed significantly reduced fear of progression (d = -0.23), depression (d = -0.27), and fatigue (d = -0.24) compared to the baseline. However, there was no change in anxiety (d = -0.09). Findings indicated marginal improvements in mental distress when using video-based intervention for cancer patients for up to three months, but long-term effectiveness must be confirmed using a controlled design.
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Affiliation(s)
| | | | | | | | - Elisabeth Jentschke
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany; (S.S.); (S.N.); (K.M.); (A.R.)
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Solk P, Song J, Welch WA, Spring B, Cella D, Penedo F, Ackermann R, Courneya KS, Siddique J, Freeman H, Starikovsky J, Mishory A, Alexander J, Wolter M, Carden L, Phillips SM. Effect of the Fit2Thrive Intervention on Patient-reported Outcomes in Breast Cancer Survivors: A Randomized Full Factorial Trial. Ann Behav Med 2023; 57:765-776. [PMID: 37203237 PMCID: PMC10441864 DOI: 10.1093/abm/kaad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Moderate to vigorous physical activity (MVPA) interventions improve patient-reported outcomes (PROs) of physical and psychological health among breast cancer survivors (BCS); however, the effects of specific intervention components on PROs are unknown. PURPOSE To use the Multiphase Optimization Strategy (MOST) to examine overall effects of the Fit2Thrive MVPA promotion intervention on PROs in BCS and explore whether there are intervention component-specific effects on PROs. METHODS Physically inactive BCS [n = 269; Mage = 52.5 (SD = 9.9)] received a core intervention (Fitbit + Fit2Thrive smartphone app) and were randomly assigned to one of 32 conditions in a full factorial experiment of five components ("on" vs. "off"): (i) support calls, (ii) deluxe app, (iii) text messages, (iv) online gym, and (v) buddy. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires assessed anxiety, depression, fatigue, physical functioning, sleep disturbance and sleep-related impairment at baseline, post-intervention (12-week), and 24-week follow-up. Main effects for all components at each time point were examined using an intention to treat mixed-effects model. RESULTS All PROMIS measures except sleep disturbance significantly improved (p's < .008 for all) from baseline to 12-weeks. Effects were maintained at 24-weeks. The "on" level of each component did not result in significantly greater improvements on any PROMIS measure compared to the "off" level. CONCLUSIONS Participation in Fit2Thrive was associated with improved PROs in BCS, but improvements did not differ for "on" vs. "off" levels for any component tested. The low-resource Fit2Thrive core intervention is a potential strategy to improve PROs among BCS. Future studies should test the core in an RCT and examine various intervention component effects in BCS with clinically elevated PROs.
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Affiliation(s)
- Payton Solk
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jing Song
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Whitney A Welch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bonnie Spring
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank Penedo
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Ron Ackermann
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Juned Siddique
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hannah Freeman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia Starikovsky
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Abby Mishory
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Melanie Wolter
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lillian Carden
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Pinto BM, Dunsiger SI, DeScenza VR, Stein K. Mediators of physical activity outcomes in a peer-led intervention for breast cancer survivors. Psychooncology 2023; 32:619-627. [PMID: 36683179 DOI: 10.1002/pon.6107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Physical activity (PA) adoption can reduce treatment-related sequelae of breast cancer. Peer-led PA interventions are a promising and relatively inexpensive approach to scaling up interventions. The current study seeks to identify mediators of PA change amongst cancer survivors enrolled in a peer-led behavior change intervention. The study team partnered with the American Cancer Society's Reach to Recovery program (RTR) whose volunteers' provided information and support to breast cancer survivors. METHODS Participants were 76 survivors (mean age 55.6 years, 1.1 years since diagnosis) who were randomized to PA Plus RTR (12-week PA telephone counseling delivered by RTR volunteers) or contact control. Data was collected on PA (self-reported and objectively measured) and potential mediators (self-efficacy, exercise decisional balance [ratio of the pros/advantages to the cons/disadvantages] and social support) at baseline and 12 weeks. Using a multiple mediation approach with bootstrapped standard errors, we examined mediators of the intervention effect on PA outcomes. RESULTS Compared to control, PA Plus RTR participants had higher mean self-efficacy, lower decisional balance cons and social support at 12 weeks controlling for baseline. Higher mean self-efficacy was associated with greater minutes of self-reported PA, whereas higher decisional balance pros was associated with higher objectively measured PA at 12 weeks. There were significant indirect effects of self-efficacy on self-reported PA and decisional balance on objectively measured PA. CONCLUSIONS PA Plus RTR increased self-reported and objectively measured PA by changing theoretical constructs hypothesized to be associated with behavior change. Peers delivering a PA intervention should focus on increasing survivors' self-efficacy for exercise especially in challenging circumstances such as being on vacation, and also help to overcome disadvantages of exercise such as taking time away from family.
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Affiliation(s)
- Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Victoria R DeScenza
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Kevin Stein
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
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Kim M, Shin K, Park S. Academic Helplessness and Life Satisfaction in Korean Adolescents: The Moderated Mediation Effects of Leisure Time Physical Activity. Healthcare (Basel) 2023; 11:healthcare11030298. [PMID: 36766872 PMCID: PMC9914214 DOI: 10.3390/healthcare11030298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
This study examined whether depression mediates a relationship between academic helplessness and life satisfaction and whether the mediating effect differs depending on participation in leisure time physical activity (LTPA) from a sample of 2384 middle school students in South Korea. Identifying these factors could help in developing intervention strategies for promoting life satisfaction. Structural equation modeling analyses were employed to understand how various factors influence adolescents' life satisfaction. First, the effect of academic helplessness on life satisfaction was mediated by depression. Second, the mediating effect of depression was moderated according to participation in LTPA: the size of the negative mediating effect of depression on the relationship between academic helplessness and life satisfaction was reduced in the LTPA group compared to the non-LTPA group. The current findings suggest that encouraging engagement in physical activity may be a crucial vehicle for affecting academic helplessness, depression, and life satisfaction among early adolescents. Implications and future directions are discussed.
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Affiliation(s)
- Mihye Kim
- Institute of Sports Science, Seoul National University of Science & Technology, Seoul 01811, Republic of Korea
| | - Kyulee Shin
- Department of Sports Sciences, Seoul National University of Science & Technology, Seoul 01811, Republic of Korea
- Correspondence:
| | - Sanghyun Park
- Department of Sport for All, Korea National Open University, Seoul 03087, Republic of Korea
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Camacho Pérez E, Mayo S, Lipton JH, Chang E, De Souza L, Santa Mina D. Evaluation of a group-based exercise and relaxation rehabilitation program during hospitalization for allogeneic hematopoietic stem cell transplant. PM R 2023; 15:51-64. [PMID: 35150088 DOI: 10.1002/pmrj.12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Exercise and relaxation interventions have demonstrated benefits in allogeneic hematopoietic stem cell transplant (allo-HSCT) patients; however, little is known about the implementation enablers and barriers for inpatient rehabilitation or its impact on health outcomes. OBJECTIVE To conduct a program evaluation of group-based rehabilitation consisting of exercise and relaxation classes for allo-HSCT inpatients. DESIGN Prospective program evaluation using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. SETTING Inpatient hospital unit at a tertiary care center. PARTICIPANTS Forty-five adult patients admitted for allo-HSCT. INTERVENTIONS Standard of care rehabilitation. MAIN OUTCOME MEASURES Program attendance, safety, satisfaction, and fidelity were assessed. Exploratory effectiveness analyses were conducted via the measurement of physical, psychosocial, clinical, and health resource use outcomes at hospital admission and discharge. RESULTS Forty-seven of the 63 patients receiving allo-HSCT between November 2019 and March 2020 were consented. Data presented in this publication are from the 33 participants who completed study assessments (high attrition due to cancellation of research during the COVID-19 pandemic). Eighty-two percent of participants attended at least one class; however, 55% of the participants invited to the classes on a daily basis were not able to attend. Barriers to participation included transplant complications, isolation for infection prevention, and fatigue. There were no adverse events associated with the intervention and 82% of participants adhered to the prescribed activities. Participants reported satisfaction with the program and enjoyed the motivational support and social interaction. Between hospital admission and discharge, anxiety scores improved; however, fatigue, depression, grip strength, functional mobility, and quality of life scores declined. Physical activity volume and lower body strength were maintained. CONCLUSIONS Group-based exercise and relaxation classes seem to be feasible and safe during hospitalization for allo-HSCT; however, there are pragmatic barriers to be considered for optimal program implementation. Further research examining program effectiveness and adoption is warranted.
