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Linero-Bocanegra M, García-Conejo C, Ramírez-Pérez L, Cuesta-Vargas AI, Trinidad-Fernández M. Effectiveness of Therapeutic Exercise for Children Undergoing Treatment for Cancer: A Systematic Review: Therapeutic Exercise Children Cancer. Pediatr Phys Ther 2024:00001577-990000000-00094. [PMID: 38980218 DOI: 10.1097/pep.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
PURPOSE To evaluate the effectiveness of therapeutic physical exercise (TPE) interventions on the physical functioning, psychosocial well-being, and quality of life (QoL) of children undergoing treatment for cancer. METHOD Systematic review: databases were searched in April 2023. Selection criteria: children (<18 years old) undergoing treatment for cancer or a malignant neoplasm, randomized controlled trial design, utilization of TPE, and including physical and psychosocial outcomes. Internal validity was measured with Physiotherapy Evidence Database scale. RESULTS Seven randomized controlled trials were included. Most studies showed that strength, fatigue, and QoL improved after the intervention. Cardiorespiratory capacity through 6-minute walk test and physical activity levels were better in the experimental groups. No changes were noted in other variables. CONCLUSIONS This review supports the importance of a TPE program during cancer treatment, with the aim of maintaining physical capacities and counteracting physical inactivity.
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Affiliation(s)
- Miriam Linero-Bocanegra
- Grupo de Investigación Clinimetría F-14, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain (Mss Linero-Bocanegra, García-Conejo, and Ramírez-Pérez, and Drs Cuesta-Vargas and Trinidad-Fernández); Departamento de Fisioterapia, Universidad de Málaga, Málaga, Spain (Mss García-Conejo and Ramírez-Pérez and Drs Cuesta-Vargas and Trinidad-Fernández)
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Bucciarelli V, Bianco F, Bisaccia G, Galanti K, Arata A, Ricci M, Bucciarelli B, Marinelli M, Renda G, Farinetti A, Mattioli AV, Gallina S. Prevention of cardiotoxicity in childhood cancer survivors: In physical exercise, we trust. Curr Probl Cardiol 2024; 49:102722. [PMID: 38908726 DOI: 10.1016/j.cpcardiol.2024.102722] [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: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
In recent years, the mean survival rate of children after a cancer diagnosis has significantly improved. At the same time, a growing interest in short and long-term cardiovascular (CV) complications of cancer therapy, as well as long-term CV risk in childhood cancer survivors (CCS) developed, along with proposals of protocols for the diagnosis, management, and prevention of cancer therapy-related CV toxicity (CTR-CVT) in this population. Many clinical and individual risk factors for CTR-CVT have been identified, and a non-negligible prevalence of traditional CV risk factors has been described in this population, potentially associated with a further worsening in both CTR-CVT and long-term CV risk. Physical exercise (PE) represents a promising, free-of-cost and free-of-complications, helpful therapy for primary and secondary prevention of CTR-CVT in CCS. The present narrative review aims to summarize the most critical evidence available about CTR-CVT in CCS, focusing on the role of PE in this clinical scenario.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy.
| | - Francesco Bianco
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Kristian Galanti
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Allegra Arata
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Mirella Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | | | - Michele Marinelli
- Department of Pediatrics, Marche Polytechnic University, 60123 Ancona, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Alberto Farinetti
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Anna Vittoria Mattioli
- Istituto Nazionale per le Ricerche Cardiovascolari, 40126 Bologna, Italy; Department of Quality of Life Sciences, University of Bologna, 40126 Bologna, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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Ben-Arye E, Samuels N, Seifert G, Gressel O, Peleg R, Jong M. Integrative Medicine Across the Pediatric Cancer Care Trajectory: A Narrative Review. Curr Oncol Rep 2024; 26:714-734. [PMID: 38733465 PMCID: PMC11169001 DOI: 10.1007/s11912-024-01538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF THE REVIEW Children and adolescents with cancer, along with their parents and other informal caregivers, often report using complementary and alternative medicine (CAM) during active oncology and hemato-oncology treatment. Some adopt an "alternative" approach to conventional medical care, which often entails the use of these practices without the knowledge of the treating pediatrician. In contrast, many others search for consultation provided by a pediatric integrative oncology (IO) practitioner working with the conventional medical team. IO seeks to provide evidence-based complementary medicine therapies, many of which have been shown to augment conventional supportive and palliative care, while ensuring the patient's safety. The present narrative review examines the current state of and future direction for the IO setting of care. RECENT FINDINGS A large body of published clinical research supports the effectiveness of leading Pediatric IO modalities, while addressing potential safety-related concerns. Despite the growing amount of clinical research supporting the beneficial effects and implementation of Pediatric IO models of care, there is still a need for further studies in order to establish clinical guidelines in the treatment of children and adolescents with cancer. Such IO-directed guidelines will need to address both the effectiveness and the safety of the CAM modalities being used in pediatric oncology and hemato-oncology settings, promoting a better understanding among pediatric healthcare professionals and helping them understand the indications for referral to the IO treatment service.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Zebulun Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Carmel &, Lin, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Zebulun Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Carmel &, Lin, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Raviv Peleg
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Integrative Pediatric Medicine Program, Petach Tikva, Israel
| | - Miek Jong
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT, Tromsø, Norway
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Kirstin S, Matthias G, Valentin B, Valerie S, Andrea F, Nedelina S, Claus K, Jochen R, Regula E. Cerebral blood flow and structural connectivity after working memory or physical training in paediatric cancer survivors - Exploratory findings. Neuropsychol Rehabil 2024:1-27. [PMID: 38809147 DOI: 10.1080/09602011.2024.2356294] [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: 08/01/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
Paediatric cancer survivors often suffer from cognitive long-term difficulties. Consequently, strengthening cognition is of major clinical relevance. This study investigated cerebral changes in relation to cognition in non-brain tumour paediatric cancer survivors after working memory or physical training compared to a control group. Thirty-four children (≥one-year post-treatment) either underwent eight weeks of working memory training (n = 10), physical training (n = 11), or a waiting period (n = 13). Cognition and MRI, including arterial spin labelling and diffusion tensor imaging, were assessed at three time points (baseline, post-training, and three-month follow-up). Results show lower cerebral blood flow immediately after working memory training (z = -2.073, p = .038) and higher structural connectivity at the three-month follow-up (z = -2.240, p = .025). No cerebral changes occurred after physical training. Short-term changes in cerebral blood flow correlated with short-term changes in cognitive flexibility (r = -.667, p = .049), while long-term changes in structural connectivity correlated with long-term changes in working memory (r = .786, p = .021). Despite the caution given when interpreting data from small samples, this study suggests a link between working memory training and neurophysiological changes. Further research is needed to validate these findings.
