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Hiensch AE, Depenbusch J, Schmidt ME, Monninkhof EM, Pelaez M, Clauss D, Gunasekara N, Zimmer P, Belloso J, Trevaskis M, Rundqvist H, Wiskemann J, Müller J, Sweegers MG, Fremd C, Altena R, Gorecki M, Bijlsma R, van Leeuwen-Snoeks L, Ten Bokkel Huinink D, Sonke G, Lahuerta A, Mann GB, Francis PA, Richardson G, Malter W, van der Wall E, Aaronson NK, Senkus E, Urruticoechea A, Zopf EM, Bloch W, Stuiver MM, Wengstrom Y, Steindorf K, May AM. Supervised, structured and individualized exercise in metastatic breast cancer: a randomized controlled trial. Nat Med 2024:10.1038/s41591-024-03143-y. [PMID: 39054374 DOI: 10.1038/s41591-024-03143-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024]
Abstract
Physical exercise both during and after curative cancer treatment has been shown to reduce side effects. Evidence in the metastatic cancer setting is scarce, and interventions that improve health-related quality of life (HRQOL) are much needed for patients with metastatic breast cancer (MBC). The multinational randomized controlled PREFERABLE-EFFECT trial assessed the effects of exercise on fatigue and HRQOL in patients with MBC. In total, 357 patients with MBC and a life expectancy of ≥6 months but without unstable bone metastases were recruited at eight study centers across five European countries and Australia. Participants were randomly assigned (1:1) to usual care (control group, n = 179) or a 9-month supervised exercise program (exercise group, n = 178). Intervention effects on physical fatigue (European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-FA12 scale) and HRQOL (EORTC QLQ-C30 summary score) were determined by comparing the change from baseline to 3, 6 (primary timepoint) and 9 months between groups using mixed models for repeated measures, adjusted for baseline values of the outcome, line of treatment (first or second versus third or higher) and study center. Exercise resulted in significant positive effects on both primary outcomes. Physical fatigue was significantly lower (-5.3 (95% confidence interval (CI), -10.0 to -0.6), Bonferroni-Holm-adjusted P = 0.027; Cohen's effect size, 0.22) and HRQOL significantly higher (4.8 (95% CI, 2.2-7.4), Bonferroni-Holm-adjusted P = 0.0003; effect size, 0.33) in the exercise group than in the control group at 6 months. Two serious adverse events occurred (that is, fractures), but both were not related to bone metastases. These results demonstrate that supervised exercise has positive effects on physical fatigue and HRQOL in patients with MBC and should be recommended as part of supportive care.ClinicalTrials.gov Identifier: NCT04120298 .
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna Depenbusch
- German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT, a partnership between DKFZ and University Medical Center Heidelberg) Heidelberg, Heidelberg, Germany
| | - Martina E Schmidt
- German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT, a partnership between DKFZ and University Medical Center Heidelberg) Heidelberg, Heidelberg, Germany
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mireia Pelaez
- Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
- Universidad Europea del Atlantico, Santander, Spain
| | | | | | | | - Jon Belloso
- Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
| | - Mark Trevaskis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Joachim Wiskemann
- Heidelberg University Hospital and NCT Heidelberg (a partnership between DKFZ and University Medical Center Heidelberg), Heidelberg, Germany
| | - Jana Müller
- Heidelberg University Hospital and NCT Heidelberg (a partnership between DKFZ and University Medical Center Heidelberg), Heidelberg, Germany
| | | | - Carlo Fremd
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
- Divison of Gynecologic Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
- German Cancer Research Center Heidelberg (DKFZ), Heidelberg, Germany
| | - Renske Altena
- Karolinska Institutet, Unit for Nursing, Karolinska Comprehensive Cancer Center, Breast and Sarcoma Unit, Karolinska University Hospital, Solna, Sweden
| | | | - Rhodé Bijlsma
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - Gabe Sonke
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ainhara Lahuerta
- Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
| | - G Bruce Mann
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Prudence A Francis
- Peter MacCallum Cancer Centre, The University of Melbourne, Victoria, Australia
| | - Gary Richardson
- Cabrini Research, Cabrini Health, Malvern, Victoria, Australia
| | - Wolfram Malter
- Center for Familial Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elsken van der Wall
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - Ander Urruticoechea
- Gipuzkoa Cancer Unit, OSID-Onkologikoa, BioGipuzkoa, Osakidetza, San Sebastian, Spain
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Malvern, Victoria, Australia
| | | | | | - Yvonne Wengstrom
- Karolinska Institutet, Unit for Nursing, Karolinska Comprehensive Cancer Center, Breast and Sarcoma Unit, Karolinska University Hospital, Solna, Sweden
| | - Karen Steindorf
- German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT, a partnership between DKFZ and University Medical Center Heidelberg) Heidelberg, Heidelberg, Germany