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Affiliation(s)
- Encarna Camacho Pérez
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Samantha Mayo
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Jeffrey H Lipton
- Department of Medical Oncology-Hematology, Princess Margaret Cancer Centre, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eugene Chang
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lyndsey De Souza
- Department of Medical Oncology-Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada
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Marker RJ, Ostendorf DM, Leach HJ, Peters JC. Cancer-related fatigue mediates the relationships between physical fitness and attendance and quality of life after participation in a clinical exercise program for survivors of cancer. Qual Life Res 2022; 31:3201-3210. [PMID: 35895163 DOI: 10.1007/s11136-022-03173-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer, negatively impacting health-related quality of life (HRQoL). Exercise improves CRF, HRQoL, and physical fitness in survivors. Prospective research trials have shown that exercise-associated fitness improvements effects on HRQoL are mediated by CRF; however, this has not been investigated in a pragmatic real-world setting. This study utilizes data from a large heterogenous population of survivors participating in a clinical exercise program to investigate this mediation effect, as well as effects of program attendance. METHODS Data were collected from 194 survivors completing the BfitBwell Cancer Exercise Program (July 2016-February 2020). Changes in HRQoL, CRF, and fitness were calculated and program attendance collected. Basic correlation analyses were performed. Linear regression analyses were performed to assess mediation by CRF. RESULTS All measures of CRF, HRQoL, and physical fitness significantly improved following the exercise program. Improvements in physical fitness were significantly correlated with improvements in HRQoL (r = 0.15-0.18), as was program attendance (r = 0.26) and CRF (r = 0.59). The effects of physical fitness and program attendance on HRQoL were at least partially mediated by the effects of CRF. CONCLUSION This study extends research findings on how exercise programs improve HRQoL in survivors of cancer to a real-world setting. Results indicate that clinical exercise programs should target reductions in CRF in survivors (during or after treatment) through improvements in physical fitness to improve HRQoL and that high attendance should be encouraged regardless of fitness changes.
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Affiliation(s)
- Ryan J Marker
- University of Colorado Anschutz Medical Campus, 12348 E Montview Blvd, MS C263, Aurora, CO, 80045, USA.
| | - Danielle M Ostendorf
- University of Colorado Anschutz Medical Campus, 12348 E Montview Blvd, MS C263, Aurora, CO, 80045, USA
| | | | - John C Peters
- University of Colorado Anschutz Medical Campus, 12348 E Montview Blvd, MS C263, Aurora, CO, 80045, USA
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Thaller L, Frühauf A, Heimbeck A, Voderholzer U, Kopp M. A Comparison of Acute Effects of Climbing Therapy with Nordic Walking for Inpatient Adults with Mental Health Disorder: A Clinical Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116767. [PMID: 35682348 PMCID: PMC9180369 DOI: 10.3390/ijerph19116767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
As climbing therapy is increasingly used for mental health disorders, the present study aimed to compare acute effects of a therapeutic climbing intervention (CT) on affective responses, anxiety, and self-efficacy with those of Nordic walking (NW) and a sedentary control condition (SC) in an inpatient setting with persons with depression, anxiety, or obsessive−compulsive disorders. A total of 21 inpatients (32 ± 12.2 years) participated in a clinical trial in all interventions using an experimental within-subject design. Anxiety and self-efficacy were assessed preintervention (t0) and postintervention (t2) using the State-Trait Anxiety Inventory and the General Self-Efficacy Scale, and affective responses were additionally evaluated during (t1) and 180 min after the intervention (t3) using the Feeling Scale, Felt Arousal Scale, and Positive and Negative Affect Schedule. Statistical evaluation was performed with a 3 × 2 or 3 × 4 repeated measures ANOVA. Significant interaction effects were found for affective responses regarding positive affect, affective valence, and perceived activation (p < 0.015) favoring CT over NW and SC. For anxiety, a significant interaction effect was found (F(2.40) = 6.603; p = 0.003; η2 = 0.248), and also perceived self-efficacy increased significantly (F(2.40) = 6.046; p = 0.005; η2 = 0.232). Single CT sessions may enhance affective responses and self-efficacy and reduce anxiety in inpatients with mental health disorders to a higher extent than NW. CT as part of an inpatient therapy program may help to improve key affective mechanisms and should be further studied in comparison with other exercise interventions with comparable intensity.
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Affiliation(s)
- Lisa Thaller
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
- Correspondence: ; Tel.: +49-151-20702742
| | - Anika Frühauf
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
| | - Alexander Heimbeck
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), 80336 Munich, Germany
| | - Martin Kopp
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
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Saito M, Hiramoto I, Yano M, Watanabe A, Kodama H. Influence of Self-Efficacy on Cancer-Related Fatigue and Health-Related Quality of Life in Young Survivors of Childhood Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031467. [PMID: 35162489 PMCID: PMC8834926 DOI: 10.3390/ijerph19031467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/10/2022]
Abstract
This study aims to elucidate how self-efficacy influences cancer-related fatigue and health-related quality of life (HRQoL) in young survivors of childhood cancer. Forty-six young survivors (age range, 8–18 years) of childhood cancer who were currently in complete remission completed measures for self-efficacy (Pediatric General Self-Efficacy Scale (PedsSE)), cancer-related fatigue (Cancer-related Fatigue Score (CRFS)), and HRQoL (Pediatric Quality of Life Inventory 4.0 Generic Core Scale, Pediatric Quality of Life Inventory (PedsQL)). Structural relationships between the PedsSE and CRFS or PedsQL, including the effects of potential demographic or clinical confounders, were examined by machine learning random forest algorithms and structural equation modeling. According to the distribution of the PedsQL, six survivors with PedsQL < 70 were determined to have compromised HRQoL (referred to as “low-PedsQL survivors”). The random forest model identified six variables for the prediction of the CRFS, with the PedsSE being the most important, and eight variables for the distinction of low-PedsQL survivors, with the CRFS being the most and the PedsSE the third most important variable. The structural equation model indicated that a direct influence of the PedsSE on the PedsQL was less detectable (β = −0.049), whereas an indirect influence of the PedsSE on the PedsQL via the CRFS was evident (β = 0.333). The model explained 51% of the variation of the CRFS and 28% of the variation of the PedsQL. The PedsSE was strongly correlated with “altered mood” in the subclass of the CRFS (r = −0.470), and “altered mood” was strongly correlated with the PedsQL (r = 0.737). In conclusion, self-efficacy is a major determinant of cancer-related fatigue and influences HRQoL via cancer-related fatigue in survivors of childhood cancer. The main pathway from self-efficacy to HRQoL is thought to be via the emotional aspect of cancer-related fatigue. However, unlike adult survivors of cancer, self-efficacy for young survivors may not contribute much to self-management behaviors that maintain HRQoL.