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Affiliation(s)
- Schuerch Kirstin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Science, University of Bern, Bern, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Grieder Matthias
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Benzing Valentin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Siegwart Valerie
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federspiel Andrea
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Slavova Nedelina
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Kiefer Claus
- Support Center for Advanced Neuroimaging (SCAN), Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Roessler Jochen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Everts Regula
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Jong MC, Fernee CR, Stenling A, Lown EA, Berntsen S, Victorson DE, Jong M. Protocol of a randomised controlled multicentre trial investigating the effectiveness and safety of a wilderness programme on the mental and physical well-being of adolescents and young adults affected by cancer: the WAYA-2 study. BMJ Open 2024; 14:e087626. [PMID: 38772886 PMCID: PMC11110565 DOI: 10.1136/bmjopen-2024-087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Adolescents and young adults (AYAs) affected by cancer are an understudied group. Effective interventions are needed to support coping with the late effects of cancer, its treatment and to promote quality of life. Nature-based interventions may be promising in support of the self-management and health of AYAs affected by cancer. However, randomised controlled studies (RCTs) on the effectiveness of such interventions are lacking. We performed a first pilot RCT (n=42) that showed that it is feasible and safe to conduct such a study. Here, we propose a full-scale RCT to investigate the effectiveness and safety of a wilderness programme on the mental and physical health of AYAs affected by cancer. METHODS AND ANALYSIS Participants are 150 AYAs affected by cancer, aged 16-39 years, who will be randomised to a wilderness (n=75) or a hotel stay (n=75). The wilderness programme is an 8-day intervention including a 6-day wilderness expedition. This is followed 3 months later by a 4-day intervention including a 2-day basecamp. Activities include hiking, backpacking, kayaking, rock climbing, mindfulness and bush-crafting. The comparison group is an 8-day hotel stay followed by a 4-day hotel stay (interventions include two travel days) at the same hotel after 3 months. Primary outcomes are psychological well-being and nature connectedness up to 1 year after the study start. Secondary outcomes are quality of life, physical activity and safety parameters. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority approved the study protocol on 27 September 2023 (reference: 2023-05247-01). The recruitment started on 19 February 2024 and the first part is planned to end on 31 December 2027. Study results will be disseminated by means of scientific publications, presentations at conferences, popular articles, interviews, chronicles and books. News items will be spread via social media, websites and newsletters. TRIAL REGISTRATION NUMBER ISRCTN93856392.
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
| | - Carina Ribe Fernee
- Department of Child and Adolescent Mental Health, Sorlandet Hospital Kristiansand, Kristiansand, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Andreas Stenling
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Psychology, Umeå University, Umea, Sweden
| | - E Anne Lown
- Department of Social & Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - David E Victorson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Caru M, Dandekar S, Gordon B, Conroy DE, Barb ED, Doerksen SE, Smink GM, McKeone DJ, Shah NB, Greiner RJ, Schramm JW, Rao P, McGregor L, Schmitz KH. Implementing a behavioral physical activity program in children and adolescent survivors of childhood cancer: a pilot randomized controlled trial. J Behav Med 2024:10.1007/s10865-024-00497-z. [PMID: 38735024 DOI: 10.1007/s10865-024-00497-z] [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: 12/05/2023] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
Purpose We aimed to document the acceptability (enrollment rate) and feasibility (phone call delivery rate) of implementing a behavioral PA intervention over 12 weeks, in addition to documenting its effects on patient-reported outcomes and physical functioning. This study also describes the costs of carrying out a behavioral PA intervention. A total of 40 participants were randomized in a 1:1 ratio. The tailored behavioral PA intervention was developed based on the most recent PA guidelines in pediatric oncology and on the COM-B framework to enact PA behavior changes. The prescription (frequency, intensity, time and type (FITT)) was adjusted each week during the weekly support calls. The control group did not receive the intervention. 26 males and 14 females (13.6 years old on average and 2.9 years post-cancer treatment on average) participated in our study. The acceptability rate was 90.9% and the feasibility rate was > 85%. We found that 85% improved PA frequency, 80% improved PA intensity, 100% improved PA time, and 50.0% achieved the recommended PA guidelines. No adverse events were reported over the duration of the intervention. Physical function improved with longer 6-minute walk distances in the intervention group (465.8 ± 74.5 m) than in the control group (398.7 ± 92.9 m) (p = 0.016). PROs scores for all participants were within the limits of the normal range. The estimated cost per participant of carrying out this intervention was USD $126.57. Our 12-week behavioral PA intervention, based on the COM-B framework, was found to be acceptable, feasible and safe in childhood cancer survivors. This study is an important step in the right direction to make exercise standard practice in pediatric oncology.
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Affiliation(s)
- Maxime Caru
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA.
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA.
| | - Smita Dandekar
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Brett Gordon
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - David E Conroy
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Emily D Barb
- School of Kinesiology, Pennsylvania State University-Harrisburg, Middletown, PA, USA
| | - Shawna E Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gayle M Smink
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Daniel J McKeone
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Nidhi B Shah
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Robert J Greiner
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Joseph W Schramm
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Pooja Rao
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Lisa McGregor
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA
| | - Kathryn H Schmitz
- School of Kinesiology, Pennsylvania State University-Harrisburg, Middletown, PA, USA
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Ross A, Gunasekera R, Rowley D. Run, walk, cheer or volunteer: a patient and public involvement survey. BMJ Open Sport Exerc Med 2024; 10:e001712. [PMID: 38410411 PMCID: PMC10895219 DOI: 10.1136/bmjsem-2023-001712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Background Children with chronic diseases have been reported to participate in less regular physical activity (PA) than peers without chronic diseases; and less than recommended in guidelines. Sheffield Children's Foundation Trust (SCFT) is an Active Hospitals pilot site, exploring options to facilitate PA for all children. One option is collaboration with Junior Parkrun: a free, weekly 2 km running event for children. The team investigated whether Junior Parkrun was of interest to guardians of children attending SCFT to increase PA. Aims This patient and public involvement survey assessed perceptions of PA for children attending SCFT according to their accompanying guardians. This will inform a possible collaboration between SCFT and Junior Parkrun. Methods A three-part, 14-question survey was developed, including demographics (age, ethnicity, postcode); perceptions of PA (barriers and facilitators); PA behaviours self-reported on Likert scales; and perceptions of Junior Parkrun. Guardians were asked whether they and their child would be interested in attending Junior Parkrun with SCFT staff support. This was distributed to guardians of children attending outpatient appointments. Results 126 guardians responded. The average age of child was 10 years 10 months. 29.1% of guardians supported daily PA for their child. Almost half of respondents reported their child would be interested in attending Junior Parkrun. Of those not interested, the most common reason was travel. Conclusion The findings highlighted PA barriers perceived by guardians, and identified that almost half of respondents would be interested in attending Junior Parkrun. A collaboration between Junior Parkrun and SCFT could be explored.
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Affiliation(s)
- Alexandra Ross
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Deborah Rowley
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Di Martino G, della Valle C, Centorbi M, Buonsenso A, Fiorilli G, Calcagno G, Iuliano E, di Cagno A. Enhancing Behavioural Changes: A Narrative Review on the Effectiveness of a Multifactorial APP-Based Intervention Integrating Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:233. [PMID: 38397722 PMCID: PMC10888703 DOI: 10.3390/ijerph21020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
The rapid evolution of technologies is a key innovation in the organisation and management of physical activities (PA) and sports. The increase in benefits and opportunities related to the adoption of technologies for both the promotion of a healthy lifestyle and the management of chronic diseases is evident. In the field of telehealth, these devices provide personalised recommendations, workout monitoring and injury prevention. The study aimed to provide an overview of the landscape of technology application to PA organised to promote active lifestyles and improve chronic disease management. This review identified specific areas of focus for the selection of articles: the utilisation of mobile APPs and technological devices for enhancing weight loss, improving cardiovascular health, managing diabetes and cancer and preventing osteoporosis and cognitive decline. A multifactorial intervention delivered via mobile APPs, which integrates PA while managing diet or promoting social interaction, is unquestionably more effective than a singular intervention. The main finding related to promoting PA and a healthy lifestyle through app usage is associated with "behaviour change techniques". Even when individuals stop using the APP, they often maintain the structured or suggested lifestyle habits initially provided by the APP. Various concerns regarding the excessive use of APPs need to be addressed.