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Phillips SM, Starikovsky J, Solk P, Desai R, Reading JM, Hasanaj K, Wang SD, Cullather E, Lee J, Song J, Spring B, Gradishar W. Feasibility and preliminary effects of the Fit2ThriveMB pilot physical activity promotion intervention on physical activity and patient reported outcomes in individuals with metastatic breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07432-5. [PMID: 39014267 DOI: 10.1007/s10549-024-07432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Physical activity research among patients with metastatic breast cancer (MBC) is limited. This study examined the feasibility and potential benefits of Fit2ThriveMB, a tailored mHealth intervention. METHODS Insufficiently active individuals with MBC (n = 49) were randomized 1:1 to Fit2ThriveMB (Fit2ThriveMB app, Fitbit, and weekly coaching calls) or Healthy Lifestyle attention control (Cancer.Net app and weekly calls) for 12 weeks. Fit2ThriveMB aimed to increase daily steps via an algorithm tailored to daily symptom rating and step goal attainment. The primary outcome was feasibility defined as ≥ 80% completion rate. Secondary feasibility metrics included meeting daily step goal and wearing the Fitbit ≥ 70% of study days, fidelity, adherence to intervention features and safety. Secondary outcomes included physical activity, sedentary time, patient reported outcomes (PROs), health-related quality of life (QOL) and social cognitive theory constructs. A subsample (n = 25) completed functional performance tests via video conferencing. RESULTS The completion rate was 98% (n = 1 died). No related adverse events were reported. Fit2ThriveMB participants (n = 24) wore the Fitbit 92.7%, met their step goal 53.1%, set a step goal 84.6% and used the app 94.1% of 84 study days. Intent-to-treat analyses indicated trends toward improvements in activity, QOL, and some PROs, social cognitive theory constructs, and functional performance tests favoring the Fit2ThriveMB group. Significant effects favoring Fit2ThriveMB were observed for self-efficacy and goal-setting. However, some PROs and functional performance improvements favored the control group (p-values > 0.05). CONCLUSIONS Fit2ThriveMB is feasible and safe for patients with MBC and warrants further evaluation in randomized controlled trials with larger sample sizes. Registration Clinicaltrials.gov NCT04129346, https://clinicaltrials.gov/ct2/show/NCT04129346.
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Affiliation(s)
- Siobhan M Phillips
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Julia Starikovsky
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Payton Solk
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Ria Desai
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Jean M Reading
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Kristina Hasanaj
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Shirlene D Wang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Erin Cullather
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Jungwha Lee
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Jing Song
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - William Gradishar
- Department of Medicine, Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Dibble KE, Rosenberg SM, Zheng Y, Sella T, Poorvu P, Snow C, Darai S, Rene C, Mack JW, Partridge AH. Psychosocial and supportive care concerns of young women living with advanced breast cancer: baseline findings from a prospective virtual support intervention study. Support Care Cancer 2024; 32:336. [PMID: 38727753 DOI: 10.1007/s00520-024-08557-5] [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: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Adolescent and young adults (AYAs) with metastatic breast cancer (MBC) experience high physical and psychosocial burdens compounded by a disrupted life trajectory. We sought to determine the psychosocial and supportive care concerns of this population to better understand and address unmet needs. METHODS AYAs diagnosed with MBC (18-39 years) participating in a prospective interventional study (Young, Empowered, and Strong) at Dana-Farber Cancer Institute completed an electronic survey following enrollment. Measures evaluated sociodemographics, health behaviors, quality of life, and symptoms, among others. We used two-sided Fisher's exact tests to determine associations between concerns (e.g., cancer progression, side effects, lifestyle, finances, fertility) and demographic variables. RESULTS Among 77 participants enrolled from 9/2020-12/2022, average age at MBC diagnosis and survey was 35.9 (range: 22-39) and 38.3 years (range: 27-46), respectively. Most were non-Hispanic white (83.8%) and 40.3% reported their diagnosis caused some financial problems. Many were concerned about fertility (27.0%), long-term treatment side effects (67.6%), exercise (61.6%), and diet (54.1%). Select concerns varied significantly by age, race/ethnicity, and education. Younger women at survey reported greater concern about familial cancer risk (p = 0.028). Women from minority racial/ethnic groups more frequently reported issues talking about their cancer to family/friends (p = 0.040) while those with more education were more frequently concerned with long-term effects of cancer on their health (p = 0.021). CONCLUSION Young women living with MBC frequently report psychosocial, health, and cancer management concerns. Tailoring supportive care and communications to address prevalent concerns including disease progression and treatment side effects may optimize wellbeing.
