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Herrero López B, Cardeña-Gutiérrez A, Godoy Ortiz A, Gonzaga López A, Grueso López AM, Nuño Alves A, Ramírez Daffós P, Rodríguez Sánchez CA, Rodríguez Pérez ÁR, Sacristán Santos V, Saura Grau S, Sebio García R, Seguí Palmer MÁ. Exercise in cancer patients: assistance levels and referral pathways-a position statement from the Spanish Society of Medical Oncology. Clin Transl Oncol 2024:10.1007/s12094-024-03546-w. [PMID: 38909323 DOI: 10.1007/s12094-024-03546-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient's needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients.
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Affiliation(s)
- Blanca Herrero López
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón. Madrid (España), Madrid, Spain.
| | - Ana Cardeña-Gutiérrez
- Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife (España), Santa Cruz de Tenerife, Spain
| | - Ana Godoy Ortiz
- UGCI Oncología Médica Hospitales Universitarios Regional y Virgen de La Victoria, Málaga, Málaga, Spain
| | | | | | | | | | | | | | | | - Salvador Saura Grau
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Miguel Ángel Seguí Palmer
- Parc Taulí Consorci Corporació Sanitaria. Sabadell. Servicio de Oncologia. Institut d'Investigació I Innovació Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain
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2
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Lim KH. Effects of Integrated Music-Video Therapy on Pain and Anxiety During High-Dose-Rate Brachytherapy. Pain Manag Nurs 2024; 25:e223-e229. [PMID: 38423804 DOI: 10.1016/j.pmn.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This study aimed to examine the effect of integrated music-video therapy on pain and anxiety of gynecologic cancer patients at different stages of brachytherapy. DESIGN This study used a single-group crossover design. METHODS Data on 27 patients diagnosed with gynecologic cancer and receiving brachytherapy were collected from February 2018 to January 2019. Participants' pain and anxiety levels were measured four times using a numerical rating scale (before, during, after applicator insertion, and during the radiation). In addition, vital signs were measured three times (before, after applicator insertion, and during radiation). Data were analyzed for frequency and percentage. The normality and homogeneity of the dependent variables were tested using the Kolmogorov-Smirnov and Mann-Whitney U tests, respectively. RESULTS Significant differences were found between the experimental and control phases in pain degree during radiation exposure (Z = -1.68, p = .046) and anxiety degree during applicator insertion (Z=-4.42, p = .000), after applicator insertion (Z = -4.85, p = .000), and during radiation exposure (Z = -5.38, p = .000). However, no significant difference was found between the changes in blood pressure, pulse, and respiration at any time point. CONCLUSIONS The findings suggest the need to actively employ integrated music-video therapy to reduce acute pain and anxiety in gynecologic cancer patients undergoing brachytherapy. CLINICAL IMPLICATIONS This study provides insights into the methodological approaches for implementing integrated music-video therapy in clinical practice, targeting the reduction of acute pain and anxiety triggered by gynecological surgeries and procedures.
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Affiliation(s)
- Kyung Hee Lim
- College of Nursing, Keimyung University, Daegu, Republic of Korea.
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Caru M, Zaorsky NG, Sturgeon KM, Potiaumpai M, Gordon B, Doerksen S, Schmitz KH. Exercise oncology clinical trials during treatments: a commentary to address the safety concerns of human subjects regulatory reviewers and committees. Support Care Cancer 2024; 32:269. [PMID: 38578453 DOI: 10.1007/s00520-024-08471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
Exercise oncology clinical trials contribute to the advancement of our scientific knowledge and to the safety and care of patients diagnosed with cancer. Nevertheless, regulatory reviewers and committees may not be familiar with the well-documented long-term health benefits and safety of the regular practice of physical activity. Moreover, they may not see how the benefits outweigh the risks in the context where patients diagnosed with cancer are typically seen as vulnerable. Therefore, we would like to provide a purpose-built overview of exercise oncology clinical trials for members involved in institutional review committees, including the Scientific Review Committee (SRC), the Institutional Review Board (IRB), and the Data Safety Monitoring Committee (DSMC) to facilitate a greater understanding of the safety and benefits of physical activity during cancer treatments. Communication is key to improve the success of exercise oncology clinical trials, which are vital for patients diagnosed with cancer.