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Affiliation(s)
- Giulia Di Martino
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Carlo della Valle
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
- Department of Neurosciences, Biomedicine and Movement, University of Verona, 37129 Verona, Italy
| | - Marco Centorbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Andrea Buonsenso
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Giovanni Fiorilli
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Giuseppe Calcagno
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (G.D.M.); (C.d.V.); (M.C.); (A.B.); (G.F.)
| | - Enzo Iuliano
- Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic;
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
| | - Alessandra di Cagno
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
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Hammoud RA, Mulrooney DA, Rhea IB, Yu C, Johnson JN, Chow EJ, Ehrhardt MJ, Hudson MM, Ness KK, Armstrong GT, Dixon SB. Modifiable Cardiometabolic Risk Factors in Survivors of Childhood Cancer: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:16-32. [PMID: 38510292 PMCID: PMC10950443 DOI: 10.1016/j.jaccao.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 03/22/2024] Open
Abstract
The growing community of childhood cancer survivors faces a heavy burden of late onset morbidities and mortality, with cardiovascular diseases being the leading noncancer cause. In addition to demographics and cancer treatment exposures, which cannot be altered, cardiometabolic risk factors (obesity, hypertension, diabetes, and dyslipidemia) and frailty potentiate the risk of morbidity and mortality associated with chronic health conditions. Important opportunities exist to target these risk factors and improve late health outcomes for survivors. Unfortunately, limited evidence exists on the optimal methods to prevent, screen, and treat cardiometabolic risk factors among survivors, resulting in significant underdiagnosis and undertreatment. In this review, we discuss the prevalence of, risk factors for, current survivor-specific recommendations, and gaps in knowledge to mitigate potentially modifiable cardiometabolic risk factors and frailty among survivors of childhood cancer.
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Affiliation(s)
- Rawan A. Hammoud
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Isaac B. Rhea
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christine Yu
- Department of Pediatric Medicine, Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jason N. Johnson
- Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Eric J. Chow
- Fred Hutchinson Cancer Center, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA
| | - Matthew J. Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephanie B. Dixon
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Salam RA, Khan MH, Meerza SSA, Das JK, Lewis-Watts L, Bhutta ZA. An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents. Nat Med 2024; 30:290-301. [PMID: 38195753 DOI: 10.1038/s41591-023-02737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.
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Affiliation(s)
- Rehana A Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Maryam Hameed Khan
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Saqlain Ali Meerza
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
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11
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Jeon M, Jang H, Jeon H, Park CG, Kim S. Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records. Support Care Cancer 2023; 32:29. [PMID: 38099981 PMCID: PMC10724335 DOI: 10.1007/s00520-023-08202-7] [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: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Because the population of older gastric cancer survivors (GCSs) is growing, understanding the long-term late effects experienced by these GCSs and their impact on survival outcomes is crucial for optimizing survivorship care. This study aims to identify and characterize these effects and investigate their association with survival outcomes. METHODS A retrospective analysis of electronic health records was conducted on 9,539 GCSs diagnosed between 2011 and 2017. The GCSs were divided into two age groups (< 65 and ≥ 65 years) and the long-term late effects were categorized by age using Cox proportional hazard models. The impact of clinical factors and age-specific late effects on survival was evaluated in the older GCSs. RESULTS Among the total GCSs, 37.6% were over and 62.4% were under 65 years of age. Significant differences between the age groups were observed in the cumulative hazard ratios (HRs) for iron and vitamin B12 levels and prognostic nutritional index (PNI) scores. In older GCSs, abnormal iron levels (HR 1.98, 95% CI 1.16-3.41, p = .013) and poor PNI scores (HR 1.59, 95% CI 1.03-2.47, p = .038) were associated with poorer survival outcomes. Additionally, being female was identified as a risk factor for lower survival rates (if male, HR 0.42, 95% CI 0.18-0.98, p = .045). CONCLUSION This study highlights the typical long-term late effects experienced by older GCSs. By tailoring survivorship care to address nutritional-, age-, and gender-related factors, the overall survival and quality of life of older GCSs can be improved.
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Affiliation(s)
- Misun Jeon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Hyoeun Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Heejung Jeon
- Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Chang Gi Park
- College of Nursing, University of Illinois, Chicago, IL, USA
| | - Sanghee Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
- Department of Artificial Intelligence, College of Computing, Yonsei University, Seoul, South Korea.
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12
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Rojulpote KV, Smith ML, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Widjaja E. Pre-Operative Predictors of Health-Related Quality of Life Two Years After Pediatric Epilepsy Surgery: A Prospective Cohort Study. Seizure 2023; 111:196-202. [PMID: 37683452 DOI: 10.1016/j.seizure.2023.08.016] [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: 07/14/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Seizure freedom is an important predictor of health-related quality of life (HRQOL) after pediatric epilepsy surgery. This study aimed to identify the pre-operative predictors of HRQOL 2 years after epilepsy surgery in children with drug-resistant epilepsy. METHODS This multicenter prospective cohort study assessed pre-operative predictors including child (demographics and clinical variables), caregiver (including caregiver depressive and anxiety symptoms) and family characteristics. HRQOL was assessed using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55 pre-operatively and 2-years after surgery. Univariable linear regression analyses were done to identify significant preoperative predictors of HRQOL 2-years after surgery, followed by multivariable regression. RESULTS Ninety-five children underwent surgery, mean age was 11.4 (SD=4.2) years, and 59 (62%) were male. Mean QOLCE scores were 57.4 (95%CI: 53.8, 61.0) pre-operatively and 65.6 (95%CI: 62.0, 69.1) after surgery. Univariable regression showed fewer anti-seizure medications (ß=-6.1 [95%CI: -11.2, -1.0], p = 0.019), older age at seizure onset (ß=1.6 [95%CI: 0.8, 2.4], p<0.001), higher pre-operative HRQOL (ß=0.7 [95%CI: 0.5, 0.8], p<0.001), higher family resources (ß=0.6 [95%CI: 0.3, 0.9], p<0.001), better family relationships (ß=1.7 [95%CI: 0.3, 3.1], p = 0.017) and lower family demands (ß=-0.9 [95%CI: -1.5, -0.4], p<0.001) were associated with higher HRQOL after surgery. Caregiver characteristics did not predict HRQOL after surgery (p>0.05). Multivariable regression showed older age at seizure onset (ß=4.6 [95%CI: 1.6, 7.6], p = 0.003) and higher pre-operative HRQOL (ß=10.2 [95%CI: 6.8, 13.6], p<0.001) were associated with higher HRQOL after surgery. CONCLUSION This study underscores the importance of optimizing pre-operative HRQOL to maximize HRQOL outcome after pediatric epilepsy surgery.