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Affiliation(s)
- Kate E Dibble
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoshana M Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yue Zheng
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tal Sella
- Deparment of Medical Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Philip Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Craig Snow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Sonja Darai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Christamar Rene
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Johnston EA, Ayre SK, Au-Yeung YT, Goodwin BC. A Scoping Review of Group Nutrition Education and Cooking Programs for People Affected by Cancer. J Acad Nutr Diet 2024:S2212-2672(24)00090-X. [PMID: 38395356 DOI: 10.1016/j.jand.2024.02.011] [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: 08/29/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Group nutrition education and cooking programs for people affected by cancer have the potential to address commonly reported unmet needs for dietary information, as well as provide opportunities for practical and social support. OBJECTIVE To report the nutrition-related content, delivery methods, and outcomes measured in group nutrition education and cooking programs for people affected by cancer in the published literature, and describe how these programs were developed, implemented, and evaluated. METHODS A scoping review of academic literature is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Key terms such as cancer, nutrition education, and cooking were searched across 4 databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, and Web of Science) on June 1, 2023, for records published over the past 10 years. Records were independently screened by 2 reviewers. Data extracted included program participants, components, nutrition-related content, delivery methods, outcomes measured, and information about how the program was developed, implemented, and evaluated. RESULTS Of 2,254 records identified, 41 articles met eligibility criteria, reporting on 37 programs. Most programs were designed for adult cancer survivors (89%) and conducted after primary treatment (81%). Four programs invited caregivers to attend. Almost all programs (97%) included a nutrition education component, and more than half (59%) included cooking activities, with a predominant focus on recommendations and practical skills for healthy eating. Most programs were delivered byregistered dietitians and/or nutritionists (54%) and included group discussions (57%) and active involvement in cooking activities (57%) in program delivery. The participant outcomes that were measured covered dietary, psychosocial, clinical, and anthropometric domains. Many programs were developed with cancer survivors, dietitians or nutritionists, and researchers. No studies reported on sustainability of program implementation or overall costs. Programs were evaluated using data from surveys, focus groups, interviews, and field notes, with articles typically reporting on participation rates, reasons for nonparticipation, program acceptability, aspects of the nutrition-related programs valued by participants, and suggestions for improvement. CONCLUSIONS Future research should prioritize assessing the effectiveness of these programs for participants. Future development, implementation, and evaluation of these programs should include family members and friends and assess the sustainability of program delivery, including cost-effectiveness.
