Evaluation and outcome of behavioural changes in the rehabilitation of cancer patients: a review

A multimodal cancer rehabilitation programme promoting sense of coherence for women treated for female reproductive cancers: a pilot randomised controlled trial

PURPOSE

To investigate the feasibility, acceptability, and preliminary effects of a theory-driven multimodal cancer rehabilitation intervention (MCRI) programme among Hong Kong Chinese women treated for female reproductive cancers (FRC).

METHODS

A single-blinded randomised controlled trial was conducted in two regional hospitals in Hong Kong involving 35 women treated for FRC. The intervention group (n = 18) received a 12-week MCRI which included 30 modules of app-based health education and three nurse-led individual counselling sessions. The control group (n = 17) received attention from the research nurse through telephone calls. Sense of coherence, health-related quality of life, and cancer-specific distress were measured at baseline (T0), immediately after completion of the intervention (T1) and 12 weeks post-intervention (T2). Twelve intervention completers were interviewed to explore the acceptability of the programme.

RESULTS

Recruitment, consent, and retention rates, counselling session attendance rate, and app usage were satisfactory. The intervention participants reported to have significant improvement in physical well-being at T1 (Cohen's d effect size (d) = 1.04, 95% CI 0.24, 1.83), sense of coherence (d = 0.76, 95% CI - 0.03, 1.54), and cancer-specific distress (d = 1.03, 95% CI - 1.83, - 0.21) at T2. Interviewed participants acknowledged the benefits of the programme and provided comments for improvement.

CONCLUSIONS

The MCRI is found to be feasible and acceptable and may improve their sense of coherence, distress, and physical health. A full-scale trial using a larger and more representative sample is warranted to confirm the effects of the programme.

IMPLICATIONS FOR CANCER SURVIVORS

Women treated for FRC may be benefited from the MCRI in improving sense of coherence, physical well-being, and distress.

TRIAL REGISTRATION

This trial was registered on ISRCTN registry with ID ISRCTN73177277.

Discussions About Lifestyle Risk Factors Following a Cancer Diagnosis: Findings from a Sample of Australian Cancer Outpatients

Individuals with a previous cancer diagnosis are at risk of cancer recurrence. However, many cancer survivors do not adhere to lifestyle recommendations to reduce cancer risk. Little is known about the extent to which cancer patients are asked about lifestyle risk factors by healthcare providers following diagnosis. The aim of this study is to determine among Australian cancer survivors the (1) proportion asked about smoking, alcohol consumption, nutrition and physical activity; (2) total number of lifestyle risk factors asked about; and (3) factors associated with being asked about fewer risk factors. A cross-sectional survey was conducted with cancer patients attending outpatient clinics. Eligible patients completed a baseline survey and a second survey 4 weeks later. Data about demographic and disease characteristics, and whether participants had been asked about smoking, alcohol, physical activity and diet since being diagnosed with cancer, was collected. A total of 144 patients were included in the analyses. Following diagnosis, most had been asked about smoking (86%), alcohol consumption (85%), physical activity (80%) and diet (69%) by a healthcare provider. Sixty-one percent of participants reported being asked about all four risk factors; only 6% recalled being asked about none. After controlling for age, participants with a high school or lower education were more likely to be asked about fewer risk factors (OR 2.16; 95%CI 1.0 to 4.6; p = 0.04) compared with those with a trade, vocational or university-level education. Just over one-third of a sample of Australian cancer patients were not asked about all assessed lifestyle risk factors following their diagnosis of cancer. These findings suggest there is scope to improve identification of lifestyle risk factors among cancer survivors.

Integrating Nutrition into Outpatient Oncology Care-A Pilot Trial of the NutriCare Program

Nutrition is an essential part of oncology care; however, nutrition advice and guidance are not always provided. This six-week pilot pretest-posttest intervention was designed to test the feasibility and effectiveness of integrating a nutrition education program (NutriCare) into outpatient oncology care. Twenty breast cancer survivors were recruited through Tufts Medical Centre. Nutrition impact symptoms and demographics were collected at baseline, dietary quality and quality of life measures were collected pre and post-intervention and an evaluation form was completed post-intervention. Forty-four percent of eligible participants were recruited, and 90% of those completed the study. The NutriCare program was well received with participants reporting that goals were feasible (94.4%), the program had a positive impact on their diet (77.8%), and over 80% would recommend the program. There was an interest in continuing with the program (89%) and in receiving additional guidance from the healthcare team (83%). There was a significant improvement (p = 0.04) in physical function over the six weeks; however, no additional significant differences in quality of life or dietary quality were seen. In conclusion, cancer survivors were positive about the NutriCare program and its integration into practice.

