How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer

Comparison of Quality of Life in Breast Cancer Survivors with and without Persistent Depressive Symptoms: A 12-Month Follow-Up Study

Although breast cancer treatments reduce mortality, their adverse effects can increase depression which impacts one's quality of life (QoL). Physical activity (PA) seems to improve the QoL of breast cancer survivors (BCS). However, an unanswered question is the influence of PA on the QoL in BCS with depressive symptoms. Thus, we analyzed the influence of PA on the QoL in BCS with persistent depressive symptoms during 12 months of follow-up. The sample included 70 female BCS. Depression and QoL domains (i.e., functional capacity, physical limitations, body pain, general health status, vitality, social and emotional aspects, and mental health) were assessed at baseline and follow-up periods by the Hospital Anxiety and Depression Scale and SF-36, respectively. Habitual PA was assessed by Baecke's questionnaire. Our results indicate a prevalence of 17.1% of depressive symptoms. Non-depressives BCS improved their physical limitations and general health status domains over time, but there were no observed differences in depressive BCS. BCS with persistent depressive symptoms (baseline and follow-up) showed worse QoL scores than non-depressives in all domains, regardless of confounding factors. When adjusted for PA, the difference between BCS depressives and non-depressives lost its significance in the functional capacity domain. In conclusion, habitual PA practice positively influenced the functional capacity domain of the QoL in BCS.

Physical, Leisure, and Daily Living Activities in Patients Before, During, and After Radiotherapy for Cancer: Which Patients Need Support in Activities?

BACKGROUND

Avoiding inactivity and staying active during cancer therapy have great health effects.

OBJECTIVE

The aims of this study were to describe level of daily, leisure, and physical activities before, during, and after radiotherapy and to investigate whether patients who had not restored activity level after radiotherapy differed from patients who had restored activity level regarding different characteristics.

METHODS

In this descriptive longitudinal study, 196 patients undergoing pelvic-abdominal radiotherapy reported their activity level at baseline, weekly during radiotherapy, and at 1 month after radiotherapy.

RESULTS

Patients decreased activity level during radiotherapy (P < .001 for all activities): physical activity (34% of patients decreased level), walking (26%), leisure activities (44%), social activities (15%), housework (34%), shopping (28%), and activities in general (28%). Almost half (47%) had not restored activity level after radiotherapy. Patients with colorectal cancer, older than 65 years, who had less education than university, and high capacity in overall daily activities at baseline were more likely than other patients not to restore activity level after radiotherapy. The patients not restoring their activity level after radiotherapy were more likely than others to experience anxious mood (P = .016), depressed mood (P = .003), and poor quality of life (P = .003) after radiotherapy.

CONCLUSION

Patients' activity level decreased during radiotherapy, and almost half of patients did not restore activity level after radiotherapy.

IMPLICATIONS FOR PRACTICE

Given that restored activity level after radiotherapy was less common in certain subgroups and that patients who restored activity level experienced better quality of life and less frequent anxious and depressed mood, cancer nursing professionals should consider supporting these subgroups of patients in performing activities.

Exercise Counteracts the Deleterious Effects of Cancer Cachexia

Simple Summary

This review provides an overview of the effects of exercise training on the major mechanisms related to cancer cachexia (CC). The review also discusses how cancer comorbidities can influence the ability of patients/animals with cancer to perform exercise training and what precautions should be taken when they exercise. The contribution of other factors, such as exercise modality and biological sex, to exercise effectiveness in ameliorating CC are also elaborated in the final sections. We provide meticulous evidence for how advantageous exercise training can be in patients/animals with CC at molecular and cellular levels. Finally, we emphasise what factors should be considered to optimise and personalise an exercise training program in CC.

