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Anandavadivelan P, Cardinale D, Blomhoff R, Sunde B, Lassen K, Kleive D, Sturesson C, Gilg S, Raastad T, Mijwel S. Blood flow restriction Exercise in the perioperative setting to Prevent loss of muscle mass in patients with pancreatic, biliary tract, and liver cancer: study protocol for the PREV-Ex randomized controlled trial. Trials 2024; 25:356. [PMID: 38835083 PMCID: PMC11149261 DOI: 10.1186/s13063-024-08207-5] [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] [Received: 03/12/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Patients diagnosed with pancreatic, biliary tract, and liver cancer often suffer from a progressive loss of muscle mass. Given the considerable functional impairments in these patients, high musculoskeletal weight loads may not be well tolerated by all individuals. The use of blood-flow restricted resistance training (BFR-T) which only requires low training loads may allow for a faster recovery of muscle due to avoidance of high levels of mechanical muscle stress associated with high-load resistance exercise. This study aims to investigate whether BFR-T can prevent or slow down the loss of skeletal muscle mass and enhance the functional capacity and mental health of patients with pancreatic, biliary tract, and liver cancer. METHODS The PREV-Ex exercise trial is a multicenter two-armed randomized controlled trial. Patients will be randomized to an exercise program consisting of home-based low-load BFR-T during a combined pre- and postoperative period for a total of 6-10 weeks (prehabilitation and rehabilitation), or to a control group. Protein supplementation will be given to both groups to ensure adequate protein intake. The primary outcomes, skeletal muscle thickness and muscle cross-sectional area, will be assessed by ultrasound. Secondary outcomes include the following: (i) muscle catabolism-related and inflammatory bio-markers (molecular characteristics will be assessed from a vastus lateralis biopsy and blood samples will be obtained from a sub-sample of patients); (ii) patient-reported outcome measures (self-reported fatigue, health-related quality of life, and nutritional status will be assessed through validated questionnaires); (iii) physical fitness/performance/activity (validated tests will be used to evaluate physical function, cardiorespiratory fitness and maximal isometric muscle strength. Physical activity and sedentary behavior (assessed using an activity monitor); (iv) clinical outcomes: hospitalization rates and blood status will be recorded from the patients' medical records; (v) explorative outcomes of patients' experience of the exercise program which will be evaluated using focus group/individual interviews. DISCUSSION It is worthwhile to investigate new strategies that have the potential to counteract the deterioration of skeletal muscle mass, muscle function, strength, and physical function, all of which have debilitating consequences for patients with pancreatic, biliary tract, and liver cancer. The expected findings could improve prognosis, help patients stay independent for longer, and possibly reduce treatment-related costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05044065. Registered on September 14, 2021.
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Affiliation(s)
- Poorna Anandavadivelan
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | - Daniele Cardinale
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- The Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Berit Sunde
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Kristoffer Lassen
- Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway
| | - Dyre Kleive
- Department of Hepatobiliary and Pancreatic Surgery, Oslo University Hospital, Oslo, Norway
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden
- Department of HPB Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Gilg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden
- Department of HPB Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Sara Mijwel
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway.
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Wall NR, Fuller RN, Morcos A, De Leon M. Pancreatic Cancer Health Disparity: Pharmacologic Anthropology. Cancers (Basel) 2023; 15:5070. [PMID: 37894437 PMCID: PMC10605341 DOI: 10.3390/cancers15205070] [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: 09/20/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Pancreatic cancer (PCa) remains a formidable global health challenge, with high mortality rates and limited treatment options. While advancements in pharmacology have led to improved outcomes for various cancers, PCa continues to exhibit significant health disparities, disproportionately affecting certain populations. This paper explores the intersection of pharmacology and anthropology in understanding the health disparities associated with PCa. By considering the socio-cultural, economic, and behavioral factors that influence the development, diagnosis, treatment, and outcomes of PCa, pharmacologic anthropology provides a comprehensive framework to address these disparities and improve patient care.
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Affiliation(s)
- Nathan R. Wall
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Ryan N. Fuller
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Ann Morcos
- Division of Biochemistry, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA; (R.N.F.); (A.M.)
| | - Marino De Leon
- Division of Physiology, Department of Basic Science, Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA 92350, USA;
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Tripepi M, Pizzocaro E, Giardino A, Frigerio I, Guglielmi A, Butturini G. Telemedicine and Pancreatic Cancer: A Systematic Review. Telemed J E Health 2023; 29:352-360. [PMID: 35861761 DOI: 10.1089/tmj.2022.0140] [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: 11/12/2022] Open
Abstract
Introduction: Pancreatic cancer requires a multidisciplinary approach in a high-volume center for all the steps of the diagnostic-therapeutic course. However, the most experienced centers are not evenly distributed throughout the country causing a real "health migration" that involves patients and families with relevant economic, time, and energy costs to bear. The COVID-19 pandemic had a deep impact on surgical and oncological care and the travel limits due to COVID-related restrictions, have delayed the care of cancer patient living far from the referral centers. In this scenario, several telemedicine approaches have been proposed to reduce the distance between clinicians and patients and to allow a fast and effective access to care even for patients distant from referral centers. The aim of the study is to analyze the evidence and describe the current utility of telemedicine tool for patients with pancreatic cancer. Methods: We systematically searched the literature in the following databases: Web of Science, PubMed, Scopus, and MEDLINE. The inclusion criteria were article describing a telemedicine intervention (virtual visits, telephone follow-up/counseling, mobile or online apps, telemonitoring) and focusing on adult patients with pancreatic cancer at any stage of the disease. Results: In total, 846 titles/abstracts were identified. Following quality assessment, the review included 40 studies. Telemedicine has been proposed in multiple clinical settings, demonstrating high levels of patient and health professional satisfaction. Conclusion: Successful telemedicine applications in patients with pancreatic cancer are telerehabilitation and nutritional assessment, remote symptom control, teledischarge after pancreatic surgery, tele-education and medical mentoring regarding pancreatic disease as well as telepathology.