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Affiliation(s)
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada; Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Philippe Major
- Division of Neurology, Department of Neurosciences, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Ste-Justine Hospital, University of Montreal, QC, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada; Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Andrea Andrade
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, Lurie Children's Hospital, Chicago, IL, USA.
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13
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Rueegg CS, Zürcher SJ, Schindera C, Jung R, Deng WH, Bänteli I, Schaeff J, Hebestreit H, von der Weid NX, Kriemler S. Effect of a 1-year physical activity intervention on cardiovascular health in long-term childhood cancer survivors-a randomised controlled trial (SURfit). Br J Cancer 2023; 129:1284-1297. [PMID: 37653075 PMCID: PMC10575964 DOI: 10.1038/s41416-023-02410-y] [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: 04/05/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) assessed the effect of a 1-year, partially supervised, physical activity (PA) intervention on a cardiovascular disease (CVD) risk score in adult survivors of childhood cancer. METHODS We included childhood cancer survivors ≥16 y at enrolment, <16 y at diagnosis and ≥5 y in remission. The intervention group was asked to perform an additional ≥2.5 h of intense physical activity/week, controls continued exercise as usual; assessments were performed at baseline, 6 months (T6) and 12 months (T12). The primary endpoint was change in a CVD risk score (average z-score of waist circumference, blood pressure, fasting glucose, inverted high-density lipoprotein cholesterol, triglycerides, and inverted cardiorespiratory fitness) from baseline to T12. We performed intention-to-treat (ITT, primary) and 3 per protocol analyses. RESULTS We randomised 151 survivors (44% females, 30.4 ± 8.6 years). We found a significant and robust reduction of the CVD risk score in the intervention compared to the control group at T6 and T12 across all analyses; with a difference in the reduction of the CVD risk z-score of -0.18 (95% confidence interval -0.29 to -0.06, P = 0.003) at T12 in favour of the intervention group (ITT analysis). CONCLUSIONS This RCT showed that a long-term PA intervention can reduce CVD risk in long-term survivors of childhood cancer. TRIAL REGISTRATION Clinicaltrials.gov: NCT02730767.
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Grants
- Swiss Cancer League (KLS-3175-02-2013), the “Stiftung für krebskranke Kinder, Regio Basiliensis”, “Gedächtnis-Stiftung Susy Rückert zur Krebsbekämpfung”, “Taecker-Stiftung für Krebsforschung”, “Stiftung Henriette & Hans-Rudolf Dubach-Bucher”, “Stiftung zur Krebsbekämpfung”, “Stiftung Krebs-Hilfe Zürich”, “Fondation Recherche sur le Cancer de l'Enfant (FORCE)”, and Fond’Action contre le Cancer. CSR has received funding from the European Union Seventh Framework Programme (FP7-PEOPLE-2013-COFUND) under grant agreement n°609020-Scientia Fellows. WHD is paid by a research grant from the South-Eastern Norway Regional Health Authority (grant number 2019039, to CSR).
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Affiliation(s)
- Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
| | - Simeon J Zürcher
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD) and University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Schindera
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ruedi Jung
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wei H Deng
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Iris Bänteli
- Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Jonathan Schaeff
- Pediatric Department, University Hospital Augsburg, Augsburg, Germany
| | - Helge Hebestreit
- Pediatric Department, University Hospital, Julius-Maximilians University, Würzburg, Germany
| | - Nicolas X von der Weid
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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14
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Dixon SB, Liu Q, Chow EJ, Oeffinger KC, Nathan PC, Howell RM, Leisenring WM, Ehrhardt MJ, Ness KK, Krull KR, Mertens AC, Hudson MM, Robison LL, Yasui Y, Armstrong GT. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet 2023; 401:1447-1457. [PMID: 37030315 PMCID: PMC10149583 DOI: 10.1016/s0140-6736(22)02471-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND 5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk. METHODS In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death ≥5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated. FINDINGS 40-year cumulative all-cause mortality was 23·3% (95% CI 22·7-24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values ≤0·002). INTERPRETATION Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis, due to many of the leading causes of death in the US population. Modifiable lifestyle and cardiovascular risk factors associated with reduced risk for late mortality should be part of future interventions. FUNDING US National Cancer Institute and the American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Eric J Chow
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy M Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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15
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Qiu L, Ye M, Tong Y, Jin Y. Promoting physical activity among cancer survivors: an umbrella review of systematic reviews. Support Care Cancer 2023; 31:301. [PMID: 37097500 PMCID: PMC10129958 DOI: 10.1007/s00520-023-07760-0] [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: 07/31/2022] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Exercise is the core element of rehabilitation for cancer patients. However, most of the patients' exercise levels failed to meet the indicators recommended by the guidelines or even decreased. Therefore, this umbrella review aims to provide an overview of review articles addressing the evidence of interventions to promote physical activity behavior change and increase physical activity among cancer patients. METHODS We searched nine databases from inception to 12 May 2022 to obtain systematic reviews and meta-analyses of interventions to promote physical activity among cancer patients. The AMSTAR-2 was used for the quality assessment. RESULTS Twenty-six individual systematic reviews including 13 studies performed meta-analyses. A total of 16 studies' designs were all in randomized controlled trial. Most reviews included studies that were mainly delivered in home settings. The most frequent and mean duration of the interventions was 12 weeks. Interventions mainly included electronic, wearable health technology-based, behavior change techniques (BCTs), and theory-based strategies. CONCLUSIONS Electronic, wearable health technology-based, BCTs, and theory-based interventions were effective and feasible in promoting physical activity in cancer survivors. Clinical practitioners should take corresponding intervention measures according to the characteristics of patients in different groups. IMPLICATIONS FOR CANCER SURVIVORS Future research may benefit cancer survivors by more comprehensively applying electronic, wearable health technology-based, BCTs, and theory-based interventions.