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Affiliation(s)
- Masayo Saito
- Department of Nursing, School of Health Science, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan; (M.S.); (I.H.)
| | - Izumi Hiramoto
- Department of Nursing, School of Health Science, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan; (M.S.); (I.H.)
| | - Michihiro Yano
- Department of Pediatrics, Akita University Hospital, Akita 010-8543, Japan;
| | - Arata Watanabe
- Department of Pediatrics, Nakadori General Hospital, Akita 010-8577, Japan;
| | - Hideya Kodama
- Department of Nursing, School of Health Science, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan; (M.S.); (I.H.)
- Correspondence: ; Tel.: +81-18-884-6513
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12
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Yoga therapy to reduce fatigue in cancer: effects of reminder e-mails and long-term efficacy. Support Care Cancer 2021; 29:7725-7735. [PMID: 34155534 PMCID: PMC8550207 DOI: 10.1007/s00520-021-06345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
Objective To examine the efficacy of reminder e-mails to continue yoga therapy on practice frequency and fatigue in cancer patients and long-term effects of yoga on fatigue, depression, and quality of life. Methodology One hundred two cancer patients who completed an 8-week yoga therapy were randomly allocated to two groups: reminder (N = 51) vs. no-reminder group (N = 51). After completing yoga therapy, the reminder group received weekly e-mails for 24 weeks, which reminded them of practicing yoga, whereas the no-reminder group did not. Primary outcomes were fatigue and practice frequency, and long-term outcomes were fatigue, depression, and quality of life. Data were assessed using questionnaires after yoga therapy (T1) and 6 months after completing yoga therapy (T2). Result A significantly stronger reduction of general (p = 0.038, d = 0.42) and emotional fatigue (p = 0.004, d = 0.59) and a higher increase of practice frequency (p = 0.015, d = 0.52) between T1 and T2 were found for the reminder group compared to the no-reminder group. In the mediation model, practice frequency as a mediator partially explained the changes in emotional fatigue (indirect effect B = − 0.10). Long-term effects of yoga therapy regarding fatigue, depression, and quality of life were found (F > 7.46, p < 0.001, d > 0.54). Conclusion Weekly reminder e-mails after yoga therapy can positively affect general and emotional fatigue and help cancer patients with fatigue establish a regular yoga practice at home. However, higher practice frequency did not lead to higher physical or cognitive fatigue improvement, suggesting other factors that mediate efficacy on physical or cognitive fatigue, such as mindfulness or side effects of therapy.
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13
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[Effect of activities profile variations on health-related quality of life among breast cancer patients: Secondary exploratory analysis from PASAPAS study data]. Bull Cancer 2020; 107:763-772. [PMID: 32416926 DOI: 10.1016/j.bulcan.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/29/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Lifestyle changes in breast cancer patients, by physical activity increasing, are becoming a main objective in supportive care. The objective of this study was to explore the impact of the daily activity profile evolution on the quality of life among this public. METHODS Sixty patients (18 to 75 years) with non-metastatic breast cancer were randomized to a 2:1 ratio (physical activity intervention; control) in the PASAPAS randomized clinical trial. Multiple linear regression analyzes were computed to explain quality of life scores 6 months after the start of adjuvant therapy. Variables retained were the baseline quality of life scores, the anxiety trait, the randomization arm, the variations of time spent in different physical activity classes ([3-4 [MET, [4-6 [MET, ≥6 MET) and in sedentary behaviors. RESULTS Only the decrease in time spent in sedentary behaviors really appeared as a predictor of the quality of physical life. Participation in the intervention group appeared as a predictor of quality of mental life. DISCUSSION Results plead in favor of sedentary life style decrease as part of the objectives of care program for women with breast cancer. It also highlights the need of collective supervised sessions implemented by competent staff. This research also suggests that the dynamics of daily activity profile variations should be studied further in association to quality of life.
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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: 17] [Impact Index Per Article: 4.3] [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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Abrahams HJG, Gielissen MFM, Braamse AMJ, Bleijenberg G, Buffart LM, Knoop H. Graded activity is an important component in cognitive behavioral therapy to reduce severe fatigue: results of a pragmatic crossover trial in cancer survivors. Acta Oncol 2019; 58:1692-1698. [PMID: 31524020 DOI: 10.1080/0284186x.2019.1659513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Fatigue is one of the most common and distressing long-term effects of cancer treatment. Cognitive behavioral therapy (CBT) is an evidence-based intervention for patients with severe post-cancer fatigue. CBT for fatigue is a complex intervention consisting of multiple elements like a graded activity program, regulation of the sleep-wake rhythm and reformulation of fatigue-related cognitions. The contribution of the separate elements to the positive effect of CBT on fatigue is unclear. The main objective of this pragmatic crossover trial was comparing the efficacy of graded activity with the other elements of CBT in reducing post-cancer fatigue.Material and methods: Severely fatigued cancer survivors were randomized to (i) graded activity followed by the other elements of CBT after crossover (n = 41), or (ii) the two components in reverse order (n = 48). Fatigue severity was measured at baseline, before crossover and after CBT (Checklist Individual Strength (CIS), Fatigue Severity subscale). Differences in effects on fatigue were examined with a linear regression analysis. Objective physical activity, perceived activity and self-efficacy were explored as mediators of the effect of graded activity.Results: Before crossover, the reduction in fatigue was significantly larger after graded activity than after the other elements (β = 4.75, 95% confidence interval (95% CI) = -9.19; -0.32). An increase in perceived activity mediated this effect (β = -4.17, 95% CI = -7.37; -1.37).Conclusions: Graded activity is an important component of CBT for post-cancer fatigue as it resulted in a larger reduction in fatigue compared with the other elements, mediated by an increased level of perceived activity. Results indicated that the other elements of CBT are of added value in reducing fatigue.