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Affiliation(s)
- Marzia Tripepi
- Department of Surgery, General and Hepatobiliary Surgery, University of Verona, Verona, Italy.,Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
| | - Erica Pizzocaro
- Department of Surgical Sciences, University of Verona, Verona, Italy
| | - Alessandro Giardino
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
| | - Isabella Frigerio
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
| | - Alfredo Guglielmi
- Department of Surgery, General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Giovanni Butturini
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
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Leske M, Koczwara B, Morris J, Beatty L. Modality preferences for health behaviour interventions for post-treatment cancer survivors: a theoretical investigation. Support Care Cancer 2023; 31:143. [PMID: 36729337 PMCID: PMC9892669 DOI: 10.1007/s00520-023-07607-8] [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: 06/16/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
PURPOSES User preferences for how programs are delivered are an important consideration when developing healthy living interventions. The aim of this study was to investigate (a) if cancer survivors prefer telephone or internet delivery for a healthy living intervention and (b) what factors were associated with delivery preference. METHODS Australian cancer survivors (18 + years) were invited to complete an online or hardcopy cross-sectional survey measuring social and clinical demographic factors and validated measures of self-efficacy, health literacy, and social support. RESULTS Of the 168 respondents, the majority were female (n = 147, 92%) and breast cancer survivors (n = 122, 80%) and preferred internet delivery (n = 109, 65%). Participants who preferred internet delivery had a longer time since diagnosis (M = 9.85 years, SD = 8.20) compared to those who preferred telephone (M = 6.80 years, SD = 5.54), p = .03. However, logistic regression analyses demonstrated that no other variables (age, gender, socio-economic status, BMI, education, self-efficacy, health literacy, nor social support) had a direct association on delivery preference. CONCLUSIONS Cancer survivors appear to prefer internet delivery to telephone, particularly for those further along the survivorship trajectory. Future intervention development should therefore consider the internet modality for delivering accessible health interventions and offer the program to long-term cancer survivors. Whether these findings are replicable in the current post-pandemic phase is an important avenue for future research.
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Affiliation(s)
- Morgan Leske
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia.
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia ,Department of Medical Oncology, Southern Adelaide Local Health Network, Adelaide, SA Australia
| | | | - Lisa Beatty
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA Australia
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Willingness, preferences, barriers, and facilitators of a multimodal supportive care intervention including exercise, nutritional and psychological approach in patients with cancer: a cross-sectional study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04232-6. [PMID: 35943598 DOI: 10.1007/s00432-022-04232-6] [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: 06/10/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Supportive care, including exercise, nutritional and psychological support, is becoming increasingly important in cancer given their impact on 'patients' quality and quantity of life. The purpose of this study was to explore willingness, preferences barriers and facilitators for a multimodal intervention in patients with cancer. METHODS An anonymous questionnaire was proposed on randomly selected days to the patients visiting the cancer outpatients' facilities at the Oncology Unit of the University Hospital of Verona. The questionnaire investigated willingness, preferences, barriers, and facilitators associated with participation in a multimodal program designed for patients with cancer. Exercise level was estimated using two open questions, nutritional risk was identified using the Nutritional Risk Screening 2002, while distress was evaluated with the Distress Thermometer. RESULTS Based on 324 participants, 65% were interested in starting a multimodal intervention. Patients declared to prefer to receive instructions from dedicated experts, with a face-to-face approach, and during the anticancer treatment. Treatment-related side effects were the major obstacles for a multimodal program, while the availability of a specialized staff as exercise kinesiologists, dietitians, and psycho-oncologists was found to be an important facilitator for increasing 'patients' participation. CONCLUSION Patients patients with cancer are interested in participating in a multimodal supportive care program specifically designed for them. Information from this study may help to design a tailored multimodal intervention for patients with cancer.
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Lee MK. Factors Affecting a Healthy Diet Based on the Integrated Model for Behavioral Change in Patients with Gastric Cancer: Cross-Sectional Study. Asia Pac J Oncol Nurs 2022; 9:100062. [PMID: 35633914 PMCID: PMC9131156 DOI: 10.1016/j.apjon.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/02/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the factors affecting a healthy diet in patients with gastric cancer. Methods Data from 146 consecutive patients with gastric cancer were collected based on the integrated model for behavior change. Core theory constructs were operationalized with decisional balance on a healthy diet, self-efficacy in fruit and vegetable (F&V) intake and diet planning, coping planning and self-leadership, and stages of change in F&V intake and adhering to a diet plan. Results Higher self-efficacy in F&V intake and diet planning were associated with a higher readiness for change in F&V intake (adjusted odds ratio [aOR] for self-efficacy, 1.02; 95% confidence interval [CI], 1.01–1.04) and for adhering to a diet plan (aOR for self-efficacy, 1.02; 95% CI, 1.01–1.04; aOR for diet planning, 1.02; 95% CI, 1.01–1.04). Coping planning was a determinant of readiness for change in F&V intake (aOR, 1.02; 95% CI, 1.01–1.04). Self-leadership in behavioral awareness and volition (aOR, 1.02; 95% CI, 1.01–1.03) and task motivation (aOR, 1.02; 95% CI, 1.00–1.03) were determinants of readiness for change in adhering to a diet plan. Conclusions Self-efficacy and coping planning were determinants of readiness for change in F&V intake in patients with gastric cancer. Self-efficacy and self-leadership were determinants of readiness for change in adhering to a diet plan in patients with gastric cancer. Improving self-efficacy, coping planning, and self-leadership is essential for changing behaviors to adopt a healthy diet. Nurses caring for patients with gastric cancer should identify strategies that improve self-efficacy in F&V intake and diet planning.
