Evolution of physical activity and body weight changes in breast cancer survivors five years after diagnosis - VICAN 2 & 5 French national surveys

Health-related quality of life in non-alcoholic fatty liver disease: A cross-cultural study between Spain and the United Kingdom

BACKGROUND

It is unclear what biopsychosocial factors influence the impact of NAFLD on health-related quality of life (HRQoL), and if these factors are equally important predictors between different nationalities.

METHODS

HRQoL (CLDQ) was measured in both Southern European (Spain, n = 513) and Northern European (United Kingdom -UK-, n = 224) cohorts of patients with NAFLD in this cross-sectional study. For each cohort, participant data were recorded on histological grade of steatohepatitis, stage of fibrosis and biopsychosocial variables. Regression analysis was used to explore which of these variables predicted HRQoL. Moderated mediation models were conducted using SPSS PROCESS v3.5 macro.

RESULTS

Participants with severe fibrosis reported more fatigue, systemic symptoms and worry, and lower HRQoL than those with none/mild fibrosis, regardless of place of origin. In addition, body mass index (BMI) and gender were found to be significant predictors of HRQoL in both Spanish and UK participants. Female gender was associated with worse emotional function, higher BMI and more fatigue, which predicted lower participants' HRQoL. UK participants showed more systemic symptoms and worry than Spanish participants, regardless of liver severity. The negative effects of gender on HRQoL through emotional function, BMI and fatigue were reported to a greater degree in UK than in Spanish participants.

CONCLUSIONS

UK participants showed a greater impairment in HRQoL as compared to Spanish participants. Higher fibrosis stage predicted lower HRQoL, mainly in the Spanish cohort. Factors such as female gender or higher BMI contributed to the impact on HRQoL in both cohorts of patients and should be considered in future multinational intervention studies in NAFLD.

[Barriers and facilitators to physical activity in oncology in Seine-Saint-Denis: A qualitative study using the socio-ecological approach]

INTRODUCTION

Despite the undeniable benefits of physical activity during and beyond cancer treatments, patients do not always undertake and/or maintain it. The aim of the study is to identify, describe and understand the barriers and facilitators of physical activity practice among adults arriving at the end of treatment for solid cancer, in precarious situations, living in Seine-Saint-Denis.

METHODS

The study was conducted using a descriptive qualitative phenomenological method involving semi-directed interviews with 23 participants during and beyond cancer.

RESULTS

Multiple-level factors (micro, meso, macro) are involved in active behavior of patients. Three main facilitators were identified: perceived benefit, social support, and urban planning. Three barriers are identified: (1) physical and psychological disorders whether or not related to cancer and its treatment, (2) precariousness, organizational constraints, unfavorable social environment, (3) lack of coordination, lack of accurate and appropriate information, lack of realistic referral to physical activity offers.

DISCUSSION

A diversity of representations, combinations of factors, and experiences are described. Getting people with cancer to engage in and maintain long-term physical activity is a complex task, requiring multidisciplinary action on all socio-ecological factors.

Upper Limb Morbidity in Newly Diagnosed Individuals After Unilateral Surgery for Breast Cancer: Baseline Results from the AMBER Cohort Study

PURPOSE

We aimed to examine potential associations between post-surgical upper limb morbidity and demographic, medical, surgical, and health-related fitness variables in newly diagnosed individuals with breast cancer.

METHODS

Participants were recruited between 2012 and 2019. Objective measures of health-related fitness, body composition, shoulder range of motion, axillary web syndrome, and lymphedema were performed within 3 months of breast cancer surgery, and prior to or at the start of adjuvant cancer treatment.

RESULTS

Upper limb morbidity was identified in 54% of participants and was associated with poorer upper limb function and higher pain. Multivariable logistic regression analysis identified mastectomy versus breast-conserving surgery (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65), axillary lymph node dissection versus sentinel lymph node dissection (OR 2.67, 95% CI 1.73-4.10), earlier versus later time from surgery (OR 1.58, 95% CI 1.15-2.18), and younger versus older age (OR 1.01, 95% CI 1.00-1.03) as significantly associated with a higher odds of upper limb morbidity, while mastectomy (OR 1.57, 95% CI 1.10-2.25), axillary lymph node dissection (OR 2.20, 95% CI 1.34-3.60), lower muscular endurance (OR 1.10, 95% CI 1.01-1.16) and higher percentage body fat (OR 1.04, 95% CI 1.00-1.07) were significantly associated with higher odds of moderate or greater morbidity severity.

CONCLUSIONS

Upper limb morbidity is common in individuals after breast cancer surgery prior to adjuvant cancer treatment. Health-related fitness variables were associated with severity of upper limb morbidity. Findings may facilitate prospective surveillance of individuals at higher risk of developing upper limb morbidity.

Health behaviour changes in female cancer survivors: The Seintinelles study

INTRODUCTION

The number of cancer survivors increases and their risks of recurrence, second cancer, morbidity and death is high; measures to prevent these risks are thus critical. Knowing the factors that lead cancer survivor to adopt or not healthy behaviours is crucial for designing effective prevention campaigns and better support them in after-cancer. Our study attempts to provide additional knowledge in this direction.

METHODS

This retrospective study was conducted via the Seintinelles collaborative research platform in a community of women with cancer volunteering to take online questionnaires. We collected data on sociodemographic factors and health, knowledge of cancer risk factors, and possible behaviour changes (tobacco/alcohol use, diet, physical activity) after cancer diagnosis.