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Affiliation(s)
- H. J. G. Abrahams
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - A. M. J. Braamse
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Bleijenberg
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L. M. Buffart
- Department of Epidemiology and Biostatistics, and Medical Oncology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H. Knoop
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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McNeely ML, Sellar C, Williamson T, Shea-Budgell M, Joy AA, Lau HY, Easaw JC, Murtha AD, Vallance J, Courneya K, Mackey JR, Parliament M, Culos-Reed N. Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study. BMJ Open 2019; 9:e029975. [PMID: 31519676 PMCID: PMC6747880 DOI: 10.1136/bmjopen-2019-029975] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy, where they may deal with significant changes to their bodies, mental health or emotional well-being. Research evidence supports the benefit of exercise during and following cancer treatments for cancer-related symptoms, physical functioning and fitness, and health-related quality of life. To move this efficacy evidence into practice, we designed and launched a 5-year study to evaluate the relative benefit from implementing a clinic-to-community-based cancer and exercise model of care. METHODS AND ANALYSIS A hybrid effectiveness and implementation trial design is being used to evaluate the effectiveness of delivery of community-based exercise and to collect data on implementation of the programme. The study opened in January 2017, with estimated completion by January 2022. The programme will be delivered in seven cities across the province of Alberta, Canada, with sites including three academic institutions, six YMCA locations, Wellspring Edmonton and Calgary, and six municipal fitness centres. Participants are adult cancer survivors (n=2500) from all tumour groups and stages and at any time point along their cancer treatment trajectory, up to 3 years post treatment completion. Survivors take part in a minimum of 60 min of mild-to-moderate intensity full body exercise twice weekly for a 12-week period. The primary effectiveness outcome is the proportion of participants meeting or exceeding 150 min of moderate intensity exercise per week at 1-year follow-up. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework will be utilised to capture individual-level and organizational-level impact of the exercise programme at 12 and 24 weeks and 1-year follow-up. The cohort of survivors participating in the study will allow for long-term (>5-year) evaluation of rates of cancer recurrence and secondary cancers beyond the funding period. ETHICS AND DISSEMINATION The study was approved by the Health Research Ethics Board of Alberta. The study is funded by Alberta Innovates and the Alberta Cancer Foundation. The study will help to answer critical questions on the effectiveness of cancer-specific community-based exercise programming in both the short-term and the long-term. Collectively, the findings will help to inform the acceptability, adoption, feasibility, reach and sustainability of community-based exercise. TRIAL REGISTRATION NUMBER NCT02984163; Pre-results.
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Affiliation(s)
- Margaret L McNeely
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | | | - Melissa Shea-Budgell
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anil Abraham Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Harold Y Lau
- Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jacob C Easaw
- Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Albert D Murtha
- Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jeffrey Vallance
- Faculty of Health Disciplines, Athabasca University, Medicine Hat, Alberta, Canada
| | - Kerry Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - John R Mackey
- Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Radiation Oncology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Sweegers MG, Buffart LM, van Veldhuizen WM, Geleijn E, Verheul HMW, Brug J, Chinapaw MJM, Altenburg TM. How Does a Supervised Exercise Program Improve Quality of Life in Patients with Cancer? A Concept Mapping Study Examining Patients' Perspectives. Oncologist 2018; 24:e374-e383. [PMID: 30425179 DOI: 10.1634/theoncologist.2017-0613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 08/31/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous systematic reviews and meta-analyses demonstrated beneficial effects of exercise during or following cancer treatment on quality of life (QoL). Aiming to understand how exercise contributes to a patient's QoL, we examined patients' perspectives via a process called concept mapping. This unique method provides structure and objectivity to rich qualitative data. METHODS Patients with cancer who were participating in an exercise program were invited to enroll. Eleven meetings with 3-10 patients were organized in which patients generated ideas in response to the question "How has participating in a supervised exercise program contributed positively to your QoL?" Next, patients individually clustered (based on similarity) and rated (based on importance) the ideas online. The online assessments were combined, and one concept map was created, visualizing clusters of ideas of how patients perceive that participating in a supervised exercise program improved their QoL. The research team labelled the clusters of ideas, and physiotherapists reflected on the clusters during semistructured interviews. RESULTS Sixty patients attended the meetings; of these, one patient was not able to generate an idea in response to the statement. Forty-four patients completed the online clustering and rating of ideas. The resulting concept map yielded six clusters: personalized care, coaching by a physiotherapist, social environment, self-concept, coping, and physical fitness and health. Personalized care was rated as most important. Overall, physiotherapists recognized these clusters in practice. CONCLUSION Patients with cancer reported that participating in a supervised exercise program improved their physical fitness and influenced social, mental, and cognitive factors, resulting in improvements in QoL. These results can be used to increase the awareness of the importance of supervised exercise programs for the QoL of patients with cancer. IMPLICATIONS FOR PRACTICE According to patients, a supervised exercise program contributes positively to their quality of life by improving physical fitness and health and providing personalized care, coaching by a physiotherapist, and improved social environment, self-concept, and coping. This knowledge could help to increase physicians' and patients' awareness of the importance of an exercise program during or following cancer treatment, possibly improving referral, participation, and adherence rates to these programs. Furthermore, patients' perspectives may be used to improve supervised exercise programs, taking into account the importance of personalized care, the supervision of a physiotherapist, the social environment, self-concept, and coping.
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Affiliation(s)
- Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Wouke M van Veldhuizen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johannes Brug
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Boland L, Bennett K, Cuffe S, Gleeson N, Grant C, Kennedy J, Connolly D. Cancer survivors' experience of OptiMal, a 6-week, occupation-based, self-management intervention. Br J Occup Ther 2018. [DOI: 10.1177/0308022618804704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Lauren Boland
- PhD Candidate, Discipline of Occupational Therapy, Trinity College Dublin, Ireland
| | - Kathleen Bennett
- Associate Professor, Division of Population Health Sciences, Royal College of Surgeons in Ireland
| | - Sinead Cuffe
- Consultant Medical Oncologist, St James Hospital, Dublin, Ireland
| | - Noreen Gleeson
- Consultant Gynaecological Oncologist and Pelvic Surgeon, St James' Hospital, Dublin, Ireland
| | - Cliona Grant
- Consultant Medical Oncologist, St James Hospital, Dublin, Ireland
| | - John Kennedy
- Consultant Medical Oncologist, St James Hospital, Dublin, Ireland
| | - Deirdre Connolly
- Associate Professor, Discipline of Occupational Therapy, Trinity College Dublin, Ireland
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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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Trinh L, Strom DA, Wong JN, Courneya KS. Modality-specific exercise guidelines and quality of life in kidney cancer survivors: A cross-sectional study. Psychooncology 2018; 27:2419-2426. [PMID: 30048023 DOI: 10.1002/pon.4844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/12/2018] [Accepted: 07/15/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Few exercise oncology trials have compared aerobic with strength exercise or compared combined exercise (ie, aerobic and strength training) with aerobic only or strength only. It is unknown what single or combined exercise modality is optimal for quality of life (QoL) in cancer survivors. The purpose of this study is to estimate the prevalence of meeting the combined and independent aerobic and strength exercise guidelines in kidney cancer survivors (KCS) and determine any associations with QoL. METHODS One thousand nine hundred eighty-five KCS were identified through a provincial registry in Canada and mailed a survey including exercise and QoL scales. RESULTS Completed surveys were received from 703 KCS. Only 10.1% of KCS reported meeting the combined exercise guidelines. Analyses of covariance indicated that, for most QoL outcomes (eg, Functional Assessment of Cancer Therapy-General and Functional Assessment of Cancer Therapy-Fatigue), meeting the combined exercise guideline was superior to meeting either single modality guideline that, in turn, were superior to meeting neither guideline. For the primary outcome of the Trial Outcome Index-Fatigue, meeting the combined exercise guideline was superior to meeting (a) neither guideline (P < 0.001), (b) the strength-only guideline (P = 0.021), and (c) the aerobic-only guideline (P = 0.051). In turn, the aerobic and strength exercise only guidelines were superior to meeting neither guideline (P < 0.001 for aerobic; P = 0.045 for strength) but were not different from each other (P = 0.50). CONCLUSIONS Meeting the combined exercise guideline has favorable associations with QoL in KCS, however, very few KCS are meeting the combined guideline.