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Affiliation(s)
- Maxime Caru
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Kathleen M Sturgeon
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Melanie Potiaumpai
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brett Gordon
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Shawna Doerksen
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn H Schmitz
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
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Harris E, Marignol L. Prehabilitation for Patients with Cancer Undergoing Radiation Therapy: a Scoping Review. Clin Oncol (R Coll Radiol) 2024; 36:254-264. [PMID: 38350785 DOI: 10.1016/j.clon.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
AIMS Prehabilitation is a process of identifying and assessing factors that could compromise the physical and psychological health of patients undergoing cancer treatment and implementing an intervention to combat such concerns. The use of prehabilitation in cancer surgery has yielded positive outcomes in rectal, lung and abdominal cancers. Prehabilitation strategies have potential to improve the management of patients receiving radiation therapy or chemoradiation. The aim of the present study was to map the evidence of the assessment and evaluation of prehabilitation for radiation therapy patients. MATERIALS AND METHODS A database search using EMBASE and PubMed was conducted. The PRISMA guidelines were adhered to. Keywords included prehabilitation, radiation therapy/radiotherapy, chemoradiotherapy/chemoradiation, intervention and exercise. Types of prehabilitation strategy, their purposes and impact, according to cancer site, were analysed. RESULTS Prehabilitation is most commonly evaluated in head and neck cancer, whereby unimodal, physical interventions manage dysphagia. Prehabilitation for lung cancer demonstrated its ability to widen treatment options for patients. Physical prehabilitation is administered to combat adverse effects of neoadjuvant chemoradiation therapy in patients with rectal cancer. CONCLUSION Prehabilitation is adaptive and tailored to specific patient and site needs; thus it is applied across a wide range of cancer sites. More interventions by which radiation therapy is the definitive treatment modality and larger sample sizes within these studies are warranted to increase prehabilitation utilisation for patients undergoing radiation therapy.
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Affiliation(s)
- E Harris
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - L Marignol
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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Berg M, Silander E, Bove M, Johansson L, Nyman J, Hammerlid E. Fatigue in Long-Term Head and Neck Cancer Survivors From Diagnosis Until Five Years After Treatment. Laryngoscope 2023; 133:2211-2221. [PMID: 36695154 DOI: 10.1002/lary.30534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Fatigue due to cancer is a challenging symptom that might be long-lasting after cancer treatment. The aim of this study was to follow the development of fatigue among head and neck cancer (HNC) patients prospectively and longitudinally and to analyze predictors for acute and chronic fatigue. METHODS HNC patients treated with curative intent were included at diagnosis and completed the following questionnaires multiple times, up to 5 years after treatment: the EORTC QLQ-FA12 for fatigue, EORTC QLQ-C30, and HNC-specific EORTC QLQ-H&N35 together with an anxiety and depression questionnaire. Predictors of fatigue were evaluated at 3 months and 5 years after treatment. RESULTS Of the 311 study participants, 74% responded at the 5-year follow-up. Physical fatigue was significantly worse 3 months after treatment, while emotional and cognitive fatigue were the worst at diagnosis and at 3 months. All fatigue domains were significantly better after 1 year, and the fatigue scores remained stable from 1 until 5 years after treatment. Three months after chemoradiotherapy, physical fatigue was more significant, but no long-term differences due to treatment modalities were found. Depression and anxiety were predictors for chronic emotional fatigue, and local HN pain and swallowing problems were predictors for chronic physical fatigue. Better global quality of life at diagnosis was associated with less physical and emotional fatigue. CONCLUSION Fatigue was worst in the short term for HNC patients and improved after 1 year, and long-term fatigue remained stable up to 5 years after treatment. A few predictors for chronic fatigue were found. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2211-2221, 2023.
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Affiliation(s)
- Malin Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Silander
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mogens Bove
- Department of Otorhinolaryngology, Northern Alvsborg County Hospital (NAL), Trollhättan, Sweden
| | - Leif Johansson
- Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Alves D, Araújo JC, Fangueiro R, Ferreira DP. Localized Therapeutic Approaches Based on Micro/Nanofibers for Cancer Treatment. Molecules 2023; 28:molecules28073053. [PMID: 37049815 PMCID: PMC10096407 DOI: 10.3390/molecules28073053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Cancer remains one of the most challenging health problems worldwide, and localized therapeutic approaches based on micro/nanofibers have shown potential for its treatment. Micro/nanofibers offer several advantages as a drug delivery system, such as high surface area, tunable pore size, and sustained release properties, which can improve drug efficacy and reduce side effects. In addition, functionalization of these fibers with nanoparticles can enhance their targeting and therapeutic capabilities. Localized delivery of drugs and/or other therapeutic agents via micro/nanofibers can also help to overcome the limitations of systemic administration, such as poor bioavailability and off-target effects. Several studies have shown promising results in preclinical models of cancer, including inhibition of tumor growth and improved survival rates. However, more research is needed to overcome technical and regulatory challenges to bring these approaches to clinical use. Localized therapeutic approaches based on micro/nanofibers hold great promise for the future of cancer treatment, providing a targeted, effective, and minimally invasive alternative to traditional treatments. The main focus of this review is to explore the current treatments utilizing micro/nanofibers, as well as localized drug delivery systems that rely on fibrous structures to deliver and release drugs for the treatment of cancer in a specific area.