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Affiliation(s)
- Elizabeth A Johnston
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
| | - Susannah K Ayre
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Yin To Au-Yeung
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
| | - Belinda C Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia; School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Wang TC, Chen PL, Liao WC, Tsai IC. Differential Impact of Exercises on Quality-of-Life Improvement in Breast Cancer Survivors: A Network Meta-Analysis of Randomized Controlled Trials. Cancers (Basel) 2023; 15:3380. [PMID: 37444490 DOI: 10.3390/cancers15133380] [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: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to assess the effectiveness of various exercise interventions in enhancing the quality of life for breast cancer survivors. To achieve this, randomized controlled trials were identified from major electronic databases, focusing on the relationship between exercise and quality of life in breast cancer survivors. The primary outcome was the impact of exercise on quality of life 12 weeks after the intervention, with a secondary outcome comparing dropout rates between intervention groups and a regular care control group. The study protocol was registered with INPLASY (INPLASY202340007). A network meta-analysis of nine randomized controlled trials involving 725 participants was conducted, examining aerobic and strength training, aerobic activity, yoga, and strength exercise. Results showed that aerobic and strength training was the most effective intervention, significantly improving the quality of life of breast cancer survivors (1.31; 95% confidence interval: 0.49 to 2.12). Aerobic activity had a borderline effect (0.83; 0.03 to 1.63), while no exercise interventions were associated with an increased dropout risk compared to the control group (regular care). The study concluded that concurrent aerobic and strength training can improve breast cancer survivors' quality of life after 12 weeks of intervention without increasing dropout risk compared to regular care.
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Affiliation(s)
- Tzu-Chieh Wang
- Doctoral Program, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | | | | | - I-Chen Tsai
- InnovaRad, Taichung 407217, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul 13572, Republic of Korea
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Teo NR, Siew LED, Ang WHD, Lau Y. Wearable-Technology-Assisted Interventions for Breast-Cancer Survivors: A Meta-Analysis and Meta-Regression. Semin Oncol Nurs 2023; 39:151403. [PMID: 36894449 DOI: 10.1016/j.soncn.2023.151403] [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: 09/03/2022] [Revised: 12/17/2022] [Accepted: 02/08/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES This review, meta-analysis, and meta-regression aimed to (1) evaluate the effect of wearable-technology-assisted interventions on the physical activity and weight of breast cancer survivors, (2) identify the essential features of wearable-technology-assisted interventions, and (3) explore the covariates of the treatment effect. DATA SOURCES Randomized controlled trials were obtained from 10 databases and trial registries from inception until December 21, 2021. Trials that examined the effects of wearable-technology-assisted interventions for individuals with breast cancer were included. The mean and standard deviation scores were used to compute the effect sizes. CONCLUSION The meta-analyses revealed significantly improved in moderate-to-vigorous activity, total physical activity, and weight control. The findings from this review suggest that wearable-technology-assisted interventions may be a potential solution to improve physical activity and weight in breast cancer survivors. Future studies should include high-quality trials with large sample sizes. IMPLICATIONS FOR NURSING PRACTICE Wearable technology has promising effects on physical activity and could be incorporated into routine care for breast cancer survivors.
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Affiliation(s)
- Neil Russell Teo
- Staff Nurse, Nursing Department, Singapore General Hospital, Singapore
| | - Li En Dana Siew
- Staff Nurse, Nursing Department, Singapore General Hospital, Singapore
| | - Wei How Darryl Ang
- PhD Candidate, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore
| | - Ying Lau
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore.
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Caru M, Abdullah S, Qiu L, Kanski B, Gordon B, Truica CI, Vasakar M, Doerksen S, Schmitz KH. Women with metastatic breast cancer don't just follow step-count trends, they exceed them: an exploratory study. Breast Cancer Res Treat 2023:10.1007/s10549-023-06980-6. [PMID: 37227610 DOI: 10.1007/s10549-023-06980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Metastatic breast cancer (MBC) patients are living longer at the cost of several side effects, affecting their physical and mental health. Physical activity can help women with MBC to improve their wellbeing. Technology-based exercise interventions have shown promising outcomes; however, studies that document their benefits on health behaviors are lacking. Therefore, we aimed to document the impact of virtual assistant technology on enhancing daily step counts in women with MBC. METHODS A total of 38 women with MBC participated in the 90-day Nurse AMIE (Addressing Metastatic Individuals Everyday) for Amazon Echo Show study, an artificial intelligence-based supportive care intervention. Each day, Nurse AMIE asked four symptom questions (sleep, pain, fatigue, and distress) and daily step counts. Based on participants' answers, an algorithm provided an activity to assist with symptom management. RESULTS During the first week of the intervention, mean step counts per day were 4935 ± 2884, and during the last week of the intervention, mean step counts per day were 1044 steps higher, for an average of 5979 ± 2651 steps. Non-significant differences were observed between the first and last week (p = 0.211) and between the first and last day (p = 0.099), despite an improvement of 21.2% over time and significant differences between baseline and the other days. CONCLUSION Women with MBC benefited from the Nurse AMIE for Amazon Echo Show intervention. Despite improvements over time (> 20%), we cannot conclude that the intervention significantly enhanced participants' daily step counts. Larger studies using virtual assistant technologies are required, and this study should be considered a first step in this direction.
