A randomised controlled trial investigating the ability for supervised exercise to reduce treatment-related decline in adolescent and young adult cancer patients

The effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, and health-related quality of life in adults with malignant lymphoma undergoing chemotherapy: a systematic review of randomized controlled trials

PURPOSE

This study aims to identify and summarize evidence on the effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, health-related quality of life (HRQoL), feasibility of the interventions, in patients with malignant lymphoma undergoing chemotherapy.

METHODS

A systematic search was conducted in six electronic databases and trials registers on November 15, 2023. Peer-reviewed randomized controlled trials (RCTs) comparing exercise intervention with controls/usual care in adults (≥18 years) diagnosed with Hodgkin's lymphoma and non-Hodgkin's lymphoma undergoing chemotherapy were considered for inclusion. All study authors were contacted to obtain unpublished subgroup data. Two reviewers independently screened and extracted data and assessed the quality of evidence using the revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Six RCTs published between 2009 and 2021, with 838 participants, were included. Due to clinical heterogeneity, a meta-analysis was not feasible, therefore the results were synthesized narratively. Exercise interventions during treatment were found to be feasible with few adverse events reported. The included studies indicate positive effects of exercise during chemotherapy on muscle mass, muscle strength, functional performance, aerobic capacity, and HRQoL compared to usual care.

INTERPRETATION

Despite extensive search criteria, a limited number of heterogenous studies were eligible, which may explain the very low certainty of evidence for all outcomes. Nonetheless, exercise-based interventions conducted during treatment were feasible, safe and potentially effective. Further studies are needed to guide future exercise recommendations for these patients.

Fitness, Body Composition, and Health Behaviors in Long-Term Survivors of Adolescent and Young Adult Cancers

Purpose: To investigate cardiorespiratory fitness (CRF), body composition, health behaviors, and health-related quality of life (HRQoL) in adolescent and young adult cancer survivors (AYA-CS) compared with age-matched counterparts without a cancer diagnosis. Methods: This cross-sectional study recruited participants aged 15-25 years at the time of their cancer diagnosis and ≥ 5 years post-treatment. Participants completed cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, food diaries, physical activity (PA), fatigue, and HRQoL questionnaires. Results: We recruited 22 participants aged 27.9 (standard deviation [SD] 3.3) years (54.5% female) and 7.2 (SD 2.2) years post-treatment. AYA-CS had lower CRF compared with age-matched norms (female 27.1 vs. 39.1 mL/kg/min, p ≤ 0.0001; male: 39.7 vs. 45.6 mL/kg/min, p = 0.04). Bone mineral density Z-scores were all within normal ranges; however, male AYA-CS had higher body fat percentage (male: 27.1% vs. 21.2%, p = 0.01) and a trend toward higher body fat percentage in female AYA-CS (32.2% vs. 29.8%, p = 03). AYA-CS had lower HRQoL, with no difference observed with fatigue. A higher proportion of AYA-CS met recommendations for weekly PA (36.4% vs. 27.3%, p = 0.34) and daily servings of fruit and vegetables (13.6% vs. 3.9%, p = 0.02) compared with normative data, demonstrating better health behaviors. A higher proportion of AYA-CS reported one or more chronic diseases compared with Australian normative data (63.7% vs. 41.5%, p = 0.04). Conclusions: AYA-CS exhibit significantly lower CRF and unfavorable body composition to age-matched counterparts. These health outcomes may adversely impact everyday functional performance and increase the risk of multimorbidity development. Interventions are needed to address these issues to improve health outcomes in AYA-CS.

Current evidence of integrative oncology modalities for managing adverse effects and survivorship issues among adolescents and young adult (AYA) cancer patients and survivors

PURPOSE OF REVIEW

Symptom burden of cancer diagnosis and treatment has led adolescents and young adult cancer patients (AYAC) and survivors to seek different self-management strategies including integrative oncology (IO) modalities. IO holds great promise to improve survivorship issues in adolescents and young adult (AYA) cancer survivors. This review aims to encompass the current evidence of IO modalities and to analyze the efficacy of IO for managing survivorship issues among AYA cancer patients and survivors.

RECENT FINDINGS

Nineteen randomized controlled trials included in this review evaluated mind and body modalities including both physical and psychological (74%) and psychological only (26%) modalities. Most assessed IO modalities were physical activity (PA) (37%) and structured exercise (10%). Most effective IO modalities found were PA, massage, mindfulness-based stress reduction (MBSR) and light therapy for treating AYA symptom burden. The Cochrane risk of bias (RoB-2) concluded 21% studies had high risk, 58% possessed some concerns and 21% had low risk.

SUMMARY

Although evidence has shown that a number of IO modalities may improve survivorship among AYA cancer survivors, more rigorous study designs are needed in order for these modalities to be routinely recommended for use in clinical practice.