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Affiliation(s)
- Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Dominick A Strom
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Jaime N Wong
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Wolvers MDJ, Bussmann JBJ, Bruggeman-Everts FZ, Boerema ST, van de Schoot R, Vollenbroek-Hutten MMR. Physical Behavior Profiles in Chronic Cancer-Related Fatigue. Int J Behav Med 2018; 25:30-37. [PMID: 28699090 PMCID: PMC5803288 DOI: 10.1007/s12529-017-9670-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Increasing physical activity level is a generally effective intervention goal for patients who suffer from chronic cancer-related fatigue (CCRF). However, patients are unlikely to benefit equally from these interventions, as their behavioral starting points might vary substantially. Therefore, we explored patterns of physical behavior of participants who suffer from CCRF. METHODS Baseline data of a randomized controlled trial were used for a latent profile analysis on nine accelerometer-derived physical behavior measures, describing levels and patterns of physical activity, moderate-to-vigorous intensity physical activity (MVPA), and sedentary behavior. The relation between participant characteristics and the latent profiles was analyzed. RESULTS Accelerometer data of 172 participants from the Netherlands was analyzed. Three latent profiles were distinguished that differed most on physical activity level and total time spent in MVPA. Eighty-eight percent of all participants were assigned to a profile with a probability higher than 8. Age and perceiving limitations by comorbid conditions and pain were significant covariates of profile membership. CONCLUSIONS We distinguished three physical behavior profiles. The differences between the patterns indicate that the heterogeneity of this sample requires patients to have substantially different treatment goals. Further research should test the applicability of these profiles in clinical practice.
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Affiliation(s)
- M D J Wolvers
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands.
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - F Z Bruggeman-Everts
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
- Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands
| | - S T Boerema
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - R van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - M M R Vollenbroek-Hutten
- Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
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Diet and exercise interventions for pediatric cancer patients during therapy: tipping the scales for better outcomes. Pediatr Res 2018; 83:50-56. [PMID: 29068433 PMCID: PMC5865395 DOI: 10.1038/pr.2017.225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022]
Abstract
Obesity at diagnosis is a negative prognostic indicator for several pediatric cancers including acute leukemia and bone tumors. Incidence of obesity in children has increased three-fold over the past 2 decades, and causes for this include poor diet, excessive caloric intake, and lack of physical activity, which are collectively referred to as energy balance-related behaviors. Few energy balance interventions have been implemented in pediatric cancer patients during treatment, and here we will probe the rationale for pursuing such studies. The need to modify composition of calories consumed and to identify specific beneficial exercise regimens will be discussed, relative to weight reduction or management.
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Self-management interventions for cancer survivors: a systematic review. Support Care Cancer 2017; 26:1585-1595. [PMID: 29199362 DOI: 10.1007/s00520-017-3999-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/24/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Many cancer survivors experience problems with persisting symptoms such as pain, fatigue, anxiety and depression post-treatment. Self-management interventions are recommended for cancer patients as they can help individuals identify and manage these continuing symptoms. This systematic review examines the type, content and impact of self-management interventions for cancer survivors on health outcomes such as activity participation, self-efficacy, quality of life and symptom management. METHODS This was a systematic review of the English language scientific literature searched for randomised controlled trials (RCT), systematic reviews and meta-analyses of self-management programmes conducted with cancer survivors. Six databases were systematically searched. RESULTS Initial searches yielded 2633 citations. Following screening and a risk of bias assessment, six studies were included in the final review. Heterogeneity of the interventions precluded meta-analysis. Three studies reported significant differences between groups in a number of areas including fatigue, physical functioning, distress and self-efficacy at their first follow-up assessment. These studies included two psychosocial interventions and one exercise and diet intervention. Not all findings were sustained across studies at follow-up assessment. CONCLUSION It is not possible to draw definitive conclusions as to the impact the different types of self-management programme had on cancer survivors. The sustainability of the interventions reviewed was poor, suggesting that cancer survivors require interventions that can be applied into their daily activities.
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White L, Cohen M, Berger A, Kupzyk K, Swore-Fletcher B, Bierman P. Perceived Self-Efficacy: A Concept Analysis for Symptom Management in Patients With Cancer. Clin J Oncol Nurs 2017; 21:E272-E279. [DOI: 10.1188/17.cjon.e272-e279] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chen HL, Liu K, You QS. Effects of couple based coping intervention on self-efficacy and quality of life in patients with resected lung cancer. PATIENT EDUCATION AND COUNSELING 2017; 100:2297-2302. [PMID: 28693921 DOI: 10.1016/j.pec.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We aimed to assess the couple based coping intervention (CBCI) for self-efficacy and quality of life in patients with resected lung cancer, compared with individual coping intervention (ICI). METHODS From October to December 2015, 132 consecutive patients with resected lung cancer who were married/lived in a stable relationship were randomly assigned to the ICI group and the CBCI group. RESULTS The CBCI group had higher GSES compared with the ICI group at 2 month after operation, and at 6 month after operation (P<0.05). The CBCI group had higher VT, SF, RE, and MH score of SF-36 compared with the ICI group at 2 month after operation, and at 6 month after operation (P<0.05), but no significant differences were found in RP, PF, BP, and GH score of SF-36 compared between two groups (P>0.05) in these 2 time points. CONCLUSION Couple based coping intervention is more effective than individual coping intervention for improving the self-efficacy and the quality of life in patients with resected lung cancer. PRACTICE IMPLICATIONS Practitioners might like to consider using couple based coping intervention strategy to improve self-efficacy and quality of life in patients with resected lung cancer.
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Affiliation(s)
- Hong-Lin Chen
- School of Nursing, Nantong University, Nantong City, Jiangsu Province, PR China
| | - Kun Liu
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China.
| | - Qing-Sheng You
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
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Kuhlman KR, Boyle CC, Irwin MR, Ganz PA, Crespi CM, Asher A, Petersen L, Bower JE. Childhood maltreatment, psychological resources, and depressive symptoms in women with breast cancer. CHILD ABUSE & NEGLECT 2017; 72:360-369. [PMID: 28888809 PMCID: PMC5659876 DOI: 10.1016/j.chiabu.2017.08.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 05/03/2023]
Abstract
Childhood maltreatment is associated with elevated risk for depression across the human lifespan. Identifying the pathways through which childhood maltreatment relates to depressive symptoms may elucidate intervention targets that have the potential to reduce the lifelong negative health sequelae of maltreatment exposure. In this cross-sectional study, 271 women with early-stage breast cancer were assessed after their diagnosis but before the start of adjuvant treatment (chemotherapy, radiation, endocrine therapy). Participants completed measures of childhood maltreatment exposure, psychological resources (optimism, mastery, self-esteem, mindfulness), and depressive symptoms. Using multiple mediation analyses, we examined which psychological resources uniquely mediated the relationship between childhood maltreatment and depressive symptoms. Exposure to maltreatment during childhood was robustly associated with lower psychological resources and elevated depressive symptoms. Further, lower optimism and mindfulness mediated the association between childhood maltreatment and elevated depressive symptoms. These results support existing theory that childhood maltreatment is associated with lower psychological resources, which partially explains elevated depressive symptoms in a sample of women facing breast cancer diagnosis and treatment. These findings warrant replication in populations facing other major life events and highlight the need for additional studies examining childhood maltreatment as a moderator of treatment outcomes.