Abstract

Cancer cachexia (CC) is a multifactorial syndrome characterised by unintentional loss of body weight and muscle mass in patients with cancer. The major hallmarks associated with CC development and progression include imbalanced protein turnover, inflammatory signalling, mitochondrial dysfunction and satellite cell dysregulation. So far, there is no effective treatment to counteract muscle wasting in patients with CC. Exercise training has been proposed as a potential therapeutic approach for CC. This review provides an overview of the effects of exercise training in CC-related mechanisms as well as how factors such as cancer comorbidities, exercise modality and biological sex can influence exercise effectiveness in CC. Evidence in mice and humans suggests exercise training combats all of the hallmarks of CC. Several exercise modalities induce beneficial adaptations in patients/animals with CC, but concurrent resistance and endurance training is considered the optimal type of exercise. In the case of cancer patients presenting comorbidities, exercise training should be performed only under specific guidelines and precautions to avoid adverse effects. Observational comparison of studies in CC using different biological sex shows exercise-induced adaptations are similar between male and female patients/animals with cancer, but further studies are needed to confirm this.

Exercise training-induced adaptations in lung cancer patients who have undergone a lobectomy

PURPOSE

To determine the safety and effectiveness of a prescribed, individualized, 12-week exercise intervention on cardiorespiratory function, muscular strength, and quality of life in lung cancer patients who have undergone a lobectomy. In addition, we sought to compare the exercise training response of lung cancer patients who have undergone a lobectomy to a population of cancer patients with all other cancers in order to examine the specific effects of a lobectomy when compared to cancer patients at large.

METHODS

Participants were referred by a physician, and upon entry, completed an exercise-based assessment and surveys to assess various quality of life measures. Participants were divided into two groups: lung cancer patients having undergone a lobectomy (LOB, n = 9) or those diagnosed with all other cancers (AOC, n = 201). Participants underwent 12 weeks of supervised exercise based on an individualized exercise prescription. Measures of cardiorespiratory function, muscular strength, and quality of life were collected prior to the intervention and after 12 weeks of exercise training.

RESULTS

Significant improvements to VO_2peak (p < 0.05) were seen in both groups. Significant improvements to muscular strength (p < 0.05) were seen in both groups for all measures aside from shoulder press in the LOB group. Both groups showed significant improvements to aspects of fatigue and quality of life (p < 0.05), but only the AOC group significantly improved in measures of depression (p < 0.05).

CONCLUSION

Exercise-based rehabilitation is a safe and effective intervention for lung cancer survivors who have undergone a lobectomy. These individuals saw significant improvements in cardiorespiratory fitness, muscular strength, and quality of life. Although there were similarities in the pattern of these training-induced improvements for these groups, lung cancer patients undergoing a lobectomy consistently demonstrated lower absolute values when compared to patients with all other cancer diagnoses.

Greater Post-Surgical Pain Predicts Long-Term Depressed Affect in Breast Cancer Patients

Abstract. Background: Depressed affect is observed during primary treatment for early-stage breast cancer and often persists into survivorship. Pain can influence the long-term emotions of women with breast cancer. Behavioral mechanisms explaining this relationship are less clear. Coping during primary treatment may play a role in the association between pain and depressed affect. Aims: Our observational study examined a longitudinal mediation model testing whether post-surgical pain intensity predicted depressed affect 5 years later via disengagement and/or engagement coping at the end of treatment. Method: Women ( N = 240) with stage 0–III breast cancer completed measures of pain, coping, and depressed affect 4–10 weeks post-surgery, and 12 months and 5 years later. Results: Structural modeling yielded measurement models of 12-month disengagement and engagement coping. Direct effects emerged between post-surgical pain intensity and 12-month disengagement (β = .37, p < .001) and engagement coping (β = .16, p < .05). Post-surgical pain intensity was also related to 5-year depressed affect (β = .25, p < .05). Disengagement and engagement coping were not associated with depressed affect at 5-year follow-up, and there was no evidence of mediation. Limitations: This is a secondary analysis of data from a trial conducted several years ago, and may not generalize due to a homogenous sample with attrition at long-term follow-up. Conclusions: Greater post-surgical pain intensity predicts more disengagement and engagement coping at the end of primary treatment, as well as depressed affect during survivorship. Managing post-surgical pain may influence the emotions of survivors of breast cancer up to 5 years later, possibly through coping or non-coping processes.