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Jacobson G, Fluss R, Dany-BenShushan A, Golan T, Meron T, Zimmermann C, Dawson LA, Barry A, Miszczyk M, Buckstein M, Diaz Pardo D, Aguiar A, Hammer L, Dicker AP, Ben-Ailan M, Morag O, Hausner D, Symon Z, Lawrence YR. Coeliac plexus radiosurgery for pain management in patients with advanced cancer : study protocol for a phase II clinical trial. BMJ Open 2022; 12:e050169. [PMID: 35332036 PMCID: PMC8948399 DOI: 10.1136/bmjopen-2021-050169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pancreatic cancer is characterised by severe mid-back and epigastric pain caused by tumour invasion of the coeliac nerve plexus. This pain is often poorly managed with standard treatments. This clinical trial investigates a novel approach in which high-dose radiation (radiosurgery) is targeted to the retroperitoneal coeliac plexus nerve bundle. Preliminary results from a single institution pilot trial are promising: pain relief is substantial and side effects minimal. The goals of this study are to validate these findings in an international multisetting, and investigate the impact on quality of life and functional status among patients with terminal cancer. METHODS AND ANALYSIS A single-arm prospective phase II clinical trial. Eligible patients are required to have severe coeliac pain of at least five on the 11-point BPI average pain scale and Eastern Cooperative Oncology Group performance status of two or better. Non-pancreatic cancers invading the coeliac plexus are also eligible. The intervention involves irradiating the coeliac plexus using a single fraction of 25 Gy. The primary endpoint is the complete or partial pain response at 3 weeks. Secondary endpoints include pain at 6 weeks, analgesic use, hope, qualitative of life, caregiver burden and functional outcomes, all measured using validated instruments. The protocol is expected to open at a number of cancer centres across the globe, and a quality assurance programme is included. The protocol requires that 90 evaluable patients" be accrued, based upon the assumption that a third of patients are non-evaluable (e.g. due to death prior to 3-weeks post-treatment assessment, or spontaneous improvement of pain pre-treatment), it is estimated that a total of 120 patients will need to be accrued. Supported by Gateway for Cancer Research and the Israel Cancer Association. ETHICS AND DISSEMINATION Ethic approval for this study has been obtained at eight academic medical centres located across the Middle East, North America and Europe. Results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03323489.
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Affiliation(s)
- Galia Jacobson
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ronen Fluss
- Gertner Institute, Sheba Mediacal Center, Tel Hashomer, Tel Aviv, Israel
| | - Amira Dany-BenShushan
- Israeli Center for Cardiovascular Research, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Talia Golan
- Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel aviv University, Tel Aviv, Israel
| | - Tikva Meron
- Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Radiation Oncology, Princess Margaret Hospital Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aisling Barry
- Radiation Oncology, Princess Margaret Hospital Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dayssy Diaz Pardo
- Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Artur Aguiar
- Radiation Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Liat Hammer
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Radiatin Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam P Dicker
- Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maoz Ben-Ailan
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Ofir Morag
- Cancer Pain Unit, Institute of Oncology, Sheba Medical Center, Tel Aviv, Israel
| | - David Hausner
- Cancer Center, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Zvi Symon
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel aviv University, Tel Aviv, Israel
| | - Yaacov R Lawrence
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel aviv University, Tel Aviv, Israel
- Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Research on Motion Behavior and Quality-of-Life Health Promotion Strategy Based on Bee Colony Optimization. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2222394. [PMID: 35281534 PMCID: PMC8916874 DOI: 10.1155/2022/2222394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/26/2022] [Indexed: 01/23/2023]
Abstract
Quality of life is a kind of sensory experience of people's physical health, social ability, and personal overall situation. Correct understanding and evaluation of the quality of life is conducive to human rational planning and control of life resources, promote physical and mental health, and improve the quality of life. In order to further explain the positive impact of physical exercise behavior on promoting physical and mental health, based on the bee colony optimization algorithm this paper analyzes the relationship between physical exercise behavior and quality of life and discusses the role of physical exercise behavior in promoting physical and mental health. The essential attributes and sociological significance of sports determine that sports play a unique role in providing people with social support. The quality of life score increases as the duration of the exercise increases. The theory and methods of defense and treatment advocated by sports thoughts will also have a positive effect on individuals avoiding and getting rid of mental illness. Teachers who have lower exercise time and frequency of exercise should also develop a step-by-step exercise program to strive to join them in the sports population.