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Affiliation(s)
- Maxime Caru
- Division of Hematology and Oncology, Department of Pediatric, Pennsylvania State Health Children's Hospital, Hershey, PA, USA
| | - Saeed Abdullah
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, USA
| | - Ling Qiu
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, USA
| | - Bethany Kanski
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Brett Gordon
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Cristina I Truica
- Division of Hematology and Oncology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Monali Vasakar
- Division of Hematology and Oncology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Shawna Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, 5150 Centre Ave., Room 549B, Pittsburgh, PA, 15232, USA.
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Thomsen SN, Lahart IM, Thomsen LM, Fridh MK, Larsen A, Mau-Sørensen M, Bolam KA, Fairman CM, Christensen JF, Simonsen C. Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials. EClinicalMedicine 2023; 59:101937. [PMID: 37096190 PMCID: PMC10121410 DOI: 10.1016/j.eclinm.2023.101937] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
Background Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. Methods This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). Findings 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47-2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11-2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03-3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55-0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14-2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence. Interpretation The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population. Funding There was no funding for this study.
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Affiliation(s)
- Simon N. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Ian M. Lahart
- Faculty of Health, Education, and Wellbeing, School of Sport, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK
| | - Laura M. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Martin K. Fridh
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, University Hospital of Copenhagen – Rigshospitalet, Juliane Maries Vej 9, 2100, Copenhagen OE, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Ryesgade 27, 2200, Copenhagen N, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Centre for Cancer and Organ Diseases, University Hospital of Copenhagen - Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen OE, Denmark
| | - Kate A. Bolam
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Lidingovagen, 5626, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 35, Stockholm, Sweden
| | - Ciaran M. Fairman
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Jesper F. Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Digestive Disease Center, Bispebjerg Hospital, Nielsine Nielsens Vej 11, 2400, Copenhagen, Denmark
| | - Casper Simonsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
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9
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A Scoping Review and a Taxonomy to Assess the Impact of Mobile Apps on Cancer Care Management. Cancers (Basel) 2023; 15:cancers15061775. [PMID: 36980661 PMCID: PMC10046563 DOI: 10.3390/cancers15061775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Mobile Health (mHealth) has a great potential to enhance the self-management of cancer patients and survivors. Our study aimed to perform a scoping review to evaluate the impact and trends of mobile application-based interventions on adherence and their effects on health outcomes among the cancer population. In addition, we aimed to develop a taxonomy of mobile-app-based interventions to assist app developers and healthcare researchers in creating future mHealth cancer care solutions. Relevant articles were screened from the online databases PubMed, EMBASE, and Scopus, spanning the time period from 1 January 2016 to 31 December 2022. Of the 4135 articles initially identified, 55 were finally selected for the review. In the selected studies, breast cancer was the focus of 20 studies (36%), while mixed cancers were the subject of 23 studies (42%). The studies revealed that the usage rate of mHealth was over 80% in 41 of the 55 studies, with factors such as guided supervision, personalized suggestions, theoretical intervention foundations, and wearable technology enhancing adherence and efficacy. However, cancer progression, technical challenges, and unfamiliarity with devices were common factors that led to dropouts. We also proposed a taxonomy based on diverse theoretical foundations of mHealth interventions, delivery methods, psycho-educational programs, and social platforms. We suggest that future research should investigate, improve, and verify this taxonomy classification to enhance the design and efficacy of mHealth interventions.
