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Cogollos-de-la-Peña R, Álvarez-Vargas A, Domínguez-Navarro F, Espelt A, Fuentes-Aparicio L, Puigpinós-Riera R. Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort. Breast Cancer Res Treat 2024; 204:377-387. [PMID: 38155271 PMCID: PMC10948522 DOI: 10.1007/s10549-023-07191-9] [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: 05/18/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.
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Affiliation(s)
| | - Anaís Álvarez-Vargas
- Departament d'Epidemiologia i Metodologia de Les Ciències Socials I de La Salut d'Umanresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Catalonia, Spain
| | - Fernando Domínguez-Navarro
- Faculty of Health Science, Universidad Europea de Valencia, Valencia, Spain.
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag 5. 46010, Valencia, Spain.
| | - Albert Espelt
- Departament de Psicobiologia i Metodologia de Les Ciències de La Salut, Bellaterra, Catalonia, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Fuentes-Aparicio
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag 5. 46010, Valencia, Spain
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rosa Puigpinós-Riera
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Catalonia, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
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2
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Yang H, Liu L, Zhang X. Exercise interventions on body composition and quality of life of overweight/obese breast cancer survivors: a meta-analysis. BMC Womens Health 2023; 23:484. [PMID: 37700300 PMCID: PMC10498647 DOI: 10.1186/s12905-023-02627-2] [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: 04/27/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to assess the effects of exercise interventions on body composition and quality of life in overweight/obese breast cancer survivors. METHODS Eligible randomized controlled trials (RCTs) were searched from the Cochrane Library, PubMed, and Embase databases and assessed using the Cochrane Collaboration's assessing risk tool. The effect size was pooled as weighted mean difference (WMD) for body composition variables (i.e., body mass index [BMI], body fat, body weight, fat mass, lean mass, bone mineral density) and quality of life (i.e., physical health and mental health), and the confidence interval (CI) was set as 95%. Since heterogeneity existed, subgroup analysis was conducted to detect the source of heterogeneity. RESULTS Eight articles from six RCTs containing 548 overweight/obese breast cancer survivors (BMI ≥ 25 kg/m2) were included and analyzed. Compared to routine care, exercise intervention significantly decreased the body mass index [WMD (95% CI) = -1.37 (-2.50, -0.23) kg/m2] and body fat [WMD (95% CI) = -3.80 (-6.59, -1.01) %] of overweight/obese breast cancer survivors. Exercise intervention showed a tendency to increase physical health [WMD (95% CI) = 2.65 (-10.19, 15.48)] and mental health [WMD (95%CI) = 1.38 (-4.18, 6.95)], but no statistical significance was observed. A subgroup analysis showed the duration of intervention was a source of heterogeneity on body composition. In the 16-week subgroup, exercise intervention decreased fat mass and BMI while increased lean mass and bone mineral density. The 52-week exercise intervention was effective in increasing lean mass. A significant exercise intervention effect on reducing body fat was only detected in the 12-week subgroup. CONCLUSION Exercise intervention significantly decreased the body mass index and body fat of overweight/obese breast cancer survivors. The benefits of exercise interventions for overweight/obese breast cancer survivors need more evidence from high-quality RCTs with large sample sizes.
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Affiliation(s)
- Hongchang Yang
- Physical Education Department, Hohai University, Nanjing, Jiangsu, China
| | - Li Liu
- Department of Rehabilitation, Brain Hospital Affiliated to Nanjing Medical University, No.264, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China.
| | - Xiaoxia Zhang
- Department of Kinesiology, Centenary College of Louisiana, 2911 Centenary Blvd, Shreveport, LA, USA.