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Hsueh HY, Pita-Grisanti V, Gumpper-Fedus K, Lahooti A, Chavez-Tomar M, Schadler K, Cruz-Monserrate Z. A review of physical activity in pancreatic ductal adenocarcinoma: Epidemiology, intervention, animal models, and clinical trials. Pancreatology 2022; 22:98-111. [PMID: 34750076 PMCID: PMC8748405 DOI: 10.1016/j.pan.2021.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 01/03/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer, and the increasing incidence of PDAC may be related to the prevalence of obesity. Physical activity (PA), a method known to mitigate obesity by increasing total energy expenditure, also modifies multiple cellular pathways associated with cancer hallmarks. Epidemiologic evidence has shown that PA can lower the risk of developing a variety of cancers, reduce some of the detrimental side effects of treatments, and improve patient's quality of life during cancer treatment. However, little is known about the pathways underlying the correlations observed between PA interventions and PDAC. Moreover, there is no standard dose of PA intervention that is ideal for PDAC prevention or as an adjuvant of cancer treatments. In this review, we summarize relevant literature showing how PDAC patients can benefit from PA, the potential of PA as an adjuvant treatment for PDAC, the studies using preclinical models of PDAC to study PA, and the clinical trials to date assessing the effects of PA in PDAC.
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Affiliation(s)
- Hsiang-Yin Hsueh
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Valentina Pita-Grisanti
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Kristyn Gumpper-Fedus
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Ali Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Myrriah Chavez-Tomar
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA
| | - Keri Schadler
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.
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The Effectiveness of Nutrition Interventions Combined with Exercise in Upper Gastrointestinal Cancers: A Systematic Review. Nutrients 2021; 13:nu13082842. [PMID: 34445002 PMCID: PMC8400981 DOI: 10.3390/nu13082842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022] Open
Abstract
Malnutrition and muscle wasting are associated with impaired physical functioning and quality of life in oncology patients. Patients diagnosed with upper gastrointestinal (GI) cancers are considered at high risk of malnutrition and impaired function. Due to continuous improvement in upper GI cancer survival rates, there has been an increased focus on multimodal interventions aimed at minimizing the adverse effects of cancer treatments and enhancing survivors’ quality of life. The present study aimed to evaluate the effectiveness of combined nutritional and exercise interventions in improving muscle wasting, physical functioning, and quality of life in patients with upper GI cancer. A comprehensive search was conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINHAL. Of the 4780 identified articles, 148 were selected for full-text review, of which 5 studies met the inclusion criteria. Whilst reviewed studies showed promising effects of multimodal interventions on physical functioning, no significant differences in postoperative complications and hospital stay were observed. Limited available evidence showed conflicting results regarding the effectiveness of these interventions on preserving muscle mass and improving health-related quality of life. Further studies examining the impact of nutrition and exercise interventions on upper GI patient outcomes are required and would benefit from reporting a core outcome set.
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Collaço N, Henshall C, Belcher E, Canavan J, Merriman C, Mitchell J, Watson E. Patients' and healthcare professionals' views on a pre- and post-operative rehabilitation programme (SOLACE) for lung cancer: A qualitative study. J Clin Nurs 2021; 31:283-293. [PMID: 34114286 DOI: 10.1111/jocn.15907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To explore patients' and healthcare professionals' views and experiences of a pre- and post-operative rehabilitation intervention (SOLACE), for patients undergoing surgery for early-stage lung cancer. BACKGROUND Considerable post-operative complications can occur after surgery. A specialist lung cancer service (SOLACE) was developed to optimise health and fitness levels prior to and following lung cancer resections, as well as reducing morbidity and mortality, and improving the physical and psychological well-being of patients. DESIGN The design was an exploratory, descriptive qualitative interview study. METHODS Seventeen lung cancer patients and eight healthcare professionals were recruited from a large teaching hospital in South England. Data were collected through semi-structured telephone and face-to-face interviews. Transcribed interview data were analysed thematically. The COREQ checklist was used to report on the study process. RESULTS The SOLACE service was positively perceived by patients and healthcare professionals. Patients valued the provision of tailored support/advice and peer support and reported benefits to their health and well-being. Barriers to patient uptake of the classes included time constraints, motivation and access for patients who lived at a distance. CONCLUSIONS There is benefit in providing a personalised approach through a pre- and post-operative rehabilitation service for lung cancer patients. Virtual support may address equality of access to service for those who live at a distance from the hospital. RELEVANCE TO CLINICAL PRACTICE Introduction of a pre- and post-operative rehabilitation service provided by specialist peri-operative rehabilitation nurses and practitioners can yield positive outcomes for patients undergoing surgical treatment of early-stage lung cancer. Engagement of key healthcare professionals, consideration of virtual follow-up services and making patients aware of services could maximise patient uptake. Further consideration is needed of the best way to promote patient self-management and long-term continuation of patient rehabilitation in the community.
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Affiliation(s)
- Nicole Collaço
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Catherine Henshall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Canavan
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Merriman
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jenny Mitchell
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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O'Connor D, Brown M, Eatock M, Turkington RC, Prue G. Exercise efficacy and prescription during treatment for pancreatic ductal adenocarcinoma: a systematic review. BMC Cancer 2021; 21:43. [PMID: 33422020 PMCID: PMC7794639 DOI: 10.1186/s12885-020-07733-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Surgical resection remains the only curative treatment for pancreatic cancer and is associated with significant post-operative morbidity and mortality. Patients eligible for surgery, increasingly receive neo-adjuvant therapy before surgery or adjuvant therapy afterward, inherently exposing them to toxicity. As such, optimizing physical function through exercise during treatment remains imperative to optimize quality of life either before surgery or during rehabilitation. However, current exercise efficacy and prescription in pancreatic cancer is unknown. Therefore, this study aims to summarise the published literature on exercise studies conducted in patients with pancreatic cancer undergoing treatment with a focus on determining the current prescription and progression patterns being used in this population. METHODS A systematic review of four databases identified studies evaluating the effects of exercise on aerobic fitness, muscle strength, physical function, body composition, fatigue and quality of life in participants with pancreatic cancer undergoing treatment, published up to 24 July 2020. Two reviewers independently reviewed and appraised the methodological quality of each study. RESULTS Twelve studies with a total of 300 participants were included. Heterogeneity of the literature prevented meta-analysis. Exercise was associated with improvements in outcomes; however, study quality was variable with the majority of studies receiving a weak rating. CONCLUSIONS High quality evidence regarding the efficacy and prescription of exercise in pancreatic cancer is lacking. Well-designed trials, which have received feedback and input from key stakeholders prior to implementation, are required to examine the impact of exercise in pancreatic cancer on key cancer related health outcomes.
