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Tan GA, Peiris CL, Dennett AM. Cancer survivors maintain health benefits 6 to 12 months after exercise-based rehabilitation: a systematic review and meta-analysis. J Cancer Surviv 2024; 18:651-672. [PMID: 36547801 DOI: 10.1007/s11764-022-01322-9] [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: 08/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months. METHODS Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied. RESULTS Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I2 = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I2 = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I2 = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I2 = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I2 = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I2 = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence. CONCLUSION Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation.
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Affiliation(s)
- Germaine A Tan
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia.
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
| | - Casey L Peiris
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
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Weemaes ATR, Beelen M, Weijenberg MP, van Kuijk SMJ, Lenssen AF. Effects of remote coaching following supervised exercise oncology rehabilitation on physical activity levels, physical fitness, and patient-reported outcomes: a randomised controlled trial. Int J Behav Nutr Phys Act 2024; 21:8. [PMID: 38273361 PMCID: PMC10809633 DOI: 10.1186/s12966-024-01561-2] [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: 05/19/2023] [Accepted: 01/14/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Studies have shown that cancer survivors experience difficulties maintaining physical activity levels after participation in a supervised exercise rehabilitation program. This study aimed to assess the effectiveness of a six-month remote coaching intervention, following a supervised exercise oncology rehabilitation program on maintenance of PA levels; and improvement of aerobic capacity, muscle strength and patient-reported outcomes in cancer survivors. METHODS Ninety-seven participants from a Dutch University Hospital's exercise rehabilitation program were randomised to the COACH group (n = 46), receiving 6 months of remote coaching after completing the exercise program, or the CONTROL group (n = 50), receiving no additional intervention. Assessment of PA levels; sedentary time; aerobic capacity; muscle strength; fatigue; health-related quality of life (HRQoL); level of anxiety and depression; and return to work (RTW) rates were conducted at baseline (T0) and six months later (T1). Multiple linear regression was used for between-group statistical comparisons of all outcomes measures. Mean differences at T1 were estimated with corresponding 95% confidence intervals (95%CI). RESULTS No significant between-group differences were observed for all outcomes at T1. An adjusted mean difference in weekly PA of 45 min (95%CI -50;140) was observed between the COACH group and the CONTROL group, favouring the COACH group, yet lacking statistical or clinical significance. CONCLUSIONS Our six-month remote coaching intervention did not notably improve PA levels; sedentary time; aerobic capacity; muscle strength; HRQoL; fatigue; anxiety and depression symptoms and RTW rates after participation in a supervised exercise oncology program. Although the participants who received coaching showed slightly higher levels of PA, these differences were not significant. More research is needed to identify patients in need for follow-up interventions following supervised exercise program and to investigate the effectiveness of remote coaching interventions in these patients. TRIAL REGISTRATION Dutch Trial Register NL7729, registered 13 may 2019, https://trialsearch.who.int/Trial2.aspx?TrialID=NL7729 .
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Affiliation(s)
- Anouk T R Weemaes
- Department of Physical Therapy, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands.