Secondary solid cancer screening following hematopoietic cell transplantation

Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.

Predictors of continuous tobacco smoking in a clinical cohort study of Danish laryngeal cancer patients smoking before treated with radiotherapy

BACKGROUND

Many cancer patients who are smokers when starting cancer therapy continue smoking despite evidence of tobacco smoking as a risk factor for poor treatment response and secondary primary cancers. Small samples and inconsistent results in previous studies warrant further research to identify predictors of being a continuous smoker during and after radiotherapy.

MATERIAL AND METHODS

In the clinical database of the Danish Head and Neck Cancer Group (DAHANCA), we identified 1455 patients diagnosed with laryngeal cancer between 2000 and 2010, who were all smokers at date of diagnosis and treated with primary radiotherapy. Information on the socio-economic characteristics of the study cohort was obtained from Statistics Denmark the year prior to diagnosis. Logistic regression analyses were applied.

RESULTS

In the cohort of laryngeal cancer patients smoking before starting radiotherapy, 50% still smoked one year after radiotherapy similar to the percentage of smokers during treatment. Being younger than 60 years (OR 1.39, 95% CI 1.00-1.91), commenced smoking before the age of 15 (OR 1.77, 95% CI 1.32-2.38), having a poor WHO Performance status (OR 3.09, 95% CI 1.71-5.61), low income (OR 2.21, 95% CI 1.23-3.98) and living alone (OR 1.56, 95% CI 1.13-2.14) were associated with increased risk of continuous smoking during treatment. Similar findings were found two months and one year after radiotherapy, however, no association with living alone (OR 1.08, 95% CI 0.73-1.59) at the one-year follow-up. Tumor stage and the average number of cigarettes smoked per day before radiotherapy were not associated with being a continuous smoker.

CONCLUSION

Younger patients, who had an early smoking initiation, a poor performance status, low income and lived alone, were most likely to continue smoking. Continuous smoking was not related to the extent of disease.

Protective skin care behaviors in cancer survivors

PURPOSE

Research suggests that physicians neglect preventive care for cancer survivors. A survivor's self-motivation with respect to preventive care is unknown. Using protective skin care as a proxy, our aims were to characterize preventive care in cancer survivors and to identify factors associated with appropriate prevention.

METHODS

Using data from the 2009 U.S. Health Information National Trends Survey, we compared preventive skin care patterns in cancer survivors and non-cancer patients. Primary endpoints were the use of sunscreens, long-sleeved shirts, hats, and shade.

RESULTS

We identified 179 early cancer survivors (<5 years), 242 intermediate cancer survivors (5-10 years), 412 long-term cancer survivors (>10 years), and 5951 non-cancer patients. The use of sunscreens (60%), long-sleeved shirts (88%), hats (58%), and shade (68%) was suboptimal. Overall, cancer survivors were not more likely to adhere to preventive care (p = 0.89). A composite score showed a significant difference between the cancer survivor groups (p < 0.01) whereby intermediate survivors reported the best preventive practices.

CONCLUSIONS

A prior diagnosis of cancer does not appear to increase personal compliance with cancer prevention. Reasons for this poor engagement are not clear. Targeted strategies to increase self-motivation might improve preventive practices in cancer survivors.

Intervention format and delivery preferences among young adult cancer survivors

BACKGROUND

Young adult cancer survivors face a number of increased medical and psychosocial risks, including an increased risk of cardiovascular disease and emotional distress. Although behavioral strategies, such as exercise, may diminish some of these risks, few behavioral interventions have been developed for this population.

PURPOSE

As a first step toward developing interventions specifically for young survivors, we conducted a qualitative study of their intervention-related preferences. A key objective was to identify the preferred format for delivering interventions (e.g., face-to-face, online).

METHOD

In-depth, semi-structured individual interviews were conducted with 20 young adult cancer survivors between the ages of 18 and 39. This research was conducted in Rhode Island, USA.