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Capozzi LC, Daun JT, Francis GJ, de Guzman Wilding M, Urgoiti GR, Langelier D, Culos-Reed N. Feasibility and Implementation of an Oncology Rehabilitation Triage Clinic: Assessing Rehabilitation, Exercise Need, and Triage Pathways within the Alberta Cancer Exercise-Neuro-Oncology Study. Curr Oncol 2023; 30:6220-6245. [PMID: 37504321 PMCID: PMC10377964 DOI: 10.3390/curroncol30070461] [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: 05/15/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Individuals living with and beyond cancer face physical impairment and inactivity in survivorship. Neuro-oncology populations have especially high rates of sedentary behaviour and functional deficits, including impaired balance, motor skills, and cognition. Our purpose was to assess the rehabilitation and exercise needs of patients with brain tumours while examining the feasibility of a rehabilitation triage clinic as a part of the Alberta Cancer Exercise-Neuro-Oncology study, where patients were referred to a triage clinic, where health, neurologic, and functional status was assessed, followed by a referral to one or multiple resources, including exercise, physiotherapy, occupational therapy, or physiatry. Qualitative perception of the triage clinic was collected. Overall, the triage clinic was feasible and safe for participants, facilitating referral into rehabilitation and exercise resources. Pre-determined enrollment and attendance rates were met, but referral rates to the triage clinic were not met. Oncology clinic staff reported forgetting to refer patients or uncertainty of who was appropriate for rehabilitation as barriers. Oncology clinic-based screening may improve the identification of patients who are sedentary or have a physical impairment. A proposed screening tool, the Cancer Rehabilitation and Exercise Screening Tool (CREST), is presented within our Cancer Rehabilitation and Exercise Pathways Model. The CREST can identify patients who are sedentary or have a functional impairment, facilitating referral to appropriate rehabilitation resources and ultimately improving patient recovery and functioning.
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Affiliation(s)
- Lauren C Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - George J Francis
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Marie de Guzman Wilding
- Supportive Care: Psychosocial and Rehabilitation Oncology, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Gloria Roldan Urgoiti
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - David Langelier
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Supportive Care, Cancer Rehabilitation and Survivorship, Princess Margaret Hospital, Toronto, ON M5G 2C1, Canada
| | - Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Supportive Care: Psychosocial and Rehabilitation Oncology, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
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Adherence to Mediterranean Diet and Nutritional Status in Women with Breast Cancer: What Is Their Impact on Disease Progression and Recurrence-Free Patients' Survival? Curr Oncol 2022; 29:7482-7497. [PMID: 36290866 PMCID: PMC9600150 DOI: 10.3390/curroncol29100589] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction: Nutritional status impacts the survival of patients with cancer. There are few studies that investigate the role of nutritional status on breast cancer survival in women with breast cancer, and even fewer regarding the impact of adhering to the Mediterranean diet (MD). The present study aims to assess the nutritional status, MD adherence, physical activity levels and health-related quality of life (HRQOL) in women diagnosed with breast cancer and evaluate these parameters regarding recurrence-free survival. Methods: A total of 114 women, aged 35-87 years old, diagnosed with breast cancer in Larissa, Greece, participated in the study. Tumor histopathology was reported, and anthropometric indices were measured by a trained nurse, while questionnaires regarding nutritional status (via mini nutritional assessment), HRQOL via EORTC QLQ-C30, physical activity levels via IPAQ and Mediterranean diet adherence via MedDietScore were administered. The participants were followed-up for a maximum time interval of 42 months or until recurrence occurred. Results: A total of 74% of patients were overweight or obese, while 4% of women were undernourished, and 28% were at risk of malnutrition. After 42 months of follow-up, 22 patients (19.3%) had relapsed. The median time to recurrence was 38 months (IQR: 33-40 months) and ranged between 23 to 42 months. Higher levels of MD adherence were significantly associated with lower body mass index (BMI) values, earlier disease stage, smaller tumor size, absence of lymph node metastases and better physical activity levels (p < 0.05). Normal nutritional status was significantly associated with higher BMI values and better health-related quality of life (p ≤ 0.05). In univariate analysis, patients with higher levels of MD adherence and well-nourished patients had significantly longer recurrence-free survival (p < 0.05). In multivariate analysis, MD adherence and nutritional status were independently associated with recurrence-free patients' survival after adjustment for several confounding factors (p < 0.05). Conclusions: The impact of MD on time to recurrence is still under investigation, and future interventional studies need to focus on the role of adhering to the MD before and after therapy in survival and breast cancer progression. Furthermore, the present study also highlights the importance of an adequate nutritional status on disease progression, and the need for nutritional assessment, education and intervention in women with breast cancer.