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Affiliation(s)
- Kate Ryan Kuhlman
- Department of Psychology & Social Behavior, University of California Irvine, Irvine, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - Chloe C Boyle
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Arash Asher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Julienne E Bower
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
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Kalter J, Kampshoff CS, Chinapaw MJM, VAN Mechelen W, Galindo-Garre F, Schep G, Verdonck-DE Leeuw IM, Brug J, Buffart LM. Mediators of Exercise Effects on HRQoL in Cancer Survivors after Chemotherapy. Med Sci Sports Exerc 2017; 48:1859-65. [PMID: 27128668 DOI: 10.1249/mss.0000000000000976] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We investigated the hypothesis that combined resistance and endurance exercise improves cardiorespiratory fitness and muscle strength, thereby reducing fatigue and improving global quality of life (QoL) and physical function among cancer survivors who completed curative treatment including chemotherapy. METHODS Cancer survivors were assigned to a 12-wk exercise intervention (n = 186) or a wait list control group (n = 91). Data were collected at baseline and after 12 wk. Path analyses using follow-up values adjusted for baseline values, age, and gender were conducted to test if the exercise effects on global QoL and physical function (European Organization Research and Treatment of Cancer Quality of Life questionnaire-Core 30) were mediated by changes in cardiorespiratory fitness (peak V˙O2), hand-grip strength, lower body muscle function (30-s chair stand test), and fatigue (Multidimensional Fatigue Inventory). RESULTS Compared with the wait list control, exercise increased cardiorespiratory fitness (β = 1.8; 95% confidence interval (CI), 1.0-2.6 mL·kg·min) and reduced general (β = -1.0; 95% CI, -1.8 to -0.2) and physical fatigue (β = -1.5; 95% CI, -2.3 to -0.6). The exercise effect on physical fatigue was mediated by change in cardiorespiratory fitness (β = -0.2; 95% CI, -0.4 to -0.1). Higher hand-grip strength was significantly associated with lower physical fatigue and better lower body muscle function with lower physical and general fatigue. Lower general fatigue and physical fatigue were significantly associated with higher global QoL (β = -1.6; 95% CI, -2.2 to -1.1; and β = -1.7; 95% CI, -2.3 to -1.1, respectively) and physical function (β = -1.0; 95% CI, -1.3 to -0.7; and β = -1.2; 95% CI, -1.6 to -0.9, respectively). The models explained 44%-61% of the variance in global QoL and physical function. CONCLUSION Beneficial effects of exercise on global QoL and physical function in cancer survivors were mediated by increased cardiorespiratory fitness and subsequent reductions in fatigue.
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Affiliation(s)
- Joeri Kalter
- 1Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, THE NETHERLANDS; 2Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, THE NETHERLANDS; 3Department of Sports Medicine, Máxima Medical Center, Veldhoven, THE NETHERLANDS; 4Department of Clinical Psychology, VU University, Amsterdam, THE NETHERLANDS; and 5Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, THE NETHERLANDS
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Esser P, Kuba K, Götze H, Mehnert A. Long-term effects and psychological adjustment: study protocol of a large register-based study on quality of life among survivors of hematological malignancies. BMC Cancer 2017; 17:482. [PMID: 28701154 PMCID: PMC5508694 DOI: 10.1186/s12885-017-3454-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/26/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Both incidence and survival rates of hematological cancers are increasing, leading to a growing number of survivors with specific late and long-term effects. However, relevant research in physical, psychological and social aspects of quality of life is scarce. Existing literature shows that a considerable number of cancer survivors report a relatively high quality of life despite a variety of adverse and persistent symptoms. To date, the reasons for this phenomenon as well as moderating and mediating factors are widely unknown. Given these research gaps, we aim to investigate the different domains of quality of life among long-term survivors of hematological cancers and to identify factors predicting high quality of life. METHODS/DESIGN This is a large cross-sectional study among hematological cancer survivors at a minimum of 3 years after diagnosis. We will collect 1000 survivors completing a set of self-report-questionnaires encompassing physical, psychological and social domains of quality of life. Participants are clustered in groups according to time since diagnosis and compared with each other. Furthermore, survivors will be compared with the general population. Factors predicting high quality of life will be identified via multiple regression analyses and structure equation modeling. DISCUSSION Our study will help to inform health care providers about the specific long-term burden among survivors with hematological malignancies. Identification of factors predicting high quality of life will help to develop adequate intervention strategies to enhance well-being in hematological cancer survivors. Our methodological advantages including the large sample as well as the assessment of different domains of quality of life will ensure novel and robust results. A limitation of the study is the cross-sectional design.
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Affiliation(s)
- Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Heide Götze
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
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Esser P, Kuba K, Mehnert A, Schwinn A, Schirmer L, Schulz-Kindermann F, Kruse M, Koch U, Zander AR, Kröger N, Schilling G, Götze H, Scherwath A. Investigating the temporal course, relevance and risk factors of fatigue over 5 years: a prospective study among patients receiving allogeneic HSCT. Bone Marrow Transplant 2017; 52:753-758. [DOI: 10.1038/bmt.2016.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/28/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023]
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Evaluation of effectiveness of survivorship programmes: how to measure success? Lancet Oncol 2017; 18:e51-e59. [DOI: 10.1016/s1470-2045(16)30563-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022]
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31
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Tran H, Lin C, Yu F, Frederick A, Mieras M, Baccaglini L. A multicenter study on the relative effectiveness of a 12-week physical training program for adults with an oncologic diagnosis. Support Care Cancer 2016; 24:3705-13. [PMID: 27037811 DOI: 10.1007/s00520-016-3194-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 03/28/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of this study was to examine the association between cancer survivors' socio-demographic and clinical characteristics and aerobic fitness changes following a physical training program. METHODS We assessed the association between participant's characteristics and aerobic fitness in the six-min walk test (6MWT) after a 12-week LIVESTRONG® at Young Men's Christian Association (YMCA) exercise program for adults with an oncologic diagnosis using linear mixed effects models. RESULTS Fifty-one percent of participants had a breast cancer diagnosis and 22 % had received treatment within 1 year of enrollment. At baseline, participants who reported good/excellent health status performed better in the 6MWT than those who reported poor/fair health status (384.2 vs. 345.0 m, p = 0.035). After 12 weeks, all participants increased their average 6MWT performance by 54.2 m. After adjustment for age, gender, physical activity level, and smoking status, participants who were 60 years old or younger had a greater increase in the 6MWT score than participants older than 60 years (63.2 vs. 43.9 m, p = 0.041) while those who had never been YMCA members had a greater increase in the 6MWT compared to those who had ever been a YMCA member (62.2 vs. 40.3 m, p = 0.041). CONCLUSION Overall, aerobic fitness among adults with an oncologic diagnosis increased after a 12-week exercise program, particularly among participants who were 60 years old or younger or were not YMCA members at enrollment. Participants with poorer health had lower aerobic fitness at baseline, though they had a similar positive response to the program as healthier participants. Future study designs may include randomization and an additional untreated arm.