RESULTS

Participants identified advantages and disadvantages to a variety of intervention formats including: telephone-based, print-based, computer-based, and several types of face-to-face interventions. The dominant theme that emerged was that interventions developed for young adult cancer survivors should take into account their multiple competing needs and obligations (e.g., work, family). Two closely related subthemes were: (1) the importance of developing interventions that are convenient and (2) the need for interventions that provide social support. Interventions for this population may be most successful if they take into account these themes.

CONCLUSION

Data indicate that young adult cancer survivors have some unique needs (e.g., multiple competing demands of young adulthood) and preferences (e.g., comfort with remotely delivered interventions) that differentiate them from older cancer survivors. Thus, young survivors would be best served by interventions designed to specifically target this population.

The ritualization of rehabilitation

There is widespread and increasing political interest in devising plans to support people who have or have had cancer to recover and recommence 'normal' lives. Educating cancer patients for this purpose is a central element in cancer rehabilitation in both Europe and the United States. One of the challenges in intervention research pertaining to rehabilitation is how to measure and explain the effects of a particular rehabilitation program. The social processes of particular programs are often a 'closed box' and not taken into consideration methodologically or analytically. In this article, we unpack and explicate the 'closed box' of a particular cancer rehabilitation program in Denmark by drawing on approaches from the study of ritual. By analyzing rehabilitation as a ritual and as ritualization, we identify and conceptualize some of the transformative activities involved in cancer rehabilitation. We highlight the significance of the ritual site, its aesthetics, its exaggerations, and the social and temporal organization of the program.

Impact of cancer on everyday life: a systematic appraisal of the research evidence

OBJECTIVE

To conduct a systematic appraisal of the published literature reviews related to the impact of cancer on everyday life. This theme was identified as the top priority area for research by participants in the Macmillan Listening Study, which was the first UK-wide public consultation exercise to identify patients' priorities for cancer research.

SEARCH STRATEGY

The top priority area was divided into ten sub-themes, and a modified systematic review was undertaken for each sub-theme using electronic searches.

INCLUSION CRITERIA

Literature review papers were included if they were written in English, involved patients diagnosed ≥18 years, any cancer types and published between 2000 and 2006.

DATA EXTRACTION AND SYNTHESIS

Two thousand and two hundred and fifty-two potentially eligible papers were identified. Abstracts were read by the first author and selected for inclusion in the review. Twenty percentages of the papers were also read independently by other authors. Sixty-two review papers were finally selected.

MAIN RESULTS

The systematic appraisal revealed that some sub-themes of the patient-identified priority area (e.g., how to support family members of cancer patients) were under-researched, while other sub-themes (e.g., anxiety and depression experienced by cancer patients) had been explored to some extent. Certain areas of research interest to patients were found to have been explored; however, their significance was limited by the quality of the research.

CONCLUSION

The systematic appraisal highlights important areas for future research and the need for more effective dissemination of study findings to wider audiences, including service users. This study also indicates the need for further research to enhance the generalizability and/or significance of findings.

No change in health behavior, BMI or self-rated health after a psychosocial cancer rehabilitation: Results of a randomized trial

INTRODUCTION

The aim of cancer rehabilitation is to enable patients to attain and maintain optimal physical, psychological and social functioning. We evaluated the effect on health behavior, BMI and self-rated health of a residential psychosocial rehabilitation course for cancer patients.

MATERIAL AND METHODS

Patients with a primary cancer of the breast, prostate, colon or rectum were randomized to either a six-day multi-focus psychosocial residential rehabilitation intervention that included lectures, discussions and peer group discussions on issues related to treatment and life with cancer or to usual care. The end points were changes in smoking, alcohol consumption, physical activity, body mass index and self-rated health between baseline and follow-up after one and six months. The primary analyses included all participants who received their allocated condition. The two follow-up times were analyzed separately in general linear and logistic regression models for continuous and dichotomous outcomes, respectively. The analyses were adjusted for baseline outcome score, cancer site, time since diagnosis, age and education.

RESULTS

Of the 507 participants who were randomly assigned, 452 were included in the analysis, of whom 404 completed the one month and 394 completed the six month assessment. The intervention group showed slightly more positive changes in health behavior, BMI and self-rated health than the usual care group, but the differences between the groups were small and not significant.

DISCUSSION

Participation in a six-day cancer rehabilitation course did not significantly influence health behavior, BMI or self-rated health among cancer patients.