Physical activity domains are differently related with quality of life in breast cancer survivors: a cross-sectional study

OBJECTIVES

Treatments for breast cancer (BC) can lead to physical and mental impairments which may affect quality of life (QoL). Physical activity (PA) is highly recommended for this population due to its protective effect against BC relapse and its ability to reduce the health impact of treatment. However, it is not clear whether the different domains of PA are associated with better QoL of BC survivors. The current study aimed to verify the relationship between different PA domains with QoL of BC survivors.

METHODS

The sample consisted of 128 women BC survivors, with a mean age of 58.2 ± 9.7 years. QoL was assessed using the Short-Form Health Survey questionnaire (SF-36) and PA was verified through the Baecke questionnaire, in domains of occupation, sports practice, and leisure time/commuting. The relationship between QoL and different PA domains was verified by linear regression, adjusted by age, marital status, and socioeconomic condition.

RESULTS

Occupational PA was negatively related to physical limitations [β= -15.36 (-29.04 to -1.68] and body pain [β=-6.61 (-14.53 to 1.31) marginal association]. Sports practice was positively related to functional capacity [β= 4.24 (0.60 to 7.88)]. Leisure time/commuting PA was positively related to functional capacity [β = 7.17 (3.09 to 11.26)], vitality [β = 4.30 (0.39 to 8.22)], social aspects [β= 5.47 (0.80 to 10.15)], and mental health [β = 4.08 (0.40 to 7.75)].

CONCLUSIONS

Sports practice and leisure time/commuting PA were positively related to QoL in BC survivors, while occupational PA was negatively related to QoL, independently of age, marital status, and socioeconomic condition.

Greater Well-Being in More Physically Active Cancer Patients Who Are Enrolled in Supportive Care Services

Background: Cancers are one of the leading causes of mortality worldwide. Cancer patients are increasingly seeking integrative care clinics to promote their health and well-being during and after treatment. Aim: To examine relationships between physical activity (PA) and quality of life (QoL) in a sample of cancer patients enrolling in integrative care in a supportive care clinic. Also, to explore circulating inflammatory biomarkers and heart rate variability (HRV) in relationship to PA and QoL. Methods: A cross-sectional design of adult patients who sought care in the InspireHealth clinic, Vancouver, British Columbia, Canada. Patients with complete PA data (n = 118) answered psychosocial questionnaires, provided blood samples, and received HRV recordings before enrollment. Patients were stratified into “less” versus “more” active groups according to PA guidelines (150 minutes of moderate or 75 minutes of vigorous PA or an equivalent combination). Results: Breast (33.1%) and prostate (10.2%) cancers were the most prevalent primary diagnoses. Patients engaging in more PA reported better physical (U = 1265.5, P = .013), functional (U = 1306.5, P = .024), and general QoL (U = 1341, P = .039), less fatigue (U = 1268, P = .014), fewer physical cancer-related symptoms (U = 2.338, P = .021), and less general distress (U = 2.061, P = .021). Between PA groups, type of primary cancer diagnosis differed (χ² = 41.79, P = .014), while stages of cancer did not (χ² = 3.95, P = .412). Fewer patients reported depressed mood within the more active group (χ² = 6.131, P = .047). More active patients were also less likely to have ever used tobacco (χ² = 7.41, P = .025) and used fewer nutritional supplements (χ² = 39.74, P ≤ .001). An inflammatory biomarker index was negatively correlated with vigorous PA (r_s = −0.215, P = .022). Multivariable linear regression (R² = 0.71) revealed that age (β = 0.22; P = .001), fatigue (β = −0.43; P ≤ .001), anxiety (β = −0.14; P = .048), and social support (β = 0.38; P = .001) were significant correlates of QoL.

Quality of Life in Patients With Non-Small Cell Lung Cancer: Structural Equation Modeling

BACKGROUND

Quality of life (QOL) is important for cancer patients, even for survival. However, factors affecting QOL of non-small cell lung cancer (NSCLC) patients have not been studied sufficiently.