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Milou Beelen
- Department of Physical Therapy, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Roustaee S, Roudi Rashtabadi O, Tirgari B, Jahani Y, Tahmasebi S. Mirror therapy effect on shoulder pain and disability and quality of life of mastectomy women: a randomized clinical trial. Disabil Rehabil 2023; 45:4227-4235. [PMID: 36428274 DOI: 10.1080/09638288.2022.2148296] [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: 03/30/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate mirror therapy (MT) influence on shoulder pain/disability and quality of life in mastectomy women. MATERIALS AND METHODS Sixty unilateral mastectomy women were recruited and randomly assigned to an MT group (N = 30) or a sham therapy (ST) (N = 30). Women in the MT and ST group attended a nurse-led, unsupervised, 30 min a day, five days a week, and at home training program for three weeks with and without a mirror, respectively. Shoulder pain and disability scale and QOL outcomes were assessed at baseline and 3 months after intervention. RESULTS Shoulder pain and disability were significantly improved in the MT group but there was not meaningful difference between groups in the EORTC-QOL scales except for some functional scores of QLQ-BR23 scale in the MT group after 3 months follow-up. CONCLUSIONS Nurses should instruct MT as a rehabilitation program to mastectomy patients during or after hospitalization to reduce their post-op shoulder pain and disability. This intervention may have also positive impact on their self-care outcomes. It is recommended that further studies should be performed with nurse-supervised exercises, a validated tool for measuring QOL for a long period after surgery, and a longer follow-up period at least for 6 months.Implication for rehabilitationThis study aimed to investigate whether an unsupervised, nurse-led mirror therapy (MT) can alleviate shoulder pain and disability of mastectomy patients and improve their quality of life.Our findings indicated that nurse-led MT as a novel rehabilitation option for mastectomy patients, may reduce shoulder pain and disability even after long period after the surgery.Rehabilitation centers can equip rooms for MT so breast cancer women can use it immediately after mastectomy.Mirror therapy can be used as a rehabilitation method for mastectomy patients because it is easy-to-use, inexpensive, and without the need to attend a rehabilitation center.Rehabilitation centers can provide mirrors along with nursing instructions to women who want to use this method at home.
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Affiliation(s)
- Sanaz Roustaee
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Omsalimeh Roudi Rashtabadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Batool Tirgari
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Vega MR, Nadeem S, Vaughan EM, Johnston CA. The Use of Reframing: Increasing the Importance of Lifestyle Medicine. Am J Lifestyle Med 2023; 17:746-749. [PMID: 38511114 PMCID: PMC10948931 DOI: 10.1177/15598276231193643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Lifestyle behavior modification is an essential component to prevention and treatment of non-communicable diseases worldwide. For the last 40 years, studies have recognized that there is suboptimal training of physicians in lifestyle medicine and its implementation in clinical settings. The lack of nutrition and exercise counseling occurring in the medical office does not reflect the high level of evidence supporting its use. Lifestyle behavior counseling is complex; as are the individualized needs of patients. Therefore, we suspect that the lack of knowledge in nutrition and exercise prescriptions are not the only barriers to providing optimal care. Reframing lifestyle medicine interventions like nutrition and exercise from adjunctive to central to treatment and reframing the role of the physician therein may be necessary to address important barriers to overall lifestyle behavioral counseling.
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Affiliation(s)
- Molly R. Vega
- Department of Health and Human Performance, University of Houston, Houston, TX, USA (MRV, SN, CAJ)
- Renal & Pheresis Services, Texas Children’s Hospital, Houston, TX, USA (MRV)
| | - Saad Nadeem
- Department of Health and Human Performance, University of Houston, Houston, TX, USA (MRV, SN, CAJ)
| | - Elizabeth M. Vaughan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA (EMV)
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA (EMV)
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, USA (MRV, SN, CAJ)