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Wen L, Chen X, Cui Y, Zhang M, Bai X. Effects of Baduanjin exercise in nasopharyngeal carcinoma patients after chemoradiotherapy: a randomized controlled trial. Support Care Cancer 2022; 31:79. [PMID: 36562869 DOI: 10.1007/s00520-022-07548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the effects of traditional Chinese Baduanjin Qigong exercises on the physical and psychological recovery of patients with nasopharyngeal carcinoma after chemoradiotherapy. METHODS Eighty-eight nasopharyngeal carcinoma patients who had completed chemoradiotherapy were randomly divided into the Baduanjin intervention group (n = 44) and the control group (n = 44). Patients in the intervention group practised Baduanjin exercise for 12 weeks, with the frequency of 40 min a day and 5 days a week after discharge from the hospital. Participants in the control group received usual care. Outcome indicators included quality of life (QOL), complications, cancer-related fatigue (CRF), sleep quality, anxiety, and depression. The intention-to-treat and per-protocol populations were compared using univariate analysis of variance. Partial eta squared was used as a measure of the effect size. RESULTS A total of 75 patients completed the study. In the intention-to-treat analysis, after 12 weeks of exercise intervention, there were significant increases in the global FACT-H&N (95% CI = 2.09 to 11.47, ηp2 = 0.088), social/family well-being (95% CI = 0.13 to 2.26, ηp2 = 0.055), emotional well-being (95% CI = 0.34 to 2.44, ηp2 = 0.074), and head and neck cancer subscale scores (95% CI = 0.17 to 3.86, ηp2 = 0.052) in the Baduanjin group compared with the control group at the 12th week. In the per-protocol analysis, there were significant increases in the global FACT-H&N (95% CI = 4.11 to 11.75, ηp2 = 0.190), physical well-being (95% CI: 0.50 to 3.04, ηp2 = 0.096), social/family well-being (95% CI: 0.32 to 2.15, ηp2 = 0.090), emotional well-being (95% CI: 0.60 to 2.53, ηp2 = 0.125), functional well-being (95% CI: 0.25 to 2.49, ηp2 = 0.075), and head and neck cancer subscale (95% CI: 1.08 to 4.08, ηp2 = 0.139) scores in the Baduanjin group compared with the control group at the 12th week. CONCLUSION The findings in this study indicate that Baduanjin exercise is an effective and appropriate intervention for improving quality of life and is worthy of recommendation and implementation by oncology nurses in the rehabilitation process of patients with nasopharyngeal carcinoma.
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Affiliation(s)
- Liying Wen
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xingyu Chen
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yuanyuan Cui
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Miao Zhang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xinghua Bai
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China. .,, Shenyang, China.
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Ma SJ, Yu H, Khan M, Yu B, Santhosh S, Chatterjee U, Gill J, Iovoli A, Farrugia M, Wooten K, Gupta V, McSpadden R, Kuriakose MA, Markiewicz MR, Al-Afif A, Hicks WL, Platek ME, Seshadri M, Ray AD, Repasky E, Singh AK. Defining the optimal threshold and prognostic utility of pre-treatment hemoglobin level as a biomarker for survival outcomes in head and neck cancer patients receiving chemoradiation. Oral Oncol 2022; 133:106054. [PMID: 35933937 PMCID: PMC10018793 DOI: 10.1016/j.oraloncology.2022.106054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES We sought to define the optimal threshold for anemia in North American head and neck cancer patients and evaluate its role as a prognostic biomarker. MATERIALS AND METHODS A single-institution database was queried for patients with head and neck cancer who underwent chemoradiation from January 2005 to April 2021. An optimal threshold of hemoglobin (Hgb) level was defined based on maximum log-rank test statistic. Cox multivariable analysis (MVA), Kaplan-Meier, and propensity score matching were performed to evaluate treatment outcomes. RESULTS A total of 496 patients were identified. Threshold for Hgb was determined to be 11.4 for both overall survival (OS) and progression-free survival (PFS). Low Hgb was associated with worse OS (adjusted hazards ratio [aHR] 2.41, 95 % confidence interval [CI] 1.53-3.80, p < 0.001) and PFS (aHR 2.01, 95 % CI 1.30-3.11, p = 0.002). Similar findings were observed among 39 matched pairs for OS (5-year OS 22.3 % vs 49.0 %; HR 2.22, 95 % CI 1.23-4.03, p = 0.008) and PFS (5-year PFS 24.3 % vs 39.1 %; HR 1.78, 95 % CI 1.02-3.12, p = 0.04). Among those with HPV-negative tumors, low Hgb was associated with worse OS (aHR 13.90, 95 % CI 4.66-41.44, p < 0.001) and PFS (aHR 5.24, 95 % CI 2.09-13.18, p < 0.001). However, among those with HPV-positive tumors, low Hgb was not associated with both OS (aHR 1.75, 95 % CI 0.60-5.09, p = 0.31) and PFS (aHR 1.13, 95 % CI 0.41-3.14, p = 0.82). CONCLUSION AND RELEVANCE Low Hgb below 11.4 was an independent adverse prognostic factor for worse survival. It was also prognostic among patients with HPV-negative tumors, but not for HPV-positive tumors.