Rehabilitation interventions for cancer survivors: The influence of context

BACKGROUND

Today more and more people survive cancer. Cancer survivors need help to recover both from the cancer and the treatment. Rehabilitative interventions have been set up to meet their needs. However, there are studies that report no major effects following careful, targeted intervention. Furthermore, it seems difficult to define whether an effect is caused by the intervention or whether it is due to contextual parameters such as human interactions, the organisation, the staff, the physical surroundings or the general atmosphere. The present study examines the influence of three contextual parameters in rehabilitation courses for cancer survivors in Denmark.

METHODS

The study was based on an ethnographic fieldwork with participant observation at nine week-long courses, on in-depth interviews and on written sources. Fieldwork is well-suited for studying interventions in context, such as social interactions between people and their physical, material and institutional surroundings. The analysis is based on Duranti's and Goodwin's theoretical approach to context.

RESULTS

The findings are categorised into three contextual parameters. The setting, including its aesthetic value, its physical surroundings and the scheduling of the courses. The behavioural environment, which comprised work commitment and the care provided by the staff. The language environment insofar as it facilitated a sense of community.

DISCUSSION

The results demonstrate the influence of contextual parameters not formalised in the intervention programme. Contexts affect the outcome of an intervention because they frame and inform the teaching, communication and various forms of social gathering. The study suggests that the effects of the intervention as measured by quantitative studies cannot be properly interpreted without taking into account the context within which the intervention is embedded.

A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control

BACKGROUND

Healthful dietary patterns, including eating fruits and vegetables (F&V) and avoiding obesity, may decrease the risk of cancer and other chronic diseases. In addition to promoting health for the general population, a cancer diagnosis may provide a "teachable moment," facilitating the adoption of more healthful eating habits and leading to lower risk of chronic disease and better overall health.

PURPOSE

This study was designed to test the effectiveness of two health communication interventions in increasing F&V consumption and physical activity in a sample of older adults (average age of 66 years), including both colorectal cancer (CRC) survivors and noncolorectal cancer-affected (N-CRC) individuals.

METHODS

CRC survivors and N-CRC individuals were recruited from a population-based case-control study and randomly assigned to four conditions using a 2 x 2 design. We tested two different methods of communicating and promoting health behavior change alone or in combination: tailored print communication (TPC) and brief telephone-based motivational interviewing (TMI).

RESULTS

A significant increase in F&V consumption was found for the combined intervention group in the entire sample (p < 0.05). When stratified by cancer survivor status, the effect was concentrated in the N-CRC subset (p < 0.01) versus CRC survivors. The combined intervention was also found to be most cost-effective for the N-CRC group, with TPC more cost-effective than TMI. For physical activity, none of the interventions produced statistically significant improvements.

CONCLUSIONS

This study indicates that combining tailoring and motivational interviewing may be an effective and cost-effective method for promoting dietary behavior change among older healthy adults. More research is needed to identify the optimal dose and timing for intervention strategies to promote dietary and physical activity change among both CRC survivors and the general population.

An exploratory study of associations between illness perceptions and adjustment and changes after psychosocial rehabilitation in survivors of breast cancer

BACKGROUND. Although psychosocial interventions have been found to be beneficial for cancer patients, the role of the patients' perceptions of illness in these interventions remains unclear. We examined illness perceptions and psychological adjustment (distress and QoL) among women who had survived breast cancer and attended a psychosocial rehabilitation course. MATERIAL AND METHODS. From an ongoing longitudinal study, we used data from two sub-studies with a total of 177 survivors (145 from the descriptive study and 32 from the randomised trial). The survivors from the descriptive study and the half of the randomised survivors attended a 1-week rehabilitation course, whereas the other half of the randomised survivors only received standard care (no intervention). All survivors filled out a questionnaire 2.5 weeks before and one and six months after the course. RESULTS AND DISCUSSION. No differences in the change of illness perceptions and the level of psychological adjustment were observed between the three groups of survivors between baseline and one and six months of follow-up. Baseline analyses showed that illness perceptions were associated with distress and QoL. This study indicates that illness perceptions are associated with adjustment; however, illness perceptions did not change after participation in a one-week multi-component rehabilitation course.