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González-Santos Á, Lopez-Garzon M, Gil-Gutiérrez R, Salinas-Asensio MDM, Postigo-Martin P, Cantarero-Villanueva I. Nonlinear, Multicomponent Physical Exercise With Heart Rate Variability-Guided Prescription in Women With Breast Cancer During Treatment: Feasibility and Preliminary Results (ATOPE Study). Phys Ther 2023; 103:pzad070. [PMID: 37347987 PMCID: PMC10506849 DOI: 10.1093/ptj/pzad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the feasibility, safety, adherence, and preliminary efficacy of the ATOPE program during radiotherapy (RT) or chemotherapy (CT) for women with breast cancer. METHODS This single-blind, pretest-posttest feasibility study included 38 women with breast cancer at the beginning of their treatment. The ATOPE program consisted of 12 to 18 sessions of a multimodal physical exercise program, prescribed based on daily heart rate variability and clinimetric assessments using the ATOPE+ mHealth system. Overall health was assessed with quality of life, autonomous balance, and body composition, whereas health-related fitness was measured through functional capacity, physical activity levels, and upper and lower limb strength. RESULTS The rates of recruitment, retention, and adherence were 52.35, 73.68, and 84.37%, respectively, and the satisfaction rating was 9.2 out of a possible 10 points. The perceived health status change score was 3.83 points, scored on a -5 to 5 point scale. No adverse effects were found. Compliance results showed that the ATOPE+ mHealth system was used on 73.38% of the days, and the Fitbit bracelet (Google, Mountain View, CA, USA) was used on 84.91% of the days. Women stayed physically active 55% of days. Regarding preliminary results, for overall health, the percentage of body fat in the RT group decreased by 1.93%, whereas it increased by 5.03% in the CT group. Lower limb strength increased in the RT group, specifically knee extensor isometric strength (6.07%), isokinetic knee flexors 180 degree/second (1.53%), and isokinetic knee extensors 300 degree/second (4.53%), in contrast with the reductions found in the CT group (11.07, 18.67, and 14.89%, respectively). CONCLUSION The ATOPE program, through nonlinear prescription based on daily monitoring with the ATOPE+ mHealth system, is feasible and safe for application during breast cancer treatment. The results suggest that the overall health can be maintained or even improved regarding most variables. IMPACT This study focused on the feasibility, safety, and completion of a physical therapist-led program at early diagnosis for adults with breast cancer. The multimodal, supervised, tailored, nonlinear physical exercise program is feasible and safe, showed a good completion rate, and was able to prevent the quality-of-life deficits that are often triggered by systemic breast cancer treatment. This study highlights the importance of daily morning assessments using the ATOPE+ mHealth system in patients with breast cancer to prescribe nonlinear physical exercise.
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Affiliation(s)
- Ángela González-Santos
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| | - Maria Lopez-Garzon
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| | - Rocío Gil-Gutiérrez
- Department of Nursing, Faculty of Health Sciences, CTS436 Group, University of Granada, Granada, Spain
- MP07-Bases Fisiopatología y Terapéutica Médica, Instituto de Investigación Biosanitaria, Granada, Spain
| | | | - Paula Postigo-Martin
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Bowman A, Denehy L, Benjemaa A, Crowe J, Bruns E, Hall T, Traill A, Edbrooke L. Feasibility and safety of the 30-second sit-to-stand test delivered via telehealth: An observational study. PM R 2023; 15:31-40. [PMID: 35138036 DOI: 10.1002/pmrj.12783] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Exercise testing is essential to determine the safety and efficacy of prescribing exercise. Limited evidence exists to support remotely supervised exercise testing in oncology literature. OBJECTIVE To determine the feasibility, safety, and convergent validity of the 30-second sit-to-stand test (30STS) delivered via telehealth in an oncology population. Exploratory analyses informed remote test feasibility according to participant and treatment characteristics. DESIGN Cross-sectional, observational study. SETTING Telehealth outpatient clinic, tertiary metropolitan oncology hospital. PARTICIPANTS Thirty-two consecutive outpatients attending telehealth exercise appointments were screened for inclusion. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A pre-test safety screening questionnaire included the Australia-modified Karnofsky Performance Status (AKPS) and Clinical Frailty Scale (CFS). Following one practice, one 30STS test was completed using a standardized protocol modified for telehealth assessment. Secondary measures: International Physical Activity Questionnaire-Short Form (IPAQ-SF) and pre/post-test Borg Rating of Perceived Exertion (RPE). RESULTS Thirty participants were deemed as being safe using the screening questionnaire and completed the remote 30STS. Participants were a median (interquartile range [IQR]) 62.5 (51.8 to 66.5) years old, 59% male, 72% undergoing cancer treatment, 34% with metastatic disease, and 56% met current exercise guidelines. Moderate correlation was found between 30STS and IPAQ-SF (rho = 0.49, p = .006), providing evidence of convergent validity. Correlations between 30STS and AKPS (rho = 0.26, p = .161), and CFS (rho = -0.23, p = .214), were fair. Chair-height standardization was poor (range 43 to 60 cm). The clinician could visualize the participant's whole body in 2 of 30 tests. No significant difference in test performance was found for participants with metastatic disease, higher age, or body mass index. No adverse events occurred. CONCLUSION With screening, the 30STS, performed by telehealth, is a safe and feasible measure of function and lower limb strength. Telehealth exercise testing presents challenges in standardizing the environment and ensuring participant safety. Minimal space and equipment requirements and moderate convergent validity with physical activity provide good clinical utility in this setting.