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Affiliation(s)
- Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Han Yu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Michael Khan
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203. USA.
| | - Brian Yu
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203. USA.
| | - Sharon Santhosh
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203. USA.
| | - Udit Chatterjee
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Jasmin Gill
- University at Buffalo, The State University of New York, 12 Capen Hall, Buffalo, NY 14260. USA.
| | - Austin Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Kimberly Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Ryan McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Moni A Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214. USA; Department of Neurosurgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203. USA.
| | - Ayham Al-Afif
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Wesley L Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Mary E Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA; Department of Nutrition and Dietetics, D'Youville University, 320 Porter Avenue, Buffalo, NY 14201. USA.
| | - Mukund Seshadri
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Elizabeth Repasky
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263. USA.
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Xiong X, Zeng B, Zhang S, Du J, Liao X, Hu S, Su X, Qiu S, Yang L. Which Type of Exercise During Radiation Therapy Is Optimal to Improve Fatigue and Quality of Life in Men with Prostate Cancer? A Bayesian Network Analysis. EUR UROL SUPPL 2022; 43:74-86. [PMID: 36353065 PMCID: PMC9638772 DOI: 10.1016/j.euros.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Context Physical exercise in men with prostate cancer (CaP) has shown benefits in improving cancer-related fatigue (CRF) and quality of life (QoL) during radiation therapy. However, types of exercises that are more effective are not well understood. Evidence acquisition We searched PubMed, Web of Science, and ClinicalTrials.gov up to November 2021 to identify potentially relevant studies. Randomized controlled trials (RCTs) testing the effects of exercise training on CRF, QoL, and treatment-related toxicities in patients with CaP undergoing radiation therapy were included. The quality of individual studies was evaluated using the Tool for the assEssment of Study qualiTy and reporting in Exercise (TESTEX) scale. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. A meta-regression analysis was conducted to test the study-level covariates. A random-effect network meta-analysis was conducted based on a Bayesian model. Evidence synthesis Eight RCTs with 466 participants were included. Exercise achieved significant improvements in CRF (standardized mean difference [SMD] = 1.24, 95% confidence interval or CI [0.43, 2.06], I2 = 93%) and QoL (SMD = 1.40, 95% CI [0.05, 2.75], I2 = 95%). Based on the meta-regression and Bayesian model, combined moderate-intensity continuous training aerobic exercise and resistance exercise (MICT/RES) showed the highest probability of ranking first in terms of CRF and QoL improvement, but the results of QoL were unstable. Exercise training also had a positive effect on urinary toxicities (SMD = –0.53, 95% CI [–0.79, –0.27], I2 = 0%). A subgroup analysis indicated that MICT/RES might be the most promising exercise modality for reducing intestinal toxicities (SMD = –1.76, 95% CI [–2.32, –1.20]). Conclusions MICT/RES might be superior to any other types of exercise at reducing CRF. MICT/RES was more effective on significantly mitigating urinary and intestinal toxicities. Patient summary In prostate cancer (CaP) survivors during radiation therapy, exercise training is an effective and safe intervention to reduce cancer-related fatigue (CRF) and improve quality of life (QoL), and should be prescribed as a rehabilitation option for clinical management. As for the types of exercises, moderate-intensity continuous training aerobic exercise and resistance exercise seem to be the most effective interventions to reduce CRF, improve QoL, and mitigate treatment-related symptoms.