Research in Danish cancer rehabilitation: social characteristics and late effects of cancer among participants in the FOCARE research project

Worldwide, the number of cancer survivors is increasing, owing to improvements in cancer therapy, resulting in an increased need to address the physical and mental sequelae of cancer. This paper introduces a Danish psychosocial cancer intervention and presents the baseline characteristics of the cancer survivors with respect to cancer site, sociodemographic variables, social network, lifestyle, self-rated health and the prevalence of cancer-related late effects. The study is part of the FOCARE research project, in which the long-term effects of the rehabilitation programme are evaluated systematically. The study is based on data from a self-administered baseline questionnaire filled in by 2 174 cancer survivors who registered for a 1-week, publicly paid rehabilitation retreat and were invited to participate in the FOCARE study in the period 25 November 2002 to 31 December 2005. The response rate at baseline was 86% (n = 1876). Most participants were younger women with breast cancer. They were generally well educated and working. The cancer survivors reported having comprehensive social networks and being physically active. Several cancer-related symptoms were reported by women with cancers at selected sites, of which fatigue was the most prevalent. More than half reported good-to-excellent self-rated health, while fair-to-poor health was reported by 40%, most of whom were survivors of lung (56%) and haematological (48%) cancers. The results indicate that Danish cancer survivors experience considerably reduced physical health, possibly as late physical effects of treatment. The problems reported by the cancer survivors suggest that cancer rehabilitation should include these aspects of living after cancer and take account of differences among cancer survivors with regard to cancer site, sex, age, family, working status and social position. These challenges might be addressed optimally in multi-dimensional rehabilitation programmes.

Assessment of degree of satisfaction of cancer patientsand their families with rehabilitation and factors associatedwith it – results of a Japanese population

PURPOSE

To evaluate the effectiveness of rehabilitation from the standpoint of both cancer patients and their families and their degree of satisfaction with it and to assess factors associated with their degree of satisfaction.

METHOD

The subjects were 23 inpatients for whom rehabilitation had been prescribed during the period of the survey, and their families. Degree of satisfaction with rehabilitation and associated factors were assessed using questionnaires by both patients and their families twice: Before and 2 weeks after the start of rehabilitation.

RESULTS

The mean scores for degree of patient satisfaction and degree of family satisfaction were 8.6 and 7.7 (0-10), respectively. Awareness of rehabilitation (after rehabilitation), willingness for rehabilitation (before and after rehabilitation), emotional state (before and after), effectiveness of rehabilitation, and communication with staff were significantly correlated with degree of patient satisfaction. Emotional state of the patient (before), change in emotional state of the patient, family awareness of rehabilitation (after), change in emotional state of the family, and communication with staff were significantly correlated with degree of family satisfaction.

CONCLUSIONS

The results indicated that both the cancer patients and their families were satisfied with rehabilitation. They also suggested a need to understand and provide care for the emotional state of patients and their families in order to increase their degree of satisfaction, and a need for adequate explanation and active involvement to increase awareness and willingness in regard to rehabilitation.

Cancer rehabilitation in Denmark: the growth of a new narrative

A fundamental assumption behind cancer rehabilitation in many Western societies is that cancer survivors can return to normal life by learning to deal with the consequences of their illness and their treatment. This assumption is supported by increasing political attention to cancer rehabilitation and a growth in residential cancer-rehabilitation initiatives in Denmark (Danish Cancer Society 1999; Government of Denmark 2003). On the basis of their ethnographic fieldwork in residential-cancer rehabilitation courses, the authors examine the new rehabilitation discourse. They argue that this discourse has challenged the dominant illness narrative, "sick-helped-cured," producing a new narrative, "sick-helped-as if cured," and that this new narrative is produced and reproduced through technologies of power and of the self.

A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants

INTRODUCTION

We reviewed physical activity (PA) studies in prostate cancer (PC) survivors investigating (a) the effects of PA on health outcomes, (b) the prevalence of PA, and (c) the determinants of PA.

MATERIALS AND METHODS

A systematic search of the literature identified nine studies on the outcomes of PA, six studies on the prevalence of PA, and four studies on the determinants of PA in PC survivors.

RESULTS

Results showed promising effects of PA on muscular fitness, physical functioning, fatigue, and health-related quality of life. The prevalence of PA varied widely from <30% to >70%, depending on the type of measure used. PA in PC survivors was predicted by motivational variables such as intentions, perceived behavioral control, and subjective norms.

CONCLUSION

Although preliminary research is promising, there remains a significant amount of research to be done on the role of PA in PC survivors. Moreover, future research would benefit from larger samples using randomized controlled trial methodology.