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Affiliation(s)
- Amy Bowman
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Health Services Research, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aisha Benjemaa
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Jess Crowe
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Emma Bruns
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Travis Hall
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Anya Traill
- Department of Physiotherapy, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Lara Edbrooke
- Department of Health Services Research, Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Weemaes ATR, Weijenberg MP, Lenssen AF, Beelen M. Exercise training as part of multidisciplinary rehabilitation in cancer survivors: an observational study on changes in physical performance and patient-reported outcomes. Support Care Cancer 2022; 30:9255-9266. [PMID: 36066627 PMCID: PMC9444699 DOI: 10.1007/s00520-022-07351-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To describe changes in physical performance and patient-reported outcomes in cancer survivors who participated in an exercise program as part of usual-care multidisciplinary rehabilitation and the influence of training adaptations during the coronavirus-19 (COVID-19) pandemic. METHODS In an observational cohort study, cancer survivors underwent usual-care multidisciplinary rehabilitation including a 10-week exercise program. During the COVID-19 pandemic, the exercise program was adapted with reduced training time and frequency. Mean changes and 95% confidence intervals in physical performance (peak oxygen uptake (VO2peak), peak work rate during a steep ramp test (SRT-WRpeak), 6-min walking distance, muscle strength) and patient-reported outcomes (health-related quality of life, fatigue, anxiety, and depression) were assessed between the start and the end of the exercise program. Linear regression analysis, adjusting for baseline levels of outcomes, was used to investigate differences in changes in outcomes between participants who underwent the original and the adapted program. RESULTS All outcomes statistically significantly improved over time, regardless of adaptations in the exercise program. VO2peak increased with 9.6% and 7.7% in the original and adapted program, respectively. Significant smaller improvements were observed in SRT-WRpeak (- 3.9%) and upper body muscle strength (- 10.8%) after participation in the adapted compared to the original program. No significant between-group differences were observed for other outcomes. CONCLUSION Physical performance and patient-reported outcomes statistically and clinically significantly improved in cancer survivors who participated in an exercise program as part of usual-care multidisciplinary rehabilitation. Improvements of performance outcomes were smaller since the training adaptations, though only significant for SRT-WRpeak and upper body strength.
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Affiliation(s)
- Anouk T R Weemaes
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, the Netherlands.
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Matty P Weijenberg
- Department of Epidemiology, School for Oncology and Reproduction (GROW), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Milou Beelen
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Dennett AM, Harding KE, Peiris CL, Shields N, Barton C, Lynch L, Parente P, Lim D, Taylor NF. Efficacy of Group Exercise-Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38553. [PMID: 35849441 PMCID: PMC9345024 DOI: 10.2196/38553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise-based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. OBJECTIVE We aimed to evaluate the efficacy of a group exercise-based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. RESULTS The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38553.