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Affiliation(s)
- Lin Qiu
- Department of Nursing, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maodie Ye
- Department of Nursing, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Tong
- Department of Nail-Breast Hernia Surgery, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongmei Jin
- Department of Nursing, 7Th Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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16
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Buro AW, Sauls R, Stern M, Carson TL. A qualitative study of stress experiences, health behaviors, and intervention preferences in young adult cancer survivors. Support Care Cancer 2023; 31:295. [PMID: 37093353 PMCID: PMC10123481 DOI: 10.1007/s00520-023-07756-w] [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: 12/02/2022] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To inform behavioral intervention development, this study examined experiences and unmet needs related to stress, diet, and physical activity in young adult (YA) cancer survivors. METHODS Twenty-three semi-structured interviews were conducted with a purposive sample of YA cancer survivors (n = 12 aged 18-29 years; n = 11 aged 30-39 years; 57% racial or ethnic minority) between May and July 2022 via Zoom. Data were analyzed using a coding reliability approach to thematic analysis. RESULTS Stressor-related themes included health and health care, economic stability, social and community context, and balancing responsibilities. Transition to independent adulthood was discussed among younger participants (18-29 years). Coping-related themes included letting go, keeping anchored in faith, and distraction. Older participants (30-39 years) reported more diverse coping strategies. Routine and consistency and the impact of stress were themes aligning with health behaviors. Control was a cross-cutting theme regarding stressors, coping, and health behaviors. Themes related to intervention preferences included individualized approach, expert-based content, peer support, integrative self-care, and manageability. Younger participants preferred multiple intervention formats (e.g., website, tracking logs). CONCLUSIONS Findings highlighted unmet needs regarding social and environmental stressors in YA cancer survivors and a preference for individualized, expert-based content and peer support in stress management-enhanced behavioral interventions. Such interventions may be tailored for specific age groups to account for differences in stress experiences and intervention preferences.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
| | - Rachel Sauls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Marilyn Stern
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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17
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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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18
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Joseph LL, Srinivasan HN, Robert M, Boddu D, John R, Mathew LG, Totadri S. The Nutritional Trajectory of Children with Acute Lymphoblastic Leukemia: A 10-Year Follow up Study from a Referral Center in South India. Nutr Cancer 2023; 75:678-684. [PMID: 36444754 DOI: 10.1080/01635581.2022.2152194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to late adverse events such as obesity and an associated metabolic syndrome. METHODS Children treated for ALL from 2002 to 2012 were included. BMI was calculated at diagnosis, end of treatment, and 5, 8, and 10-years from diagnosis. BMI-centiles were used to categorize the patients: underweight (<5th-percentile), normal (5th-85th percentile), overweight (85th-95th percentile), and obese (≥95th centile). RESULTS The study included 179 children with ALL (median age: 59-months). The proportions of patients who were underweight, normal, overweight/obese, were 37%, 56% and 7%, respectively, at diagnosis; and 15%, 51% and 34%, respectively, at 5-years from diagnosis. The median (IQR) BMI Z-score at diagnosis was -1.12(-2.40, -0.26). The median (IQR) BMI z-score of the cohort was higher after 5 [0.22(-0.83,1.24), P < 0.001] and 10-years of diagnosis [0.30(-0.69,0.99), P < 0.001], respectively. The proportion of overweight/obese individuals was higher after 5 (34%, P < 0.001) and 10 (26%, P = 0.001) years. There was a significant correlation between the baseline BMI Z-score and that observed after 5-years (ρ = 0.49, P < 0.001), and 10-years (ρ = 0.55, P < 0.001). CONCLUSION At 10-years of follow-up, >25% of children with ALL were overweight/obese. The BMI Z-score at the time of diagnosis continued to correlate with the Z-score after 10-years.
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Affiliation(s)
- Leenu Lizbeth Joseph
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Hema Nalapullu Srinivasan
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Magdalenal Robert
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Deepthi Boddu
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Rikki John
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Leni Grace Mathew
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
| | - Sidharth Totadri
- Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College, Vellore, India
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19
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Williams AM, Mandelblatt J, Wang M, Armstrong GT, Bhakta N, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Mulrooney DA, Small BJ, Wang Z, Srivastava D, Robison LL, Hudson MM, Ness KK, Krull KR. Premature aging as an accumulation of deficits in young adult survivors of pediatric cancer. J Natl Cancer Inst 2023; 115:200-207. [PMID: 36370084 PMCID: PMC9905971 DOI: 10.1093/jnci/djac209] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to characterize premature aging as an accumulation of deficits in survivors of pediatric cancer compared with community controls and examine associations with host and treatment factors, neurocognition, and mortality. METHODS Pediatric cancer survivors (n = 4000, median age = 28.6, interquartile range [IQR] = 23-35 years; 20 years postdiagnosis: IQR = 15-27), and community participants without a history of cancer serving as controls (n = 638, median age = 32, IQR = 25-40 years) completed clinical assessments and questionnaires and were followed for mortality through April 30, 2020 (mean [SD] follow-up = 7.0 [3.4] years). A deficit accumulation index (DAI) score was calculated from 44 aging-related items including self-reported daily function, psychosocial symptoms, and health conditions. Items were weighted from 0 (absent) to 1 (present and/or most severe), summed and divided by the total yielding a ratio (higher = more deficits). Scores less than 0.20 are robust, and 0.06 is a clinically meaningful difference. Linear regression compared the DAI in survivors and controls with an age*survivor or control interaction. Logistic regression and Cox-proportional hazards estimated the risk of neurocognitive impairment and death. Models were minimally adjusted for age, sex, and race and ethnicity. RESULTS The adjusted mean DAI among survivors at age 30 years was 0.16 corresponding to age 63 years in controls (33 years premature aging; β = 0.07, 95% confidence interval [CI] = 0.06 to 0.08; P < .001). Cranial and abdominal radiation, alkylators, platinum, and neurosurgery were associated with worse DAI (P ≤ .001). Higher scores were associated with increased risk of neurocognitive impairment in all domains (P < .001) and increased risk of death (DAI = 0.20-0.35, hazard ratio = 2.80, 95% CI = 1.97 to 3.98; DAI ≥ 0.35, hazard ratio = 5.08, 95% CI = 3.52 to 7.34). CONCLUSION Pediatric cancer survivors experience clinically significant premature aging. The DAI may be used to identify survivors at greatest risk of poor health outcomes.
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Affiliation(s)
- AnnaLynn M Williams
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Current affiliation: Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | | | - Mingjuan Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Physical activity and exercise for cancer-related cognitive impairment among individuals affected by childhood cancer: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:47-58. [PMID: 36309037 DOI: 10.1016/s2352-4642(22)00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals affected by childhood cancer can have cognitive dysfunction that persists into adulthood and negatively affects quality of life. In this study, we aimed to evaluate the effects of physical activity and exercise on cognitive function among individuals affected by childhood cancer. METHODS In this systematic review and meta-analysis, we searched seven databases (CINAHL Plus, Cochrane Library, Embase, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) for randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) published (or registered) from database inception to Jan 30, 2022, with no language restrictions. We included studies that compared the effects of physical activity or exercise interventions with controls (no intervention or usual care) on cognitive function among individuals diagnosed with any type of cancer at age 0-19 years. Two reviewers (JDKB and FR) independently screened records for eligibility and searched references of the selected studies; extracted study-level data from published reports; and assessed study risk of bias of RCTs and NRSIs using the Cochrane risk of bias tool for randomised trials (RoB 2) and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tools, certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and any adverse events. We used intention-to-treat data and unpublished data if available. Cognitive function was assessed by standardised cognitive performance measures (primary outcome) and by validated patient-reported measures (secondary outcome). A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates (Hedges' g) and 95% CI values. We estimated the heterogeneity variance by the restricted maximum likelihood method and calculated I2 values to measure heterogeneity. We examined funnel plots and used Egger's regression test to assess for publication bias. This study is registered with PROSPERO, CRD42021261061. FINDINGS We screened 12 425 titles and abstracts, which resulted in full-text assessment of 131 potentially relevant reports. We evaluated 22 unique studies (16 RCTs and six NRSIs) with data on 1277 individuals affected by childhood cancer and low-to-moderate risk of bias. Of the 1277 individuals, 674 [52·8%] were male and 603 [47·2%] were female; median age at study start was 12 (IQR 11-14) years, median time since the end of cancer treatment was 2·5 (IQR -1·1 to 3·0) years, and median intervention period was 12 [IQR 10-24] weeks. There was moderate-quality evidence that, compared with control, physical activity and exercise improved cognitive performance measures (five RCTs; Hedges' g 0·40 [95% CI 0·07-0·73], p=0·027; I2=18%) and patient-reported measures of cognitive function (13 RCTs; Hedges' g 0·26 [0·09-0·43], p=0·0070; I2=40%). No evidence of publication bias was found. Nine mild adverse events were reported. INTERPRETATION There is moderate-certainty evidence that physical activity and exercise improves cognitive function among individuals affected by childhood cancer, which supports the use of physical activity for managing cancer-related cognitive impairment. FUNDING Research Impact Fund of Research Grants Council of the Hong Kong University Grants Committee (R7024-20) and Seed Fund for Basic Research of the University of Hong Kong. COPYRIGHT © 2022 Published by Elsevier Ltd. All rights reserved.