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Nehlsen AD, Sindhu KK, Jones BM, Lehrer EJ, Rowley JP, Bakst RL. Moving beyond Definitive Therapy: Increasing Physical Activity in Survivors of Cancers of the Head and Neck. Curr Oncol 2022; 29:1213-1222. [PMID: 35200602 PMCID: PMC8870667 DOI: 10.3390/curroncol29020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
As chemotherapeutic, radiation, and surgical techniques have improved, there has been a dramatic improvement in survival in patients diagnosed with cancers of the head and neck. As a result, a heightened focus on survivorship by clinicians will increasingly prove necessary. In particular, medical care teams will have to pay special attention to mitigating the long-term sequelae of definitive cancer treatments, many of which act as barriers to exercise. This is unfortunate, as the benefits of exercise in patients with cancer have become increasingly recognized. In this review, we discuss the potential benefits of and barriers to exercise in survivors of cancers of the head and neck. We also review existing exercise guidelines and strategies by which clinicians can promote exercise in this unique patient population.
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Fitz T, Sörgel C, Rutzner S, Hecht M, Fietkau R, Distel LV. Baseline Quality of Life of Physical Function Is Highly Relevant for Overall Survival in Advanced Rectal Cancer. Healthcare (Basel) 2022; 10:healthcare10010141. [PMID: 35052304 PMCID: PMC8775862 DOI: 10.3390/healthcare10010141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
In advanced rectal cancer, neoadjuvant radiochemotherapy and total mesorectal excision lead to long overall survival. The quality of life (QOL) of the patients is clearly related to the prognosis. Our question was whether the prognosis can be represented with only one question or one score from the QOL questionnaires. 360 consecutively recruited patients diagnosed with advanced rectal cancer were questioned during radiochemotherapy and a follow-up of 8 years. The questionnaires QLQ-C30 and QLQ-CR38 were used; 10 functional and 17 symptom scores were calculated. The functional score “physical function” and the symptom scores “fatigue”, “nausea and vomiting”, “pain” and “appetite loss” were highly prognostic (p < 0.001) for overall survival. “Physical function” was highly prognostic at all time points up to 1 year after starting therapy (p ≤ 0.001). The baseline “physical function” score divided the cohort into a favorable group with an 8-year overall survival rate of 70.4% versus an unfavorable group with 47.5%. In the multivariable analysis, baseline “physical function”, age and distant metastases were independent predictors of overall survival. The score “physical function” is a powerful unrelated risk factor for overall survival in patients with rectal cancer. Future analyses should study whether increased “physical function” after diagnosis could improve survival.
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Affiliation(s)
- Tim Fitz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: (T.F.); (L.V.D.)
| | - Christopher Sörgel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Sandra Rutzner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Luitpold V. Distel
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (C.S.); (S.R.); (M.H.); (R.F.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: (T.F.); (L.V.D.)
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Zaorsky NG, Garrett S, Spratt DE, Nguyen PL, Sciamanna C, Schmitz K. Exercise: A Treatment That Should Be Prescribed With Radiation Therapy. Int J Radiat Oncol Biol Phys 2022; 112:96-98. [PMID: 34561128 DOI: 10.1016/j.ijrobp.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Sara Garrett
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Chris Sciamanna
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Medicine Division of General Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kathryn Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Michael CM, Lehrer EJ, Schmitz KH, Zaorsky NG. Prehabilitation exercise therapy for cancer: A systematic review and meta-analysis. Cancer Med 2021; 10:4195-4205. [PMID: 34110101 PMCID: PMC8267161 DOI: 10.1002/cam4.4021] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6-minute-walk test (6MWT). DATA SOURCES PRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions. STUDY SELECTION The inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise. DATA EXTRACTION AND SYNTHESIS Guidelines were applied by independent extraction by multiple observers. Data were pooled using a random-effects model. MAIN OUTCOME(S) AND MEASURE(S) Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the DerSimonian and Laird method. RESULTS Objective 1. Across 21 studies included in this review, 1564 patients were enrolled, 1371 (87.7%) accepted the trial; of 1371, 1230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta-analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference = +27.9 m; 95% confidence interval (CI): 9.3; 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference = -24.1 m; 95% CI: -45.7; -2.6). Meta-analysis demonstrated improvements in 6MWT distance 4-8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference = -58.0 m, 95% CI: -92.8; -23.3). CONCLUSIONS AND RELEVANCE Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity.
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Affiliation(s)
| | - Eric J. Lehrer
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | | | - Nicholas G. Zaorsky
- Department of Radiation OncologyPenn State Cancer InstituteHersheyPAUSA
- Department of Public Health SciencesPenn State College of MedicineHersheyPAUSA
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