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Affiliation(s)
- Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Christian Barton
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lauren Lynch
- Community Health, Eastern Health, Healesville, Australia
| | - Phillip Parente
- Department of Cancer Services, Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Monash University, Clayton, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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11
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Gil Herrero L, McNeely ML, Courneya KS, Castellanos Montealegre M, González Marquez AI, Pollan Santamaría M, Casla Barrio S. Safety, feasibility, and effectiveness of implementing supervised exercise into the clinical care of individuals with advanced cancer. Clin Rehabil 2022; 36:1666-1678. [PMID: 35850600 DOI: 10.1177/02692155221114556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the safety, feasibility, and preliminary effectiveness of implementing supervised exercise programming into the clinical care of individuals with advanced cancer. DESIGN Single group implementation feasibility study using a pre-posttest design. SETTING Exercise Oncology Unit of the Spanish Cancer Association (a cancer-specific community facility outside the hospital setting). PARTICIPANTS Adult individuals with advanced cancer profile involving advanced local cancer or distant metastases. INTERVENTION A 12-week, twice-weekly, supervised, clinic-based multi-component exercise program. MAIN MEASURE Paired t-tests were used to assess pre-post changes and analyses of covariance were used to compare effects based on selected participant characteristics. RESULTS Eighty-four individuals with advanced cancer completed the baseline assessment, with six participants withdrawing prior to the start of the program. Of the 78 participants, 17 dropped out, thus, a total of 61 completed the final assessment. Mean adherence was 82.5%. No serious adverse events occurred. Exercise significantly improved VO2max by 5.2 mL·kg·min (p < 0.001), chest strength (p < 0.001), leg strength (p < 0.001), lean body mass (p = 0.003), skeletal muscle mass (p < 0.002), % body fat (p = 0.02), quality of life by 5.3 points (p = 0.009), fatigue by 3.2 points (p = 0.012), and physical activity by 1680 METs/week (p < 0.001). CONCLUSIONS Our clinically supervised and tailored exercise program involving moderate to vigorous intensity exercise was found to be feasible, safe, and effective for individuals with advanced cancer. IMPLICATIONS FOR CANCER SURVIVORS With proper screening and supervision, individuals with advanced cancer can benefit from tailored exercise oncology support as part of an overall therapeutic care plan.
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Affiliation(s)
| | - Margaret L McNeely
- Department of Physical Therapy/Department of Oncology, 3158University of Alberta, Edmonton, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, 3158University of Alberta, Edmonton, Canada
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12
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Granger CL, Edbrooke L, Antippa P, Wright G, McDonald CF, Lamb KE, Irving L, Krishnasamy M, Abo S, Whish-Wilson GA, Truong D, Denehy L, Parry SM. Effect of a postoperative home-based exercise and self-management programme on physical function in people with lung cancer (CAPACITY): protocol for a randomised controlled trial. BMJ Open Respir Res 2022; 9:9/1/e001189. [PMID: 35039313 PMCID: PMC8765028 DOI: 10.1136/bmjresp-2021-001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Exercise is important in the postoperative management of lung cancer, yet no strong evidence exists for delivery of home-based programmes. Our feasibility (phase I) study established feasibility of a home-based exercise and self-management programme (the programme) delivered postoperatively. This efficacy (phase II) study aims to determine whether the programme, compared with usual care, is effective in improving physical function (primary outcome) in patients after lung cancer surgery. METHODS AND ANALYSIS This will be a prospective, multisite, two-arm parallel 1:1, randomised controlled superiority trial with assessors blinded to group allocation. 112 participants scheduled for surgery for lung cancer will be recruited and randomised to usual care (no exercise programme) or, usual care plus the 12-week programme. The primary outcome is physical function measured with the EORTC QLQ c30 questionnaire. Secondary outcomes include health-related quality of life (HRQoL); exercise capacity; muscle strength; physical activity levels and patient reported outcomes. HRQoL and patient-reported outcomes will be measured to 12 months, and survival to 5 years. In a substudy, patient experience interviews will be conducted in a subgroup of intervention participants. ETHICS AND DISSEMINATION Ethics approval was gained from all sites. Results will be submitted for publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617001283369.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia .,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Research and Education Lead Program, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Methods and Implementation Support for Clinical Health research platform MISCH, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.,Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shaza Abo
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina A Whish-Wilson
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dominic Truong
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Selina M Parry
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Dennett A, Harding KE, Reimert J, Morris R, Parente P, Taylor NF. Telerehabilitation's Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation. JMIR Cancer 2021; 7:e33130. [PMID: 34854817 PMCID: PMC8768007 DOI: 10.2196/33130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. OBJECTIVE Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. METHODS A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. RESULTS The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus $1104 (US $790). CONCLUSIONS Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation.
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Affiliation(s)
- Amy Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Jacoba Reimert
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Rebecca Morris
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Phillip Parente
- Department of Cancer Services, Eastern Health, Box Hill, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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