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Affiliation(s)
- Dominic O'Connor
- School of Nursing and Midwifery, Queen's University, 8 Fitzwilliam Street, Belfast, Northern Ireland, BT9 6AW, UK.
| | - Malcolm Brown
- School of Nursing and Midwifery, Queen's University, 8 Fitzwilliam Street, Belfast, Northern Ireland, BT9 6AW, UK
| | - Martin Eatock
- The Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland
- The Patrick G Johnston Centre for Cancer Research, Queen's University, Belfast, Northern Ireland
| | - Richard C Turkington
- The Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland
- The Patrick G Johnston Centre for Cancer Research, Queen's University, Belfast, Northern Ireland
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University, 8 Fitzwilliam Street, Belfast, Northern Ireland, BT9 6AW, UK
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Avancini A, Trestini I, Tregnago D, Cavallo A, Bragato M, Bonaiuto C, Lanza M, Milella M, Pilotto S. Multidisciplinary lifestyle intervention to manage pancreatic cancer-related cachexia: a case report. Future Sci OA 2020; 7:FSO659. [PMID: 33437520 PMCID: PMC7787172 DOI: 10.2144/fsoa-2020-0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 01/06/2023] Open
Abstract
Pancreatic cancer remains an aggressive disease, with a poor prognosis and a high risk of incurring into cachexia. Supportive care, such as exercise, nutritional and psychological support, may be effective in reducing functional loss, psychological distress and improving nutritional status. We report the effect of 12 weeks of multimodal lifestyle intervention in a 55-year-old female, diagnosed with unresectable body/tail pancreatic cancer and metastasis in the liver, bone, lymph node and lung, to counteract cachexia. The multimodal program resulted safe and feasible. Over 12 weeks, considerable improvements were found in body weight, health-related physical fitness, nutritional status, distress scores, anxiety and depression levels. These findings highlight the potential role of integrated supportive interventions to manage metastatic cancer and cancer-induced cachexia.
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Affiliation(s)
- Alice Avancini
- Department of Medicine, Biomedical, Clinical & Experimental Sciences, University of Verona Hospital Trust, Verona 37134, Italy
| | - Ilaria Trestini
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Daniela Tregnago
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Alessandro Cavallo
- Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy
| | - Marco Bragato
- Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy
| | - Clelia Bonaiuto
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine & Movement Sciences, University of Verona, Verona 37134, Italy
| | - Michele Milella
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
| | - Sara Pilotto
- Department of Medicine, Medical Oncology, University of Verona Hospital Trust, Verona 37134, Italy
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Antonowicz S, Reddy S, Sgromo B. Gastrointestinal side effects of upper gastrointestinal cancer surgery. Best Pract Res Clin Gastroenterol 2020; 48-49:101706. [PMID: 33317793 DOI: 10.1016/j.bpg.2020.101706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
In this chapter, we describe the gastrointestinal side effects of oesophagectomy, gastrectomy and pancreaticoduodenectomy for cancer, with a focus on long-term functional impairments and their management. Improvements in upper gastrointestinal cancer surgery have led to a growing group of long-term survivors. The invasive nature of these surgeries profoundly alters the upper gastrointestinal anatomy, with lasting implications for long-term function, and how these impairments may be treated. Successfully maintaining a high quality of survivorship requires multidisciplinary approach, with survivorship care plans focused on function as much as the detection of recurrence.
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Affiliation(s)
- S Antonowicz
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, UK
| | - S Reddy
- Hepatobiliary and Pancreatic Unit, Oxford University Hospitals NHS Trust, UK
| | - B Sgromo
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, UK.