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Affiliation(s)
- Hoang Tran
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cheng Lin
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fang Yu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Lorena Baccaglini
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
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Wolvers MD, Bruggeman-Everts FZ, Van der Lee ML, Van de Schoot R, Vollenbroek-Hutten MM. Effectiveness, Mediators, and Effect Predictors of Internet Interventions for Chronic Cancer-Related Fatigue: The Design and an Analysis Plan of a 3-Armed Randomized Controlled Trial. JMIR Res Protoc 2015; 4:e77. [PMID: 26104114 PMCID: PMC4526958 DOI: 10.2196/resprot.4363] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/13/2022] Open
Abstract
Background Internet interventions offer advantages that especially cancer survivors who suffer from fatigue could benefit from. Given the growing number of such patients, Internet interventions could supplement and strengthen currently available health care. Objective This paper describes the design and analysis plan that will be used to study 2 Internet interventions aimed at reducing severe fatigue in cancer survivors: a mobile ambulant activity feedback therapy supported through a weekly email by a physiotherapist and a weekly Web- and mindfulness-based cognitive therapy supported online by a psychologist. The data resulting from this trial will be used to (1) investigate the effectiveness, (2) investigate potential mediators of these interventions, and (3) explore participant characteristics that can predict the effect of these interventions. Methods A 3-armed randomized controlled trial is proposed that compares both Internet interventions with an active control condition that solely consists of receiving psycho-educational emails. The intervention period is 9 weeks for all 3 conditions. Six months after baseline, participants in the control condition can choose to follow 1 of the 2 experimental Internet interventions. Outcomes are measured in terms of fatigue severity, mental health, and self-perceived work ability. All are Web-assessed at baseline, 2 weeks after the intervention period, and at 6 and 12 months after baseline. Fatigue severity, mindfulness, physical activity, expectations and credibility of the intervention, therapeutic working alliance, sleep quality, and sense of control over fatigue are assessed 3 times during the intervention period for identifying mediators of the interventions. Recruitment is performed nationally throughout the Netherlands through patient organizations and their websites, newspapers, and by informing various types of health professionals. All participants register at an open-access website. We aim at including 330 cancer survivors who have finished curative-intent cancer treatment at least 3 months previously, and have been suffering from severe fatigue ever since. All cancer types are included. A detailed analysis plan is described to address the research questions, which allows for individual variation, and fully exploits the longitudinal design. Results Recruitment started in April 2013 and will proceed until April 2015. Conclusions This paper describes a systematic trial design for studying 2 different interventions for chronic cancer-related fatigue in order to gain insight into the effectiveness and mediators of the interventions. This design will also be used to identify predictors for the interventions’ effect on fatigue. By publishing our hypotheses and analysis plan before completion of data collection, this paper is a first step in reporting on this trial comprehensively. Trial Registration The Netherlands National Trial Register (NTR3483). (Archived by WebCite at http://www.webcitation.org/6NWZqon3o).
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Affiliation(s)
- Marije Dj Wolvers
- Roessingh Research and Development, Telemedicine Group, Enschede, Netherlands.
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Travier N, Velthuis MJ, Steins Bisschop CN, van den Buijs B, Monninkhof EM, Backx F, Los M, Erdkamp F, Bloemendal HJ, Rodenhuis C, de Roos MAJ, Verhaar M, ten Bokkel Huinink D, van der Wall E, Peeters PHM, May AM. Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial. BMC Med 2015; 13:121. [PMID: 26050790 PMCID: PMC4461906 DOI: 10.1186/s12916-015-0362-z] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/08/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Exercise started shortly after breast cancer diagnosis might prevent or diminish fatigue complaints. The Physical Activity during Cancer Treatment (PACT) study was designed to primarily examine the effects of an 18-week exercise intervention, offered in the daily clinical practice setting and starting within 6 weeks after diagnosis, on preventing an increase in fatigue. METHODS This multi-centre controlled trial randomly assigned 204 breast cancer patients to usual care (n = 102) or supervised aerobic and resistance exercise (n = 102). By design, all patients received chemotherapy between baseline and 18 weeks. Fatigue (i.e., primary outcome at 18 weeks), quality of life, anxiety, depression, and physical fitness were measured at 18 and 36 weeks. RESULTS Intention-to-treat mixed linear model analyses showed that physical fatigue increased significantly less during cancer treatment in the intervention group compared to control (mean between-group differences at 18 weeks: -1.3; 95 % CI -2.5 to -0.1; effect size -0.30). Results for general fatigue were comparable but did not reach statistical significance (-1.0, 95%CI -2.1; 0.1; effect size -0.23). At 18 weeks, submaximal cardiorespiratory fitness and several muscle strength tests (leg extension and flexion) were significantly higher in the intervention group compared to control, whereas peak oxygen uptake did not differ between groups. At 36 weeks these differences were no longer statistically significant. Quality of life outcomes favoured the exercise group but were not significantly different between groups. CONCLUSIONS A supervised 18-week exercise programme offered early in routine care during adjuvant breast cancer treatment showed positive effects on physical fatigue, submaximal cardiorespiratory fitness, and muscle strength. Exercise early during treatment of breast cancer can be recommended. At 36 weeks, these effects were no longer statistically significant. This might have been caused by the control participants' high physical activity levels during follow-up. TRIAL REGISTRATION Current Controlled Trials ISRCTN43801571, Dutch Trial Register NTR2138. Trial registered on December 9th, 2009.
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Affiliation(s)
- Noémie Travier
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands. .,Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, 08907, Spain. .,Department of Clinical Sciences, University of Barcelona, Barcelona, 08907, Spain.
| | - Miranda J Velthuis
- Comprehensive Cancer Organisation (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands.
| | - Charlotte N Steins Bisschop
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.
| | - Bram van den Buijs
- Department of Rehabilitation, Nursing Sciences and Sport, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands.
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.
| | - Frank Backx
- Department of Rehabilitation, Nursing Sciences and Sport, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands.
| | - Maartje Los
- Medical Oncology, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - Frans Erdkamp
- Internal Medicine - Medical Oncology, Obis Medisch Centrum, Dr vander Hoffplein 1, 6166 BG, Sittard-Geleen, The Netherlands.
| | - Haiko J Bloemendal
- Department of Internal Medicine, Medical Center, Maatweg 3, 3818 TZ, Amersfoort, The Netherlands.
| | - Carla Rodenhuis
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CG, Utrecht, The Netherlands.
| | - Marnix A J de Roos
- Department of Surgery, Ziekenhuis Rivierenland, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands.
| | - Marlies Verhaar
- Department of internal medicine, Hofpoort Ziekenhuis, Polanerbaan 2, 3447 GN, Woerden, The Netherlands.
| | | | - Elsken van der Wall
- Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, STR 6.131, 3508 GA, Utrecht, The Netherlands.