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Li Y, Xiao X, Zhang Y, Tang W, Zhong D, Liu T, Zhu Y, Li J, Jin R. Effect of Exercise on Breast Cancer: A Systematic Review and Meta-analysis of Animal Experiments. Front Mol Biosci 2022; 9:843810. [PMID: 35733941 PMCID: PMC9208379 DOI: 10.3389/fmolb.2022.843810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/29/2022] [Indexed: 12/09/2022] Open
Abstract
Objective: Exercise is reported to be beneficial for breast cancer. However, the results seem inconsistent. We conducted this systematic review and meta-analysis of animal experimental studies to fully understand the effect of exercise on breast cancer in animal model. Methods: We searched databases from inception to April 2022 and manually searched related references to retrieve eligible studies. We screened eligible studies and extracted related data. We assessed the risk of bias and reporting quality using the SYstematic Review Centre for Laboratory animal Experimentation Risk of Bias tool and the Animal Research: Reporting of In Vivo Experiments guidelines 2.0, respectively. We summarized the study characteristics and findings of included studies and conducted meta-analysis with RevMan software. Subgroup analysis and sensitivity analysis were also performed. Results: We identified 537 potential literatures and included 47 articles for analysis. According to the results of risk of bias assessment, only selective outcome reporting was in low risk of bias. Items of sequence generation, random outcome assessment, and incomplete outcome data were rated as high risk of bias. Most of other items were rated unclear risk of bias. In reporting quality assessment, all included articles reported grouping method and experimental procedures. However, no study provided information of the study protocol registration. Meta-analysis showed that, compared with sedentary lifestyle, exercise reduced more tumor weight (MD = −0.76, 95%CI −0.88 to −0.63, p = 0.85, I2 = 0%) and tumor number per animal (MD = −0.61, 95%CI −0.91 to −0.31, p = 0.34, I2 = 8%). Exercise decreased more tumor incidence than sedentary lifestyle both in motorized wheel/high-intensity (OR = 0.22, 95%CI 0.11 to 0.46, p = 0.09, I2 = 41%) and free wheel/low-intensity treadmill running (OR = 0.45, 95%CI 0.14 to 1.44, p = 0.04, I2 = 60%). Sensitivity analysis showed that the results were robust. Conclusion: Exercise could reduce tumor weight, number of tumors per animal, and incidence of tumor in breast cancer model of mice and rats. However, the risk of bias items and reporting guidelines in preclinical studies should be concerned. Future research should consider standards of conducting and reporting preclinical studies and choose suitable exercise protocol for higher quality evidence of exercise for breast cancer.
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Affiliation(s)
- Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xili Xiao
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenjing Tang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tianyu Liu
- School of Sports, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuanyuan Zhu
- Affiliated Hospital of Panzhihua University Panzhihua, Panzhihua, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Affiliated Hospital of Panzhihua University Panzhihua, Panzhihua, China
- *Correspondence: Juan Li, ; Rongjiang Jin,
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Affiliated Hospital of Panzhihua University Panzhihua, Panzhihua, China
- *Correspondence: Juan Li, ; Rongjiang Jin,
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Jensen RK, Jakobsen S, Gundersen SV, Andersen MF, Kongsgaard M, Thomsen JL, Riis A. Patients' Expectations of Physiotherapeutic Treatment for Long-Term Side Effects After Cancer: A Qualitative Study. Cancer Control 2021; 28:10732748211047091. [PMID: 34582740 PMCID: PMC8485255 DOI: 10.1177/10732748211047091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aims to explore the expectations of physiotherapeutic treatment of long-term side effects (LTSEs) after cancer among patients treated in physiotherapy clinics. METHODS This a qualitative interview study based on a phenomenological approach. Adult patients with LTSEs after cancer were recruited through The Danish Cancer Society and a private physiotherapy clinic in Denmark. Individual semi-structured interviews were carried out using Microsoft Teams based on an interview guide piloted before the interviews. Interviews were audiotaped and transcribed verbatim. Sampling was conducted with a focus on variation in LTSE. The data were analyzed using Malterud's principles of systematic text condensation and coded in NVivo 12. RESULTS 2 males and 8 females with an average age of 55.8 years were interviewed for between 40 and 60 minutes from October to November 2020. Four main themes emerged from the interviews1: The importance of the physiotherapist's approach,2 the benefits of meeting patients with similar symptoms,3 the importance of receiving knowledge, and4 patients seeking to maintain their current state more often than aiming to improve their condition. CONCLUSIONS Patients consulting a physiotherapy clinic with LTSE after cancer prefer the physiotherapist to have knowledge about cancer and to be emphatic. Furthermore, patients prefer to meet like-minded people and expect support to maintain their current condition rather than improve their condition.
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Affiliation(s)
| | - Sarah Jakobsen
- Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
| | | | | | - Marianne Kongsgaard
- Quality Unit for General Practice in the North Denmark Region, Aalborg, Denmark
| | - Janus Laust Thomsen
- Research Unit for General Practice in Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Allan Riis
- Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
- Research Unit for General Practice in Aalborg, Denmark
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