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Promoting Physical Activity Among Childhood Cancer Survivors: The Way Forward. Cancer Nurs 2023; 46:86-87. [PMID: 36449988 DOI: 10.1097/ncc.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Brackmann LK, Foraita R, Schwarz H, Galetzka D, Zahnreich S, Hankeln T, Löbrich M, Poplawski A, Grabow D, Blettner M, Schmidberger H, Marron M. Late health effects and changes in lifestyle factors after cancer in childhood with and without subsequent second primary cancers – the KiKme case-control study. Front Oncol 2022; 12:1037276. [PMID: 36324589 PMCID: PMC9618813 DOI: 10.3389/fonc.2022.1037276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Improved treatments for childhood cancer result in a growing number of long-term childhood cancer survivors (CCS). The diagnosis and the prevalence of comorbidities may, however, influence their lifestyle later in life. Nonetheless, little is known about differences in late effects between CCS of a first primary neoplasm (FPN) in childhood and subsequent second primary neoplasms (SPN) and their impact on lifestyle. Therefore, we aim to investigate associations between the occurrence of FPN or SPN and various diseases and lifestyle in the later life of CCS. Methods CCS of SPN (n=101) or FPN (n=340) and cancer-free controls (n=150) were matched by age and sex, and CCS additionally by year and entity of FPN. All participants completed a self-administered questionnaire on anthropometric and socio-economic factors, medical history, health status, and lifestyle. Mean time between FPN diagnosis and interview was 27.3 years for SPN and 26.2 years for FPN CCS. To confirm results from others and to generate new hypotheses on late effects of childhood cancer as well as CCS´ lifestyles, generalized linear mixed models were applied. Results CCS were found to suffer more likely from diseases compared to cancer-free controls. In detail, associations with cancer status were observed for hypercholesterinemia and thyroid diseases. Moreover, CCS were more likely to take regular medication compared to controls. A similar association was observed for CCS of SPN compared to CCS of FPN. In contrast to controls, CCS rarely exercise more than 5 hours per week, consumed fewer soft and alcoholic drinks, and were less likely to be current, former, or passive smokers. Additionally, they were less likely overweight or obese. All other exploratory analyses performed on cardiovascular, chronic lung, inflammatory bone, allergic, and infectious diseases, as well as on a calculated health-score revealed no association with tumor status. Conclusion CCS were more affected by pathologic conditions and may consequently take more medication, particularly among CCS of SPN. The observed higher disease burden is likely related to the received cancer therapy. To reduce the burden of long-term adverse health effects in CCS, improving cancer therapies should therefore be in focus of research in this area.
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Affiliation(s)
- Lara Kim Brackmann
- Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Ronja Foraita
- Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Heike Schwarz
- Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University, Mainz, Germany
| | - Markus Löbrich
- Radiation Biology and deoxyribonucleic acid (DNA) Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Desiree Grabow
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Manuela Marron
- Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- *Correspondence: Manuela Marron,
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Misiąg W, Piszczyk A, Szymańska-Chabowska A, Chabowski M. Physical Activity and Cancer Care—A Review. Cancers (Basel) 2022; 14:cancers14174154. [PMID: 36077690 PMCID: PMC9454950 DOI: 10.3390/cancers14174154] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary The aim of this paper is to outline the role and potential benefits of physical activity for cancer patients. We present a review of publications on the subject in order to compare the findings reported in the literature and draw general conclusions that could help clinicians who provide cancer care to develop a more comprehensive treatment approach. This review may also help patients overcome barriers and become more motivated to take up physical activity, which would improve their quality of life. We wish to demonstrate to patients that physical activity should not be regarded as a burdensome medical recommendation but rather as a factor that can reduce the risk of cancer mortality and recurrence. Abstract In 2020, 19.3 million new cancer cases were diagnosed, and almost 10 million deaths from cancer were recorded. Cancer patients may experience fatigue, depression, anxiety, reduced quality of life and sleep problems. Cancer treatments cause numerous side effects and have a negative impact on all body systems. Physical activity is important for cancer patients. The aim of this review is to analyse recent studies on the role of physical activity in cancer patients and emphasize its importance. The review included 36 papers published in English between 2017 and 2021. The findings from these studies show that physical activity decreases the severity of side effects of cancer treatment, reduces fatigue, improves quality of life, has a positive impact on mental health and improves aerobic fitness in cancer patients. Moreover, it reduces the risk of cancer recurrence and death. Physical activity is recommended for patients with any type of cancer and at all stages of treatment. The type of physical activity should depend on the condition of the individual patient. It is extremely difficult to determine what type, intensity and duration of physical activity is likely to have the greatest effect.
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Affiliation(s)
- Weronika Misiąg
- Student Research Club No. 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Piszczyk
- Student Research Club No. 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Szymańska-Chabowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland
- Correspondence: ; Tel.: +48-691-097-454
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Schulte F, Chen Y, Yasui Y, Ruiz ME, Leisenring W, Gibson TM, Nathan PC, Oeffinger KC, Hudson MM, Armstrong GT, Robison LL, Krull KR, Huang IC. Development and Validation of Models to Predict Poor Health-Related Quality of Life Among Adult Survivors of Childhood Cancer. JAMA Netw Open 2022; 5:e2227225. [PMID: 35976647 PMCID: PMC9386537 DOI: 10.1001/jamanetworkopen.2022.27225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Risk prediction models are important to identify survivors of childhood cancer who are at risk of experiencing poor health-related quality of life (HRQOL) as they age. OBJECTIVE To develop and validate prediction models for a decline in HRQOL among adult survivors of childhood cancer. DESIGNS, SETTING, AND PARTICIPANTS This prognostic study included 4755 adults from the Childhood Cancer Survivor Study (CCSS) diagnosed between January 5, 1970, and December 31, 1986, who completed baseline (time 0 [November 3, 1992, to August 28, 2003]) and 2 follow-up (time 1 [February 12, 2002, to May 21, 2005] and time 2 [January 6, 2014, to November 30, 2016]) surveys. Data were analyzed from June 19, 2019, to February 2, 2022. EXPOSURES Sociodemographic, lifestyle, and emotional factors, and chronic health conditions (CHCs) were assessed at time 0 and time 1, and neurocognitive factors were assessed at time 1 to predict HRQOL at time 2 and a decline in HRQOL between time 1 and time 2. Impaired health states were defined as CHC grades 2 to 4 using the modified Common Terminology Criteria for Adverse Events, version 4.03, and mental and neurocognitive status as 1 SD or more below reference levels. MAIN OUTCOMES AND MEASURES Health-related quality of life was operationalized using the Medical Outcomes Study 36-Item Short Form Health Survey Physical (PCS) and Mental (MCS) Component Summary and classified by optimal (≥40) or suboptimal (<40) at each point (main outcome). A decline in HRQOL was defined as a change from optimal to suboptimal between time 1 and time 2. Multivariable logistic regression identified factors associated with HRQOL decline. The cohort was randomly split into training (80%) and test (20%) data sets for