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10
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Cooper KB, Lapierre S, Carrera Seoane M, Lindstrom K, Pritschmann R, Donahue M, Christou DD, McVay MA, Jake-Schoffman DE. Behavior change techniques in digital physical activity interventions for breast cancer survivors: a systematic review. Transl Behav Med 2023; 13:268-280. [PMID: 36694356 DOI: 10.1093/tbm/ibac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Given the broad benefits of physical activity (PA) but low PA levels among breast cancer survivors (i.e., women who have received a breast cancer diagnosis), innovative and evidence-based techniques are needed to motivate and support exercise. This study systematically reviews the use of behavior change techniques (BCTs) in digital PA interventions for breast cancer survivors. Studies were retrieved from five electronic databases and were included if they (i) sampled exclusively female breast cancer survivors aged >18 years, (ii) involved a digital intervention with the primary purpose of increasing PA, (iii) included a BCT component, (iv) used a randomized or quasi-randomized design, and (v) were published from January 2000 to May 2022. Two coders independently extracted data. Twenty primary studies met the inclusion criteria and were included in this review. All interventions used at least one BCT (mean 4 ± 1, range 2-13); self-monitoring (85%) and goal setting (79%) were the most common BCTs. Twelve of 20 (60%) studies reported improvements in PA behavior in the intervention vs. control group, and self-monitoring and goal setting were the most commonly used BCTs in these studies. Of the 93 total BCTs, 66 were not used in any interventions in the review, including critical constructs for PA behavior change (e.g., biofeedback). BCTs, important facilitators of PA behavior change, are being underutilized in digital PA interventions for breast cancer survivors. Future research should incorporate more diverse BCTs to explore if they can add to the effectiveness of digital interventions for this population.
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Affiliation(s)
- Kellie B Cooper
- Department of Health Education and Behavior, University of Florida, Gainesville, FL 32611, USA
| | - Stephanie Lapierre
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | | | - Katie Lindstrom
- Department of Health Education and Behavior, University of Florida, Gainesville, FL 32611, USA
| | - Ricarda Pritschmann
- Department of Health Education and Behavior, University of Florida, Gainesville, FL 32611, USA
| | - Marissa Donahue
- Department of Psychology, Utah State University, Logan, UT 84322, USA
| | - Demetra D Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL 32611, USA
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11
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Exploring health behaviors and the feasibility of a lifestyle intervention for patients with multiple myeloma. Support Care Cancer 2022; 30:9771-9779. [DOI: 10.1007/s00520-022-07385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/02/2022] [Indexed: 10/31/2022]
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12
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Wong VWH, Ho FYY, Shi NK, Sarris J, Ng CH, Tam OKY. Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials. J Affect Disord 2022; 310:354-368. [PMID: 35523299 DOI: 10.1016/j.jad.2022.04.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lifestyle medicine (LM) is gaining increasing attention as a treatment option for anxiety, but the current state of evidence has not yet been systematically examined. METHODS Six electronic databases were systematically searched from inception to February 2022. Randomized controlled trials (RCTs) comparing the effects of multicomponent LM interventions on anxiety symptoms with either care-as-usual, waitlist, no intervention, or attention control group on anxiety symptoms were identified. RESULTS A total of 53 RCTs with 18,894 participants were included for qualitative synthesis, in which 45 RCTs with data available were included for meta-analysis. Multicomponent LM intervention was significantly more effective than the control groups in reducing anxiety symptoms at immediate posttreatment (d = 0.19, p < .001) and at short-term follow-up (d = 0.29, p < .001). However, no significant difference at medium-term was found (p = .14), whereas more studies are needed to study the long-term effects. The subgroup analyses suggested that baseline anxiety symptoms was a significant moderator, suggesting that those with moderate level of baseline anxiety symptoms appeared to have greater improvements (d = 0.66, p < .05). LIMITATIONS Minimal anxiety symptoms at baseline contributed to the floor effect and influenced the degree of improvement. The included RCTs had a high risk of bias in general with potential publication bias detected. CONCLUSION The findings of this meta-analysis provided support for the positive effects of multicomponent LM interventions for anxiety symptoms. Future research is needed to determine the long-term effects of multicimponent LM and the optimal baseline anxiety severity.