RESULTS

The study involved 1180 women aged between 26 and 79 years. Several cancer-related factors (cancer other than breast cancer, longer time since diagnosis, taking drug treatment for cancer, sequelae, negative evolution of the cancer) favoured certain positive changes in behaviour. Sociodemographic factors (age, habitat environment, currently employed, living status, dependent children) or factors related to health (general condition, presence of comorbidities, neurological problems, hospitalizations, body mass index) favoured or not certain changes in behaviour. Lack of knowledge about modifiable risk factors for cancer was associated with not adopting healthy behaviours after cancer.

DISCUSSION

This study made it possible to identify important elements to be addressed in order to improve cancer risk prevention messages.

Sexuality after breast cancer, how to provide a global and contemporary approach

Patients' sexuality is one of the major and most neglected impact of breast cancer (BC) and its treatment. Even though research is ongoing on the subject, sexuality issues are rarely taken into account and efficiently dealt with in clinical practice. The objective is to review the impact of BC and its treatment on modern women sexuality. In the literature, a heterogeneous level of advancement is notable in the different publishing countries depending on the cultural background; some countries simply do not publish on the matter, others mainly discuss the male partners and practicians experience, and lastly, the most progressive countries have moved up to studying niches of patients such as sexual and gender minorities. A multidisciplinary approach, including pharmacologic and nonpharmacologic management, appears most efficient. There is a need for greater inclusion of partners and for providing a specific training to first-line health care providers. This review provides a general contemporary worldwide overview of the state of the art in sexuality issues in BC patients and survivors.

[Nutrition and physical activity (AP) during and after cancer treatment: Therapeutic benefits, pathophysiology, recommendations, clinical management]

Lifestyle behaviors, such as diet and physical activity, are factors that influence risk of numerous cancers. They are also decisive during and after cancer for the course of oncological treatment, but also in the immediate and long-term prognosis, and quality of life during and after treatment. Separately, physical activity and nutritional support can reduce the risk of sarcopenia and its consequences, and improve quality of life during treatment. Whan introduced early, such a combination, increases the prognostic benefits. In remission, particularly in overweight patients, the APA-diet combination reduces the risk of cancer relapse and improves cardiovascular performance. These programs require a precise assessment of capacities and habits of each patient, and interventions of trained professionals (certified exercise instructor, dietician trained in oncology). The funding conditions for these programs exist for cancer survivors and should be considered for oncological treatment period.

Mindfulness-based Interventions and Yoga for Managing Obesity/Overweight After Breast Cancer: A Scoping Review

Introduction

Weight gain after breast cancer is common, and obesity after breast cancer increases breast cancer recurrence and mortality. Mindfulness-based interventions (MBIs) and yoga have been shown to be effective in managing obesity/overweight in people without breast cancer. There is a need to systematically map the extent and range of evidence on yoga and MBIs for managing obesity/overweight after breast cancer in order to aid planning and commissioning of future research.

Methods

We conducted a scoping review informed by methods described by Levac et al. Five electronic databases were searched for any peer-reviewed original research (including systematic reviews) that examined the role of yoga and/or MBIs for managing overweight/obesity after breast cancer. Data were extracted on study, population, intervention, comparator and outcome characteristics, and described narratively.

Results:

We found 18 publications representing 15 unique studies (11 clinical trials, 2 systematic reviews, and 2 observational studies). There were 10 studies on yoga, and 5 on MBIs. Of the clinical trials, only 4/11 examined a weight-related outcome as the primary outcome. The remaining trials examined lifestyle or metabolic outcomes (5/11) or unrelated outcomes such as psychological health (2/11). Gaps in the literature included small sample sizes, lack of cultural diversity amongst participants, inadequate reporting of the intervention, few lifestyle co-interventions offered, lack of active comparator groups, and inadequate safety reporting.

Conclusions:

There is a need for adequately-powered RCTs that adhere to reporting guidelines. The use of gold-standard methods for measuring outcomes, and active comparator groups, is also recommended.

A Qualitative Study Exploring Feasibility and Acceptability of Acupuncture, Yoga, and Mindfulness Meditation for Managing Weight After Breast Cancer

Introduction:

Weight gain is common after breast cancer. Yoga, mindfulness meditation, and acupuncture may assist with managing weight. However, evidence on effectiveness is limited. This study assessed the feasibility and acceptability of recruiting for and implementing a randomized controlled trial (RCT) evaluating these interventions as adjuncts to lifestyle interventions (diet and exercise) for weight management in women with breast cancer.

Methods:

Qualitative study involving virtual focus groups or semi-structured interviews. Participants were recruited via email invitation from a breast cancer consumer organization and breast cancer center in Australia. Eligible participants had received treatment for breast cancer, and were fluent in English. A purposive sample of culturally and linguistically diverse (CALD) participants was also recruited. Focus groups and interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis with the constant comparison method.

Results:

Emails were sent to 1415 women of which 37 provided data in 5 focus groups and 1 semi-structured interview, including 1 focus group (n = 6) with only women from CALD backgrounds. Yoga and mindfulness meditation were perceived as feasible and acceptable for weight management, but acupuncture was seen to be too invasive to be acceptable. A focus on wellness rather than weight reduction, flexible program delivery, trusted advice, consideration of participant burden and benefit, and peer-support were key factors perceived to increase feasibility and acceptability.

Conclusions:

Yoga and mindfulness meditation are acceptable and useful adjuncts to lifestyle interventions for weight management after breast cancer. This research places end-users at the forefront of trial design, and will inform future trials using these interventions for weight management and improving health and wellbeing after breast cancer.