model development and validation; the area under the receiver operating characteristic curve was used to evaluate prediction performance. RESULTS A total of 4755 adults (mean [SD] age at time 0, 24.3 [7.6] years; 2623 [55.2%] women) were included in the analysis. Between time 1 and time 2, 285 of 3294 survivors (8.7%) had declining PCS and 278 of 3294 (8.4%) had declining MCS. Risk factors associated with PCS decline included female sex (odds ratio [OR], 1.67 [95% CI, 1.25-2.24]), family income less than $20 000 vs $80 000 or more (OR, 2.00 [95% CI, 1.21-3.30]), presence of CHCs (OR for neurological, 2.16 [95% CI, 1.51-3.10]; OR for endocrine, 2.25 [95% CI, 1.44-3.52]; OR for gastrointestinal tract, 1.89 [95% CI, 1.32-2.69]; OR for respiratory, 1.66 [95% CI, 1.06-2.59]; OR for cardiovascular, 1.53 [95% CI, 1.14-2.06]), and depression (OR, 1.79 [95% CI, 1.20-2.67]). Risk factors associated with MCS decline included unemployment vs full-time employment (OR, 1.68; [95% CI, 1.19-2.38]), current vs never cigarette smoking (OR, 2.03 [95% CI, 1.37-3.00]), depression (OR, 4.29 [95% CI, 2.44-7.55]), somatization (OR, 1.63 [95% CI, 1.05-2.53]), impaired task efficiency (OR, 1.90 [95% CI, 1.34-2.68]), and impaired organization (OR, 1.67 [95% CI, 1.12-2.48]). The areas under the receiver operating characteristic curve for the test models were 0.74 (95% CI, 0.67-0.81) for declining PCS and 0.68 (95% CI, 0.60-0.75) for declining MCS. CONCLUSIONS AND RELEVANCE In this prognostic study of adult survivors of childhood cancer who experienced declining HRQOL, CHCs were associated with a decline in physical HRQOL, whereas current smoking and emotional and neurocognitive impairment were associated with a decline in mental HRQOL. These findings suggest that interventions targeting modifiable risk factors are needed to prevent poor HRQOL in this population.
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Affiliation(s)
- Fiona Schulte
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Yan Chen
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Maritza E. Ruiz
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children’s & Women’s Hospital Long Beach,Long Beach, California
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Todd M. Gibson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Paul C. Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
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Devine KA, Kwok G. Improving Physical Activity in Pediatric Cancer Survivors-Engaging Parents. JAMA Netw Open 2022; 5:e2219327. [PMID: 35699961 DOI: 10.1001/jamanetworkopen.2022.19327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katie A Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Gary Kwok
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Cheung AT, Li WHC, Ho LLK, Chan GCF, Lam HS, Chung JOK. Efficacy of Mobile Instant Messaging-Delivered Brief Motivational Interviewing for Parents to Promote Physical Activity in Pediatric Cancer Survivors: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2214600. [PMID: 35699959 PMCID: PMC9198728 DOI: 10.1001/jamanetworkopen.2022.14600] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Physical activity has beneficial effects that mitigate cancer- and treatment-related late effects. However, children who survive cancer are often physically inactive. Brief motivational interviewing may be an effective approach for increasing children's physical activity levels. OBJECTIVE To examine the effects of mobile instant messaging-delivered brief motivational interviewing for parents in promoting regular physical activity in children who have survived cancer. DESIGN, SETTING, AND PARTICIPANTS An assessor-blinded randomized clinical trial was conducted at 2 Hong Kong pediatric oncology outpatient clinics from March 1, 2019, to January 29, 2021. A total of 161 children who had survived cancer, aged 9 to 16 years, and their parents were randomized (1:1) to an intervention or control group. INTERVENTIONS The intervention group received a 6-month mobile instant messaging-delivered brief motivational interviewing using a strategy menu. Parent-child dyads in both groups received a health advice session and were directed to a physical activity website at baseline. MAIN OUTCOMES AND MEASURES The primary outcome was the children's physical activity levels at 12-month follow-up, measured by the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth (total sores: 0-10, higher scores indicate greater physical activity levels). Secondary outcomes were cancer-related fatigue levels, handgrip strength, peak expiratory flow rate, and quality of life. Intention-to-treat analysis was performed. RESULTS Of the 161 children included in the study, 93 were boys (57.8%), and the mean (SD) age was 12.4 (2.4) years. Generalized estimating equation analyses showed a significant improvement in outcomes in the intervention group compared with the control group: physical activity levels (group-by-time interaction, 6 months: β = 3.09; 95% CI, 2.65-3.53; P < .001; 12 months: β = 3.91; 95% CI, 3.45-4.36; P < .001), cancer-related fatigue (6 months: β = -5.69; 95% CI, -8.03 to -3.35; P < .001; 12 months: β = -9.16; 95% CI, -11.31 to -7.00; P < .001), left handgrip strength (6 months: β = 2.69; 95% CI, 0.96-4.43; P = .002; 12 months: β = 5.52; 95% CI, 3.70-7.33; P < .001), right handgrip strength (6 months: β = 2.75; 95% CI, 1.01-4.50; P = .002; 12 months: β = 5.45; 95% CI, 3.62-7.27; P < .001), peak expiratory flow rate (12 months: β = 28.51; 95% CI, 16.10-40.92; P < .001), and quality of life (6 months: β = 5.01; 95% CI, 1.19-8.82; P = .01); 12 months: β = 14.19; 95% CI, 10.84-17.54; P < .001). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, mobile instant messaging-delivered brief motivational interviewing was effective in promoting the adoption and maintenance of regular physical activity and ameliorating cancer- or treatment-related adverse effects in children who survived cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03859271.
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Affiliation(s)
- Ankie Tan Cheung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - William Ho Cheung Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Laurie Long Kwan Ho
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong Children’s Hospital, Hong Kong
| | - Huen Sum Lam
- Hong Kong Council for Accreditation of Academic and Vocational Qualifications, Hong Kong
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Kim Y, Chae H, Park SJ. Feasibility and benefits of a videoconferencing-based home exercise programme for paediatric cancer survivors during the coronavirus disease 2019 pandemic. Eur J Cancer Care (Engl) 2022; 31:e13624. [PMID: 35606331 PMCID: PMC9347713 DOI: 10.1111/ecc.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/17/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
Objective We aimed to determine the feasibility and benefits of a videoconferencing‐based home exercise programme to improve health‐related quality of life (HRQOL), posttraumatic growth and physical strength levels of paediatric cancer survivors during the coronavirus disease 2019 (COVID‐19). Methods Eight paediatric cancer survivors participated in the intervention for 8 weeks. The programme comprised home exercise sessions administered using Zoom, a videoconferencing platform. The supervised exercise sessions were performed two times per week; the participants were taught to perform joint exercises at home for the remaining 5 days of the week. HRQOL, posttraumatic growth and physical strength levels were assessed at baseline and after the intervention. Results The rates of recruitment, retention and attendance were 52.9%, 88.9% and 98.4%, respectively. There were no cases of adverse events. The programme significantly improved flexibility (z = −2.21, p = 0.03), muscle strength (z = −2.67, p = 0.01) and power (z = −2.41, p = 0.02) among five domains of physical fitness measured using a physical activity promotion system and also improved total physical strength (z = −2.67, p = 0.01). Posttraumatic growth decreased slightly, whereas HRQOL improved slightly; however, the change was not statistically significant. Conclusion The study findings present preliminary evidence of the feasibility and benefits of this videoconferencing‐based home exercise programme among paediatric cancer survivors.