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O'Neill L, Guinan E, Doyle S, Connolly D, O'Sullivan J, Bennett A, Sheill G, Segurado R, Knapp P, Fairman C, Normand C, Geoghegan J, Conlon K, Reynolds JV, Hussey J. Rehabilitation strategies following oesophagogastric and Hepatopancreaticobiliary cancer (ReStOre II): a protocol for a randomized controlled trial. BMC Cancer 2020; 20:415. [PMID: 32404096 PMCID: PMC7222585 DOI: 10.1186/s12885-020-06889-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Curative treatment for upper gastrointestinal (UGI) and hepatopancreaticobiliary (HPB) cancers, involves complex surgical resection often in combination with neoadjuvant/adjuvant chemo/chemoradiotherapy. With advancing survival rates, there is an emergent cohort of UGI and HPB cancer survivors with physical and nutritional deficits, resultant from both the cancer and its treatments. Therefore, rehabilitation to counteract these impairments is required to maximise health related quality of life (HRQOL) in survivorship. The initial feasibility of a multidisciplinary rehabilitation programme for UGI survivors was established in the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) feasibility study and pilot randomised controlled trial (RCT). ReStOre II will now further investigate the efficacy of that programme as it applies to a wider cohort of UGI and HPB cancer survivors, namely survivors of cancer of the oesophagus, stomach, pancreas, and liver. METHODS The ReStOre II RCT will compare a 12-week multidisciplinary rehabilitation programme of supervised and self-managed exercise, dietary counselling, and education to standard survivorship care in a cohort of UGI and HPB cancer survivors who are > 3-months post-oesophagectomy/ gastrectomy/ pancreaticoduodenectomy, or major liver resection. One hundred twenty participants (60 per study arm) will be recruited to establish a mean increase in the primary outcome (cardiorespiratory fitness) of 3.5 ml/min/kg with 90% power, 5% significance allowing for 20% drop out. Study outcomes of physical function, body composition, nutritional status, HRQOL, and fatigue will be measured at baseline (T0), post-intervention (T1), and 3-months follow-up (T2). At 1-year follow-up (T3), HRQOL alone will be measured. The impact of ReStOre II on well-being will be examined qualitatively with focus groups/interviews (T1, T2). Bio-samples will be collected from T0-T2 to establish a national UGI and HPB cancer survivorship biobank. The cost effectiveness of ReStOre II will also be analysed. DISCUSSION This RCT will investigate the efficacy of a 12-week multidisciplinary rehabilitation programme for survivors of UGI and HPB cancer compared to standard survivorship care. If effective, ReStOre II will provide an exemplar model of rehabilitation for UGI and HPB cancer survivors. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov, registration number: NCT03958019, date registered: 21/05/2019.
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland.
| | - Emer Guinan
- School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Suzanne Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College, the University of Dublin and St. James's Hospital, Dublin, Ireland
| | - Annemarie Bennett
- Department of Clinical Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research, and School of Public Health, Physiotherapy and Sports Sciences, University College Dublin, Dublin, Ireland
| | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, York, UK
| | - Ciaran Fairman
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Justin Geoghegan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Kevin Conlon
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, Trinity College, the University of Dublin, Dublin, Ireland
| | - John V Reynolds
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College, the University of Dublin and St. James's Hospital, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
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DeGuzman PB, Chu C, Keim-Malpass J. Built and Natural Environment Barriers and Facilitators to Physical Activity in Rural, Suburban, and Small Urban Neighborhoods. Oncol Nurs Forum 2020; 46:545-555. [PMID: 31424449 DOI: 10.1188/19.onf.545-555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore built and natural environment barriers and facilitators to walking for exercise in cancer survivors. PARTICIPANTS & SETTING Cancer survivors (N = 7) living in rural, suburban, and small urban neighborhoods in central Virginia. METHODOLOGIC APPROACH The authors used a qualitative descriptive design with photovoice to explore the cancer survivors' experience with residential walkability. FINDINGS The following three themes were identified from the data. IMPLICATIONS FOR NURSING Clinicians should consider an evaluation of the built and natural environment to support walking in cancer survivors. These findings may be used in conjunction with known individual-level barriers to physical activity to develop guidance for oncology nurses to help survivors safely achieve physical activity goals.
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Watson EK, Brett J, Hay H, Witwicki C, Perris A, Poots AJ, Sizmur S, Soonawalla Z, Tallett A. Experiences and supportive care needs of UK patients with pancreatic cancer: a cross-sectional questionnaire survey. BMJ Open 2019; 9:e032681. [PMID: 31690609 PMCID: PMC6858107 DOI: 10.1136/bmjopen-2019-032681] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Patients diagnosed with pancreatic cancer have the poorest survival prognosis of any cancer. This survey aimed to describe their experiences of care and supportive care needs to inform future service provision. DESIGN Cross-sectional questionnaire survey of patients with pancreatic cancer in the UK. SETTING Individuals at any stage along the care pathway were recruited via five National Health Service sites in the UK, and online, from January to June 2018. PARTICIPANTS 274 individuals completed the questionnaire (78% (215) were completed online). Approximately half of participants were diagnosed within the last year (133/274). Of 212 providing gender details, 82 were male and 130 were female. Ninety per cent (192/213) described themselves as White British. PRIMARY OUTCOME MEASURES Experiences of communication and information; involvement in treatment decisions; supportive care needs. RESULTS Communication with, and care received from, clinical staff were generally reported positively. However, 29% (75/260) of respondents did not receive enough information at diagnosis, and 10% (25/253) felt they were not involved in decisions about their treatment, but would have liked to be. Supportive care needs were greatest in psychological and physical/daily living domains. 49% (108/221) of respondents reported one or more moderate/high unmet needs within the last month, of which the most commonly reported were: dealing with uncertainty about the future; fears about the cancer spreading; not being able to do things they used to; concerns about those close to them; lack of energy; anxiety; feelings of sadness and feeling down/depressed. Experiences were poorer, and unmet supportive care needs greater, in patients with unresectable disease. CONCLUSIONS Patients with pancreatic cancer have unmet information and support needs across the cancer trajectory. Psychological and physical support appears to be the biggest gap in care. Needs should be assessed and supportive care interventions implemented from the point of diagnosis, and monitored regularly to help patients live as good a quality of life as possible.