Lifestyle behaviors, obesity, and perceived health among men with and without a diagnosis of prostate cancer: a population-based, cross-sectional study

Background

A better understanding of how prostate cancer survivors differ from men without prostate cancer and whether these potential differences vary across demographic subgroups will help to focus and prioritize future public health interventions for improving the health and well-being of prostate cancer survivors. Therefore, our study aims were to compare lifestyle behaviors, body mass index (BMI), and perceived health in men with and without a diagnosis of prostate cancer in a national, population-based sample and to explore whether these comparisons differ for demographic subgroups.

Methods

In a cross-sectional study, men aged ≥ 40 were identified from the Behavioral Risk Factor Surveillance System (BRFSS) 2002 data (n = 63,662). Respondents reporting history of prostate cancer (n = 2,524) were compared with non prostate cancer controls (n = 61,138) with regard to daily fruit and vegetable servings (FVPD), smoking, alcohol, sedentary behavior, BMI, and perceived health. Multivariable logistic regression calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the entire sample and for age, race, education, and urbanicity subgroups.

Results

Men with prostate cancer did not differ from men without prostate cancer with regard to smoking, alcohol, sedentary behavior, and obesity but were more likely to consume ≥ 5 FVPD (OR, 95% CI: 1.30, 1.09–1.56) and report poor or fair health (OR, 95% CI: 1.62, 1.33–1.97). Subgroup analyses demonstrated attenuation of the higher likelihood of ≥ 5 FVPD among prostate cancer survivors in rural respondents (OR, 95% CI: 0.98, 0.72–1.33). Poorer perceived health was greatest if ≤ 65 years of age (OR, 95% CI: 2.54, 1.79–3.60) and nonsignificant if black (OR, 95% CI: 1.41, 0.70–2.82). Smoking and alcohol which were not significant for the sample as a whole, demonstrated significant associations in certain subgroups.

Conclusion

Although efforts to enhance perceived health and healthy lifestyle behaviors among prostate cancer survivors are warranted, demographic subgroups such as prostate cancer survivors ≤ 65 and rural populations may require more aggressive interventions.

Quality of life, drinking to cope, alcohol consumption and smoking in successfully treated HNSCC patients

CONCLUSION

The level of coping by alcohol consumption is broadly associated with level of general quality of life (QoL) in patients with successfully treated head and neck squamous cell carcinoma (HNSCC).

OBJECTIVE

The aim of this study was to investigate the association between self-reported level of general coping, drinking to cope (DTC), reported alcohol and tobacco use as well as QoL in successfully treated HNSCC patients.

PATIENTS AND METHODS

We employed a cross-sectional design. Sample I included all patients <80 years old who had been diagnosed with HNSCC in Western Norway in the period from 1992 to 1997, and who were disease-free in the year 2000. The patients were interviewed at a routine follow-up visit. Sample II included all Norwegian laryngectomized patients. General coping and DTC were assessed by the COPE questionnaire and the QoL was assessed by the EORTC-QLQ (C30/H&N35) questionnaire. Reported level of alcohol consumption was associated with global QoL (r = -0.22) and with DTC (r = 0.31). Reported smoking level was associated with DTC (r = 0.26) and inversely with C30 functional/symptom sum QoL scores (r = -0.31/0.27). Level of DTC was associated with C30 global (r = -0.30) and C30 functional/symptom sum QoL scores (r = -0.31/0.27) and this association was still present after adjustment for gender, age, levels of neuroticism and avoidance coping.

Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population

In the world today, there are roughly 25 million cancer survivors. Although the increasing numbers of survivors testifies to the success of early detection and treatment, there is a downside. Cancer survivors are at increased risk for second cancers, other forms of comorbidity (e.g., cardiovascular disease, diabetes, osteoporosis), and functional decline. Lifestyle factors, such as a healthy diet, regular exercise, and smoking cessation may prevent these conditions and improve survivors' quality of life. Data also are accumulating to suggest that healthful lifestyle practices and successful weight management may prevent progressive or recurrent disease. Previous surveys conducted among both adult and pediatric cancer survivors indicate that most survivors have high levels of interest in diet and exercise interventions. Additionally, survivors who smoke report high levels of interest in interventions aimed at smoking cessation. Many factors, such as intervention timing and duration and channels of delivery, must be carefully considered in developing interventions that best meet the needs of this vulnerable population. Total transparency also is necessary in reporting the results of trials to ensure the inclusion of information regarding proportional accrual, attrition, and study sample sociodemographic characteristics to move toward the development of interventions most likely to gain broad-scale acceptance and adherence. Home-based interventions that rely on telephone counseling, mailed materials, or computer-assisted approaches offer promising means of reaching the geographically dispersed population of cancer survivors. More research is necessary to develop interventions that can reach and effectively promote long-term behavior change in this ever-increasing population.