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Affiliation(s)
- Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Heemin Chae
- Department of Nursing, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Sung Je Park
- College of sport science, Chung-Ang University, Anseong, South Korea
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Fontana A, Matthey S, Mayor C, Dufour C, Destaillats A, Ballabeni P, Maeder S, Newman CJ, Beck Popovic M, Renella R, Diezi M. PASTEC - a prospective, single-center, randomized, cross-over trial of pure physical versus physical plus attentional training in children with cancer. Pediatr Hematol Oncol 2022; 39:329-342. [PMID: 34752205 DOI: 10.1080/08880018.2021.1994677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Despite recent improvements in survival rates in children with cancer, long-term toxicities remain a major concern. Physical activity could reduce the impact of long-term sequelae, notably in neuropsychological and physical areas. We report of a randomized trial of pure physical versus physical/attentional training in pediatric oncology patients. Twenty-two patients aged 6-18 y.o. were included, irrespective of their clinical diagnosis or treatment status, stratified by age and randomized 1:1 into pure physical vs. physical/attentional activity arms, with a cross-over at study midpoint. Neurological, motor and neuropsychological assessments were performed at inclusion, start, crossover and end of the program. Feasibility, defined as > 80% patients attending > 80% of sessions, was the primary endpoint. Secondary outcomes were improvements in neuropsychological and motor performance tests. While 68% of patients attended more than 80% of sessions during the pre-crossover phase of the study, this dropped to 36% post-crossover. Our study therefore failed to meet our primary endpoint. Nonetheless, significant improvements in anxiety (p<0.001), emotional control (p = 0.04), organization skills (p = 0.03), as well as motor deficit scores (p = 0.04) were observed. We noted no significant difference between the pure physical and the physical/attentional training arms, or when analyzing subgroups by age or sequence of intervention. We conclude that physical activity has a positive impact on anxiety, emotional and organizational aspects as well as motor deficits. Attendance dropped during the course of the study and motivational interventions should be included in future studies or equivalent programs.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.1994677 .
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Affiliation(s)
- Andrea Fontana
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sonia Matthey
- Centre Sport et Santé, Sports Universitaires, University of Lausanne, Lausanne, Switzerland
| | - Claire Mayor
- Neuropsychology, Pediatric Neurology and Neurorehabilitation Unit, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline Dufour
- Pediatric Occupational Therapy, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Destaillats
- Clinical Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Clinical Research Centre, Lausanne University Hospital and Institute of General Medicine and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Maeder
- Centre Sport et Santé, Sports Universitaires, University of Lausanne, Lausanne, Switzerland
| | - Christopher J Newman
- Pediatric Neurology and Neurorehabilitation Unit, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maja Beck Popovic
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raffaele Renella
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Pediatric Hematology Oncology Research Laboratory, Division of Paediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuel Diezi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Clinical Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Morales JS, Valenzuela PL, Velázquez-Díaz D, Castillo-García A, Jiménez-Pavón D, Lucia A, Fiuza-Luces C. Exercise and Childhood Cancer-A Historical Review. Cancers (Basel) 2021; 14:cancers14010082. [PMID: 35008246 PMCID: PMC8750946 DOI: 10.3390/cancers14010082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Childhood cancer survivors are at risk of developing important adverse effects, but there is growing evidence that physical exercise could help in this regard. The present review summarizes the history of pediatric exercise oncology and the main milestones achieved along the way. Overall, physical exercise appears to be safe and beneficial even during the most aggressive phases of pediatric cancer treatment and can represent an effective coadjuvant therapy for attenuating cancer-related adverse effects. Abstract Childhood cancer survivors are at risk of developing important adverse effects, many of which persist for years after the end of treatment. The implementation of interventions aiming at attenuating tumor/treatment-associated adverse effects is therefore a major issue in pediatric oncology, and there is growing evidence that physical exercise could help in this regard. The present review aims to summarize the main milestones achieved in pediatric exercise oncology. For this purpose, we conducted a systematic review of relevant studies written in English in the electronic database PubMed (from inception to 14 August 2021). This review traces the field of pediatric exercise oncology throughout recent history based on three fundamental pillars: (i) exercise during childhood cancer treatment; (ii) exercise during/after hematopoietic stem cell transplantation; and (iii) exercise after childhood cancer treatment. Accumulating evidence––although still preliminary in many cases––supports the safety and potential benefits of regular exercise (with no major contraindications in general) in the childhood cancer continuum, even during the most aggressive phases of treatment. Exercise can indeed represent an effective coadjuvant therapy for attenuating cancer-related adverse effects.
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Affiliation(s)
- Javier S. Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain; (J.S.M.); (D.V.-D.); (D.J.-P.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
| | - Pedro L. Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (P.L.V.); (A.L.)
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
| | - Daniel Velázquez-Díaz
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain; (J.S.M.); (D.V.-D.); (D.J.-P.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
| | | | - David Jiménez-Pavón
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, 11519 Cadiz, Spain; (J.S.M.); (D.V.-D.); (D.J.-P.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cadiz, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain; (P.L.V.); (A.L.)
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Carmen Fiuza-Luces
- Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
- Correspondence: ; Tel.: +34-91-779-2713
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Lie HC, Anderssen S, Rueegg CS, Raastad T, Grydeland M, Thorsen L, Stensrud T, Edvardsen E, Larsen MH, Torsvik IK, Bovim LP, Götte M, Lähteenmäki PM, Kriemler S, Larsen HB, Fridh MK, Ørstavik K, Brun H, Matthews I, Hornset E, Ruud E. The Physical Activity and fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an international, mixed-methods study (Preprint). JMIR Res Protoc 2021; 11:e35838. [PMID: 35258456 PMCID: PMC8941432 DOI: 10.2196/35838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. Objective The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). Methods The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Results Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. Conclusions The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation. International Registered Report Identifier (IRRID) DERR1-10.2196/35838
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Affiliation(s)
- Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigmund Anderssen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - May Grydeland
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Elisabeth Edvardsen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Lars Peder Bovim
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Miriam Götte
- Department of Pediatric Hematology/Oncology, Clinic for Pediatrics III, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Päivi Maria Lähteenmäki
- Department of Pediatric and Adolescent Hematology/Oncology, Turku University Hospital, University of Turku, Turku, Finland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Institute for Clinical Medicine, Faculty of Health Science, The University of Copenhagen, Copenhagen, Denmark
| | - Martin Kaj Fridh
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Kristin Ørstavik
- Department of Neurology, Section for Clinical Neurophysiology, Oslo University Hospital, Oslo, Norway
| | - Henrik Brun
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Iren Matthews
- Department of Paediatric Allergy and Pulmonology, Oslo University Hospital, Oslo, Norway
| | - Else Hornset
- Norwegian Childhood Cancer Society, Oslo, Norway
| | - Ellen Ruud
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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