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Affiliation(s)
- Eila K Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Jo Brett
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Ninot G, Debourdeau P, Blanc-Legier F, De Crozals F, De Rauglaudre G, Khouri S, Kirscher S, Mineur L, Piollet I, Sant I, Schillinger P, Serin D. Pour des soins de support de l’après cancer. Bull Cancer 2018; 105:763-770. [DOI: 10.1016/j.bulcan.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 01/03/2023]
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Arvaniti M, Danias N, Igoumenidis M, Smyrniotis V, Tsounis A, Sarafis P. Comparison of Quality of Life before and after pancreaticoduodenectomy: a prospective study. Electron Physician 2018; 10:7054-7062. [PMID: 30128096 PMCID: PMC6092134 DOI: 10.19082/7054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
Background Pancreatic cancer is an aggressive malignancy, and surgical resection is the only therapeutic option with pancreaticoduodenectomy being considered the standard of care. It is essential to take into account the patients’ Quality of Life after the resection, in order to make more informed decisions about treatment options. Objective The aim of the study was to determine perceived Quality of Life levels among patients who undergo pancreaticoduodenectomy, in a period of six months after surgery. Methods This prospective study was conducted on all patients (n=40) who underwent pancreaticoduodenectomy in Attikon University General Hospital in Athens, Greece, from January 2013 to June 2015. The Quality of Life was assessed by use of EORTC QLQ-C30 and EORTC QOL-PAN26 questionnaires at four phases: First, after admission at the hospital preoperatively, and then one month, three months, and six months postoperatively. Repeated measurements analysis of variance (ANOVA) was used in order to evaluate changes in Quality of Life measures during the follow-up (postoperative) period. Data analysis was conducted using SPSS version 19. A p-value of less than or equal to 0.05 was set as the level of significance. Results The study revealed a mixed image. Except for the nausea and vomiting scale, where indeed a symptom increase is initially reported and then gradually decreases below preoperative levels by 6 months, scoring in many symptom scales worsens postoperatively. From first to fourth assessment, fatigue (Mean from 23.61 to 38.72, p=0.005) and financial difficulties scoring (Mean from 5.98 to 42.42, p<0.001) consistently worsen. Functionality scales scoring also tends to get worse between first and fourth assessment, with statistically significant changes for physical (p<0.001), role (p<0.001) and social functioning (p<0.001). However, a slight improvement can be noted in many scales from third to fourth assessment, as in diarrhea (Mean from 32.38 to 29.29), pancreatic pain (Mean from 17.71 to 2.34), global health status (Mean from 50.48 to 52.53) and social functioning (Mean from 43.81 to 48.48) scales. Conclusions Quality of Life levels among patients who undergo pancreaticoduodenectomy are getting worse following surgery. However, the longitudinal study of these changes may improve patients’ postoperative life by formulating evidence-based interventions concerning symptoms treatment and psychological and social support.
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Affiliation(s)
| | - Nikolaos Danias
- University of Athens Medical School, University Hospital "Attikon", Athens, Greece
| | - Michael Igoumenidis
- Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - Vassilios Smyrniotis
- University of Athens Medical School, University Hospital "Attikon", Athens, Greece
| | - Andreas Tsounis
- Centers for the Prevention of Addictions and Promoting Psychosocial Health of Municipality of Thessaloniki, Thessaloniki, Greece
| | - Pavlos Sarafis
- Nursing Department, Cyprus University of Technology, Limassol, Cyprus
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Wong JN, McAuley E, Trinh L. Physical activity programming and counseling preferences among cancer survivors: a systematic review. Int J Behav Nutr Phys Act 2018; 15:48. [PMID: 29879993 PMCID: PMC5992647 DOI: 10.1186/s12966-018-0680-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) participation and adherence among cancer survivors is low, despite research indicating numerous physical, psychological and emotional health benefits of exercise. Tailoring exercise programs specific to the PA preferences in cancer survivors has merit for increasing PA participation and adherence to accrue these benefits. This systematic review identifies and differentiates PA programming and counseling preferences of adult cancer survivors across various cancer survivor groups. METHODS PubMed, SPORTDiscus, Scopus, PsycINFO, EMBASE, Web of Science and CINAHL were electronically searched (inception to Oct 2017) and articles were identified using PRISMA guidelines. Two reviewers independently assessed identified articles to determine eligibility and then individually performed a quality assessment on all final studies. Extracted and analyzed data included participant characteristics, interest in exercise counseling and programming, as well as specific exercise and counseling preferences (e.g. location, timing, intensity). RESULTS Forty-one articles were included in this systematic review. Most studies assessed mixed cancer survivor groups or breast cancer survivors. Most cancer survivors felt able and interested in participating in a PA program, though starting a PA program after or before treatment was preferred. Walking was the strongest PA modality preference, and most cancer survivors preferred moderate intensity PA. Cancer survivors also indicated preferences for home-based PA that could take place in the morning. Slight preferences were found towards physical activity counseling delivered by a fitness expert from a cancer center. Both quantitative and qualitative studies were found to be of moderate to high quality based on the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Consolidated Criteria for Reporting Qualitative Research (COREQ), respectively. CONCLUSION Cancer survivors have an interest in participating in PA programs with walking as the primary modality. Additionally, morning-based PA programs that can be tapered to home-based programs are desirable. However, there was wide variation in other PA preference variables, suggesting multiple program options would be beneficial. Many cancer survivors felt interested and able to participate in PA, and therefore designing PA programs that are tailored to cancer survivors is integral for optimizing recruitment and adherence, as well as enhancing health outcomes in cancer survivors.