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Affiliation(s)
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Nga-Kwan Shi
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Jerome Sarris
- Western Sydney University, NICM Heath Research Institute, Westmead, NSW, Australia; Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, VIC, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, The University of Melbourne, Richmond, VIC, Australia
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13
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Barnes O, Wilson RL, Gonzalo-Encabo P, Kang DW, Christopher CN, Bentley T, Dieli-Conwright CM. The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review. Nutrients 2022; 14:nu14102110. [PMID: 35631251 PMCID: PMC9145470 DOI: 10.3390/nu14102110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023] Open
Abstract
Advanced and metastatic cancers significantly alter body composition, leading to decreased lean mass and variable effects on fat mass. These effects on body composition are associated with significant physical dysfunction and poor prognosis in patients with cancer. Whilst exercise and nutritional interventions are likely to be of benefit in counteracting these effects, relatively little is known about using such interventions in patients with advanced or metastatic cancer. Therefore, in this systematic review we examine the effect of exercise and combined exercise and nutritional interventions on lean mass and fat mass among patients diagnosed with advanced or metastatic cancer. Following PRISMA guidelines, we identified 20 articles from PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PEDro, SPORTDiscus, and REHABDATA. Overall, advanced or metastatic cancer populations comprising of mixed cancer types were most commonly examined (n = 8) with exercise or combined exercise and nutritional interventions being well-tolerated with few adverse effects. Both intervention approaches may preserve lean mass, while only combined interventions may lead to alterations in fat mass. However, further exercise and nutritional studies are needed to definitively understand their effects on body composition. As exercise and nutrition-related research continues in this understudied population, the knowledge gained will help guide supportive clinical treatments.
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Affiliation(s)
- Oscar Barnes
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (O.B.); (T.B.)
| | - Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Epidemiology, Boston University, Boston, MA 02118, USA
| | - Thomas Bentley
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (O.B.); (T.B.)
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
- Correspondence:
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14
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Myosteatosis at diagnosis is adversely associated with 2-year survival in women with estrogen receptor-negative metastatic breast cancer. Breast Cancer Res Treat 2021; 190:121-132. [PMID: 34389926 DOI: 10.1007/s10549-021-06358-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE To examine the relationship between skeletal muscle (SM) and cancer-specific outcomes for women with estrogen receptor-negative (ER-) metastatic breast cancer (MBC). METHODS For this retrospective cohort, females (≥ 18 years) with histologically confirmed ER- MBC and computerized tomography (CT) imaging were screened. Demographic, anthropometric, and clinical data were collected uniformly from the electronic medical record. CT images inclusive of the third lumbar region (L3) at diagnosis, 6 and 12 months, were used to classify sarcopenia (≤ 41 cm2/m2) and myosteatosis (< 41 or 33 Hounsfield Units, adjusted for body mass index (BMI)) and to evaluate changes in SM and total adipose tissue (TAT) over time. Kaplan-Meier curves, Cox Proportional Hazards (PH), and restricted mean survival time (RMST) estimates were generated to examine the relationship between sarcopenia and myosteatosis and time to tumor progression (TTP), treatment toxicity and 2-year survival, adjusting for covariates. RESULTS Participants were 58.0 (15.0) years of age, ethnically diverse (55% non-Hispanic white, 31% Black, 11% Hispanic), post-menopausal (73%, n = 111), and classified as overweight (BMI 29.4 (7.6)). At diagnosis, 40% (n = 61) were sarcopenic, 49% had myosteatosis, and 28% (n = 42) had both. While Cox PH modeling and RMST analysis reveal no significant relationship between sarcopenia at diagnosis and 2-year survival (RMST difference - 1.6 (1.4) months, HR 1.35 (0.88-2.08)), these analyses support a significant, adverse association between myosteatosis at diagnosis and 2-year survival (RMST difference - 2.4 (1.5) months, HR 1.72 (1.09-2.72)). Incident sarcopenia was 11% (n = 5/45) and 2.5% (n = 1/40), respectively, while incident myosteatosis was 19% (n = 8/42) and 15% (n = 5/34) at 6 and 12 months, respectively. TTP and treatment toxicities did not appear to be related to diagnostic SM or body composition changes over time. CONCLUSION Targeted interventions initiated within the first year of diagnosis to preserve or improve SM quality seem warranted for women with ER-MBC.
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