Physical Activity Intervention Characteristics and Effects on Behavioral and Health-Related Outcomes Among Adolescents and Young Adults Living with and Beyond Cancer: A Systematic Review

Participation in physical activity (PA) during and after cancer treatment is safe and beneficial in the adolescent and young adult (AYA) cancer population. PA can positively impact health-related outcomes; however, participation remains low. This systematic review aims to describe PA intervention characteristics and outcomes in AYA survivors of cancer (AYASCa). This review followed Preferred Reporting Index for Systematic Reviews and Meta Analyses (PRISMA) guidelines and was registered with Prospero (CRD42022365661). PubMed, CINAHL, and Scopus databases were searched for randomized control trials (RCTs) and pre/post-test studies without a control group through December 31, 2022. Data included: participant demographics, PA intervention characteristics, and health-related outcomes. Studies were assessed using the National Institute of Health Critical Appraisal Tools, and findings were synthesized to identify common characteristics of PA interventions and outcomes. Twenty-three studies were included: 15 RCTs and 8 pre/post-test studies. Heterogeneity existed across design, sample demographics, intervention timing, and observed outcomes. The most common characteristics of PA interventions were supervision of PA, wearable device use, tailored/individualized PA prescriptions, and goal setting. PA interventions positively affected health-related outcomes, with 21 studies reporting statistically significant findings. Implementing personalized PA prescriptions, utilizing wearable devices, and incorporating goal setting as characteristics in PA interventions hold potential benefits for AYASCa, leading to improved outcomes. Still, additional research is needed to explore interventions that utilize these PA characteristics and determine which ones are most effective for AYASCa. By further investigating and identifying optimal PA characteristics, interventions can be better tailored to meet this population's specific needs and preferences, ultimately enhancing their overall well-being and recovery.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention in adolescent and young adult (AYA) cancer survivors: results from the SURVAYA study

PURPOSE

For adolescent and young adult (AYA) cancer survivors with a good prognosis, having a healthy lifestyle prevents morbidity and mortality after treatment. The aim of this study was to investigate the prevalence of (un)healthy lifestyle behaviors and related determinants in AYA cancer survivors.

METHODS

A population-based, cross-sectional study was performed among long-term (5-20 years) AYA cancer survivors (18-39 years old at diagnosis) registered within the Netherlands Cancer Registry. Self-reported questionnaires data about health behaviors were used to calculate the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) adherence score. Associations between the score and clinical/sociodemographic determinants of (un)healthy behaviors were investigated using logistic regression models.

RESULTS

The mean WCRF/AICR score was low to moderate, 3.8 ± 1.2 (0.5-7.0) (n = 3668). Sixty-one percent adhered to "limit the consumption of sugar sweetened drinks," 28% to "be a healthy weight," 25% to "fruit and vegetable consumption," and 31% to "limit alcohol consumption." Moderate and high adherence were associated with being a woman (ORmoderate = 1.46, 95% CI = 1.14-1.85, and ORhigh = 1.87, 95% CI = 1.46-2.4) and highly educated (ORmoderate = 1.54, 95% CI = 1.30-1.83, and ORhigh = 1.87, 95% CI = 1.46-2.4). Low adherence was associated with smoking (ORmoderate = 0.68, 95% CI = 0.50-0.92, and ORhigh = 0.30, 95% CI = 0.21-0.44) and diagnosis of germ cell tumor (ORmoderate = 0.58, 95% CI = 0.39-0.86, and ORhigh = 0.45, 95% CI = 0.30-0.69).

CONCLUSIONS

Adherence to the 2018 WCRF/AICR lifestyle recommendations was low to moderate, especially regarding body weight, fruit, vegetables, and alcohol consumption. Men, current smokers, lower-educated participants, and/or those diagnosed with germ cell tumors were less likely to have a healthy lifestyle.

IMPLICATIONS FOR CANCER SURVIVORS

Health-promotion programs (e.g., age-specific tools) are needed, focusing on high-risk groups.

Physical activity and physical fitness assessments in adolescents and young adults diagnosed with cancer: a scoping review

PURPOSE

This scoping review describes the assessment methodologies for physical activity (PA) and physical fitness assessments used in studies focusing on adolescents and young adults (AYAs) diagnosed with cancer.

METHODS

A search of the literature was conducted in PubMed, CINAHL, Web of Science, and Cochrane Library following the PRISMA-ScR statement. A total of 34 studies were included in this review.

RESULTS

PA was primarily assessed via self-reported questionnaires (30/34) either completed in-person (n = 17) or online (n = 13) at different time points and different stages along the cancer trajectory (i.e., from diagnosis onward). A total of 9 studies conducted a physical fitness assessment.

CONCLUSIONS

PA and physical fitness measurements are key when trying to describe outcomes, assess for associations, track changes, measure intervention adherence, and test intervention efficacy and effectiveness. Considerable heterogeneity across studies was reported limiting the generation of formal recommendations or guidance for researchers, healthcare providers, and policy makers.