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Affiliation(s)
- Jaime N. Wong
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6 Canada
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Catt S, Sheward J, Sheward E, Harder H. Cancer survivors’ experiences of a community-based cancer-specific exercise programme: results of an exploratory survey. Support Care Cancer 2018; 26:3209-3216. [DOI: 10.1007/s00520-018-4179-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
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Addington EL, Sohl SJ, Tooze JA, Danhauer SC. Convenient and Live Movement (CALM) for women undergoing breast cancer treatment: Challenges and recommendations for internet-based yoga research. Complement Ther Med 2018; 37:77-79. [PMID: 29609942 DOI: 10.1016/j.ctim.2018.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To conduct a pilot trial of internet-based, cancer-adapted yoga for women receiving breast cancer treatment. DESIGN Women undergoing radiation or chemotherapy for breast cancer were recruited for 12, 75-min, biweekly, cancer-adapted yoga classes delivered via internet-based, multipoint videoconferencing. Data were collected on feasibility and acceptability, including qualitative feedback from participants and the yoga instructor. RESULTS Among 42 women approached, 13 declined eligibility screening, and 23 were ineligible. All 6 women who were eligible provided consent, but 2 withdrew prior to beginning yoga classes. The remaining 4 participants attended 1-11 of 12 online yoga classes. In post-intervention interviews, participants and the instructor agreed that internet-based yoga classes hold great potential for increasing access and improving psychological outcomes in adults with cancer. Qualitative feedback from participants revealed suggestions for future trials of internet-based, cancer-adapted yoga classes, including: continued use of group format; offering more varied class times to accommodate patients' demanding schedules and fluctuating symptoms; enrolling patients after they have acclimated to or completed cancer treatment; streamlining the technology interface; and careful attention to participant burden when designing surveys/forms. The instructor recommended closed session courses, as opposed to rolling enrollment; teaching the same modified poses for all participants, rather than individual tailoring; and using a large screen to allow closer monitoring of students' class experience. CONCLUSIONS Internet delivery may increase patients' access to cancer-adapted yoga classes, but cancer-related and technological barriers remain. This study informs how to optimally design yoga classes, technology, and research procedures to maximize feasibility and acceptability in future trials.
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Affiliation(s)
- Elizabeth L Addington
- Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, 625 N. Michigan Ave., 27th floor, Chicago, IL 60611, United States.
| | - Stephanie J Sohl
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, United States
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Cox-Martin E, Song J, Demark-Wahnefried W, Lyons EJ, Basen-Engquist K. Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors. Support Care Cancer 2018; 26:2387-2395. [PMID: 29423679 DOI: 10.1007/s00520-018-4084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/29/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based). METHODS Secondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data. RESULTS Results identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention. CONCLUSION Although there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.
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Affiliation(s)
- Emily Cox-Martin
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, Aurora, CO, 80045, USA.
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Birmingham, AL, 35233, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-1124, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, 77230-1439, USA
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Hoedjes M, de Kruif A, Mols F, Bours M, Beijer S, Winkels R, Westerman MJ, Seidell JC, Kampman E. An exploration of needs and preferences for dietary support in colorectal cancer survivors: A mixed-methods study. PLoS One 2017; 12:e0189178. [PMID: 29253011 PMCID: PMC5734680 DOI: 10.1371/journal.pone.0189178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To describe the proportion of colorectal cancer (CRC) survivors who perceive a need for dietary support; to examine which socio-demographic, cancer-related, and health-related characteristics are associated with this need; to explore reasons for (not) needing support; and to explore CRC survivors' specific needs and preferences with regard to lifestyle (i.e., dietary, exercise, and/or weight management) support. METHODS This mixed-methods study comprised a cross-sectional survey among 1774 Dutch CRC survivors and three focus groups (n = 16). To examine associations, logistic regression analyses were conducted. Focus groups were audio-taped, transcribed verbatim, and analyzed using a thematic approach. RESULTS Of 1458 respondents (82%), 1198 (67.5%) were included for analyses. 17.5% reported a need for dietary support. Characteristics associated with this need were: being younger, living without a partner, having a stoma, having diabetes, and being overweight or obese. The main reason for needing support was being unable to initiate and maintain lifestyle changes without support. CRC survivors preferred receiving information soon after diagnosis to make an autonomous, informed decision on improving their lifestyle. They preferred to receive individually-tailored lifestyle support in an autonomy-supportive environment, preferably with involvement of their family and fellow-sufferers. CONCLUSIONS This study has provided knowledge on appropriate support for CRC survivors in need for dietary support to improve health outcomes by promoting adherence to lifestyle and body weight recommendations. Findings can be used to better identify CRC survivors in need for dietary support, and to tailor lifestyle support to their needs and preferences in order to promote uptake, adherence, and effectiveness.
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Affiliation(s)
- Meeke Hoedjes
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- * E-mail:
| | - Anja de Kruif
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Floortje Mols
- Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Martijn Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Renate Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Jaap C. Seidell
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
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Abstract
PURPOSE OF REVIEW Due to medical advances and an aging population, the number of cancer survivors continues to rise. Survivors often experience late and long-term sequelae of cancer and its treatment (e.g., fatigue, pain, fear of recurrence, and stress). As a result, some patients have utilized or expressed interest in integrative medicine (IM) modalities for prevention of recurrence, optimizing health, enhancing quality of life, and managing symptoms. The purpose of this review is to focus on research published during the past year that informs our understanding of the utility of IM for cancer survivors. RECENT FINDINGS Physical activity, diet, dietary supplements, mind-body modalities, acupuncture, and massage therapy all may play a role in the management of the physical (e.g., fatigue and pain) and emotional (e.g., anxiety and fear) issues faced by cancer survivors. SUMMARY IM therapies are appealing to and utilized by many cancer survivors and may reduce symptom burden. Clinicians who provide cancer survivorship care may improve patient care by understanding the evidence for and against their use.
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