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Buffart LM, Newton RU, Chinapaw MJ, Taaffe DR, Spry NA, Denham JW, Joseph DJ, Lamb DS, Brug J, Galvão DA. The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long-term survivors of prostate cancer. Cancer 2015; 121:2821-30. [PMID: 25891302 DOI: 10.1002/cncr.29406] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/20/2015] [Accepted: 03/20/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The current study examined effects, moderators (for whom), and mediators (working mechanisms) of 12 months of exercise on health-related quality of life (HRQoL) in older long-term survivors of prostate cancer. METHODS In total, 100 men aged 71.7 years (standard deviation, 6.4 years) were randomly assigned to 6 months of supervised aerobic and resistance exercise followed by 6 months of a home-based exercise maintenance program (EX group) or printed education material regarding physical activity for 12 months (PA group). Assessments took place at baseline and after 6 and 12 months. Generalized estimating equations were used to study the effects of EX versus PA on HRQoL at 6 and 12 months, adjusting for baseline HRQoL. The authors examined potential sociodemographic and clinical moderators by adding interaction terms, and potential physical and psychological mediators using the product-of-coefficients test. RESULTS At 6 months, significant beneficial effects were found for global QoL, physical function, and social function in the EX group compared with the PA group. For physical function, beneficial effects were sustained at 12 months. Moderation analyses demonstrated larger effects of EX versus PA for patients who were married, started exercising sooner after their diagnosis, and previously used bisphosphonates. Changes in lower body functional performance significantly mediated the effect of EX on global QoL, physical function, and social function. No mediating effects on HRQoL were found for aerobic fitness, physical activity, fatigue, distress, or falls self-efficacy. CONCLUSIONS Aerobic and resistance exercise appears to have beneficial effects on HRQoL among older, long-term survivors of prostate cancer. Effects were moderated by marital status, time since diagnosis, and use of bisphosphonates, and were mediated by lower body functional performance.
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Affiliation(s)
- Laurien M Buffart
- Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Robert U Newton
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mai J Chinapaw
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Dennis R Taaffe
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nigel A Spry
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Faculty of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Newcastle Mater Hospital, Newcastle, New South Wales, Australia
| | - David J Joseph
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - David S Lamb
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Daniel A Galvão
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
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Kalter J, Buffart LM, Korstjens I, van Weert E, Brug J, Verdonck-de Leeuw IM, Mesters I, van den Borne B, Hoekstra-Weebers JEHM, Ros WJG, May AM. Moderators of the effects of group-based physical exercise on cancer survivors' quality of life. Support Care Cancer 2015; 23:2623-31. [PMID: 25680762 PMCID: PMC4519631 DOI: 10.1007/s00520-015-2622-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/22/2015] [Indexed: 01/23/2023]
Abstract
Purpose This study explored demographic, clinical, and psychological moderators of the effect of a group-based physical exercise intervention on global quality of life (QoL) among cancer survivors who completed treatment. Methods Cancer survivors were assigned to a 12-week physical exercise (n = 147) or a wait-list control group (n = 62). The main outcome measure was global QoL, assessed with the EORTC QLQ-C30 at baseline and 12 weeks later. Potential moderators were age, gender, education level, marital status, employment status, type of treatment, time since treatment, the presence of comorbidities, fatigue, general self-efficacy, depression, and anxiety. Linear regression analyses were used to test effect modification of the intervention by each moderator variable using interaction tests (p ≤ 0.10). Results The physical exercise intervention effect on global QoL was larger for cancer survivors who received radiotherapy (β = 10.3, 95 % confidence interval (CI) = 4.4; 16.2) than for cancer survivors who did not receive radiotherapy (β = 1.8, 95 % CI = −5.9; 9.5, pinteraction = 0.10), larger for cancer survivors who received a combination of chemoradiotherapy (β = 13.0, 95 % CI = 6.0; 20.1) than for those who did not receive this combination of treatments (β = 2.5, 95 % CI = −3.7; 8.7, pinteraction = 0.02), and larger for cancer survivors with higher baseline levels of fatigue (β = 12.6, 95 % CI = 5.7; 19.6) than for those with lower levels (β = 2.4, 95 % CI = −3.9; 8.7, pinteraction = 0.03). No other moderating effects were found. Conclusions This study suggests that cancer treatment modality and baseline fatigue levels moderate the effect of a physical exercise program on cancer survivors’global QoL.
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Affiliation(s)
- Joeri Kalter
- EMGO+ Institute, Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Vardar Yağlı N, Şener G, Arıkan H, Sağlam M, İnal İnce D, Savcı S, Çalık Kutukcu E, Altundağ K, Kaya EB, Kutluk T, Özışık Y. Do Yoga and Aerobic Exercise Training Have Impact on Functional Capacity, Fatigue, Peripheral Muscle Strength, and Quality of Life in Breast Cancer Survivors? Integr Cancer Ther 2015; 14:125-32. [DOI: 10.1177/1534735414565699] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim. The aim of the study was to compare the effects of aerobic exercise training and yoga on the functional capacity, peripheral muscle strength, quality of life (QOL), and fatigue in breast cancer survivors. Material and methods. A total of 52 patients with a diagnosis of breast cancer were included in the study. The patients were randomly assigned to 2 groups: aerobic exercise (n = 28) and yoga added to aerobic exercise (n = 24). Both groups participated in submaximal exercise 30 minutes/d, 3 d/wk for 6 weeks. The second group participated in a 1-hour yoga program in addition to aerobic exercise training. Functional capacity was assessed by the 6-Minute Walk Test (6MWT). Peripheral muscle strength was evaluated with a hand-held dynamometer. The fatigue severity level was assessed with the Fatigue Severity Scale (FSS). The QOL was determined by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. Results. There were statistically significant increases in peripheral muscle strength, the 6MWT distance, and the perception of QOL in both groups ( P < .05). Additionally, the group with aerobic exercise and yoga showed marked improvement compared with the aerobic exercise group in fatigue perception ( P < .05). Conclusion. According to the data from this study, aerobic exercise training and yoga improved the functional capacity and QOL of breast cancer patients. Aerobic exercise programs can be supported by body mind techniques, such as yoga, in the rehabilitation of cancer patients for improving functional recovery and psychosocial wellness.
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Affiliation(s)
- Naciye Vardar Yağlı
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabiltation, Ankara, Turkey
| | - Gül Şener
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabiltation, Ankara, Turkey
| | - Hülya Arıkan
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabiltation, Ankara, Turkey
| | - Melda Sağlam
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabiltation, Ankara, Turkey
| | - Deniz İnal İnce
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabiltation, Ankara, Turkey
| | - Sema Savcı
- Dokuz Eylul University, Department of Physiotherapy and Rehabilitation, İzmir, Turkey
| | - Ebru Çalık Kutukcu
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabiltation, Ankara, Turkey
| | - Kadri Altundağ
- Hacettepe University, Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Ergun Barış Kaya
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Tezer Kutluk
- Hacettepe University, Faculty of Medicine, Department of Pediatric Oncology, Ankara, Turkey
| | - Yavuz Özışık
- Hacettepe University, Faculty of Medicine, Department of Medical Oncology, Ankara, Turkey
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Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K. Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: A randomized controlled trial. Int J Cancer 2014; 137:471-80. [DOI: 10.1002/ijc.29383] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/24/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Martina E. Schmidt
- Division of Preventive Oncology; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Joachim Wiskemann
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) and University Hospital Heidelberg; Heidelberg Germany
| | - Petra Armbrust
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) and University Hospital Heidelberg; Heidelberg Germany
| | - Andreas Schneeweiss
- Division of Medical Oncology; National Center for Tumor Diseases (NCT) and University Hospital Heidelberg; Heidelberg Germany
| | - Cornelia M. Ulrich
- Division of Preventive Oncology; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Karen Steindorf
- Division of Preventive Oncology; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ); Heidelberg Germany
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Physical Activity After Breast Cancer: Effect on Survival and Patient-Reported Outcomes. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-014-0147-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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