Promoting Health and Physical Function Among Cancer Survivors: Potential for Prevention and Questions That Remain

Cancer survivors are at increased risk, not only for progressive and recurrent disease, but also other cancers, cardiovascular disease, diabetes, osteoporosis, and functional decline. Lifestyle interventions to improve dietary and physical activity behaviors, and smoking cessation, have the potential to improve the overall health and quality of life of this vulnerable population. Studies on overall health and physical function from 1966 and beyond regarding the impact of behavioral interventions that used randomized and controlled designs were identified through MEDLINE and PubMed searches. Published reports currently exist for 22 exercise interventions, 11 diet-related interventions (excluding those limited to dietary supplements or single nutrients), two diet and exercise interventions, and 10 behavioral-based smoking cessation interventions. Although many interventions have been successful in promoting behavioral change and have resulted in improvements in various health-related outcomes, more research is needed to determine the key components of interventions that are able to produce the greatest behavioral change and the most favorable health-related benefits. The oncology care provider can play a pivotal role in improving the long-term health of cancer survivors by (1) being aware of opportunities to encourage healthful behaviors (ie, smoking cessation, weight control, and increased physical activity); (2) vigilantly tracking long-term effects among cancer survivors and exploring whether they are amenable to intervention; (3) staying abreast of current health behavior guidelines for cancer survivors and existing resources for professional and patient education; and (4) supporting and contributing to efforts aimed at primary and tertiary prevention research.

Personality traits and cancer survival: a Danish cohort study

We conducted a population-based prospective cohort study in Denmark to investigate associations between the personality traits and cancer survival. Between 1976 and 1977, 1020 residents of the Copenhagen County completed a questionnaire eliciting information on personality traits and various health habits. The personality traits extraversion and neuroticism were measured using the short form of the Eysenck Personality Inventory. Follow-up in the Danish Cancer Registry for 1976-2002 revealed 189 incidents of primary cancer and follow-up for death from the date of the cancer diagnosis until 2005 revealed 82 deaths from all-cause in this group. A Cox proportional-hazards model was used to estimate the hazard ratios (HRs) of death from all-cause according to extraversion and neuroticism adjusting for potential confounding factors. A significant association was found between neuroticism and risk of death (HR, 2.3 (95% CI=1.1-4.7); Linear trend P=0.04) but not between extraversion and risk of death (HR, 0.9 (0.4-1.7); Linear trend P=0.34). Similar results were found when using cancer-related death. Stratification by gender revealed a strong positive association between neuroticism and the risk of death among women (Linear trend P=0.03). This study showed that neuroticism is negatively [corrected] associated with cancer survival. Further research on neuroticism and cancer survival is needed.

A meta-analysis of exercise interventions among people treated for cancer

GOAL

This review applied meta-analytic procedures to integrate primary research findings that tested exercise interventions among people treated for cancer.

METHODS

Extensive literature searching strategies located published and unpublished intervention studies that tested exercise interventions with at least five participants (k = 30). Primary study results were coded. Meta-analytic procedures were conducted.

MAIN RESULTS

The overall weighted mean effect size (ES) for two-group comparisons was 0.52 (higher mean for treatment than control) for physical function, 0.35 for symptoms other than fatigue, and 0.27 for body composition. More modest positive ESs were documented for mood (0.19), quality of life (0.14), fatigue (0.11), and exercise behavior (0.04). ESs were larger among single-group pre-post design studies. ESs among control group participants were typically negative and not (statistically) significantly different from 0.

CONCLUSIONS

Exercise interventions resulted in small positive effects on health and well-being outcomes among existing studies. Future research should examine intervention-specific characteristics that result in optimal results, such as dose.

Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer

PURPOSE

Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population.

METHODS

Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches.

RESULTS

Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance.

CONCLUSION

With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.