OBJECTIVE

The aims of this study were to understand the relationships among social support, resilience, distress, and symptom and to identify predictors of QOL for NSCLC patients.

METHODS

Participants were 212 adult patients who visited an outpatient department at a tertiary hospital located in Seoul, Korea. Data were collected using self-reported questionnaires and clinical records.

RESULTS

Social support, resilience, distress, symptom burden, and QOL explained 99.9% of the variance in QOL. Social support was not a significant predictor of distress and QOL, but a significant predictor of resilience. Resilience was a significant predictor of both distress and QOL. Distress was not a significant predictor of QOL, but a significant predictor of symptom burden. Symptom burden was a significant predictor of QOL and had the largest direct effect on QOL. Resilience also had an important impact on QOL because resilience influenced QOL in various paths.

CONCLUSION

This study suggests that social support, resilience, distress, and symptom burden are predictors of QOL in an NSCLC population. These predictors had direct and indirect effects on each other and on QOL.

IMPLICATIONS FOR PRACTICE

Developing an interventional program to increase resilience and social support as well as to decrease symptom burden and distress may be necessary to improve QOL of NSCLC patients.

Identifying female pelvic cancer survivors with low levels of physical activity after radiotherapy: women with fecal and urinary leakage need additional support

Objective

To investigate the frequency of physical activity among female pelvic cancer survivors (i.e., gynecological, rectal, and anal cancer survivors) and to investigate if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and fecal leakage, clinical and sociodemographic characteristics, quality of life (QoL), and depressed and anxious mood.

Methods

Female pelvic cancer survivors (n = 578, mean age 64 years) answered a questionnaire 6–48 months after radiotherapy. A multivariable regression model analyzed factors covarying with frequency of physical activity. We compared QoL and depressed and anxious mood between women practicing physical activity at least or less than once a week.

Results

Of 568 women delivering data, 186 (33%) practiced physical activity less than once a week while 382 (67%) practiced physical activity at least weekly. Women who leaked a large or all volume of stools (p = 0.01), had just elementary school level of education (p < 0.001), smokers (p = 0.049), or had lymphedema without receiving lymphedema treatment (p = 0.030) were more likely to practice physical activity less than weekly (50%, 45%, 45%, and 37%, respectively) compared with other women. Women practicing physical activity at least weekly reported better QoL (p < 0.001) and lower frequency of depressed mood (p = 0.044) compared with the others.

Conclusions

Female cancer survivors experiencing fecal leakage were less likely to practice weekly physical activity than survivors without leakage. The survivors practicing weekly physical activity experienced better QoL and experienced depressed mood less frequently than the others.

Psychosocial risk and management of physical diseases

During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in understanding the role of psychosocial risk and management of physical diseases. We here describe the development of these fundamental concepts from early research on stress through studies of the Type A behavior pattern to more contemporary approaches to the relationship between psychosocial risks and benefits in relation to disease processes. This includes the relationship of psychosocial risk to cancers, cardiovascular diseases (CVD), cardiometabolic disorders, Human Immunodeficiency Virus (HIV)/Acquired Human Immune Deficiency Syndrome. During the past 40 years the effects of prolonged distress responses in the pathogenesis of some cancers and CVD have been well-established and modifiable behavioral, cognitive and social factors have been shown to produce favorable outcome components in the management of such diseases as breast cancer, coronary heart disease and HIV.

Variability and Influencing Factors of QOL in Breast Cancer Patients Having Chemotherapy

Variability and factors influencing quality of life (QOL) in breast cancer patients having chemotherapy were examined in a longitudinal prospective cohort study in two teaching hospitals in China. Physical, mental, social/family, and functional QOL changed significantly over time with varying patterns. In addition, various factors influenced the QOL of breast cancer patients at each chemotherapy cycle. Health professionals should focus on critical time periods during chemotherapy, particularly at baseline and during the fourth and fifth cycles when the QOL in our sample was at the lowest point, and they should provide additional support to patients to ensure that chemotherapy is delivered in an optimal fashion.