Motivational readiness for physical activity and quality of life in long-term lung cancer survivors

The effectiveness of an accelerometer-based physical activity enhancement intervention for patients undergoing lung resection - A pilot randomized controlled trial

OBJECTIVES

Increasing physical activity after lung resection is important for maintaining quality of life. It is unclear whether accelerometer-based exercise instruction contributes to increasing daily physical activity after lung resection. We examine whether accelerometer-based exercise instruction will lead to increased physical activity in patients undergoing lung resection.

MATERIALS AND METHODS

Forty-six patients undergoing lung resection were randomly assigned to either the intervention group (n = 22) or the control group (n = 24). Twelve participants dropped out. Ultimately, 16 participants in the intervention group and 18 participants in the control group were eligible for analysis. Each group allocation was only known to the person in charge of allocation. The physiotherapists and assessors were not blinded in this study. The intervention group participated in a postoperative rehabilitation program and received physical activity instruction preoperatively and at discharge. The control group participated in a postoperative rehabilitation program only. The primary outcomes was physical activity such as the number of daily steps, light intensity physical activity (LPA) and moderate-vigorous intensity physical activity (MVPA) at the two month postoperative follow-up.

RESULTS

Thirty-four participants were enrolled in this study. Sixteen participants in the intervention group and 18 participants in the control group were included for analysis. Although there was no significant difference in physical activity at baseline, the number of daily steps in the intervention group at the two month postoperative follow-up was significantly higher than that in the control group (8039.2 ± 3480.8 vs. 4887.0 ± 2376.5 steps/day, p = 0.004). Compared to the control group, the intervention group also had greater increases in LPA (63.8 ± 25.1 vs. 44.5 ± 24.5 min/day, p = 0.030) and MVPA (20.2 ± 19.6 vs. 9.6 ± 8.6 min/day, p = 0.022).

CONCLUSIONS

This study showed that accelerometer-based exercise instruction led to an increase in physical activity after lung resection in an unsupervised setting.

CLINICAL TRIAL REGISTRATION

The University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN trial No. UMIN000039369).

Identification of Cognitive Strategies Used by Cancer Patients as a Basis for Psychological Self-Support during Oncological Therapy

Background: Cancer diagnosis is associated not only with health problems but also with psycho-social disability. Both medical and non-medical problems have impacts on cancer patients’ quality of life. The aim of the study was the identification of cognitive emotion regulation strategies among cancer patients during radiotherapy. Methods: The study was conducted on 78 radically treated cancer patients (median 63 years). A Cognitive Emotion Regulation Questionnaire (CERQ) was used. Results: Cancer patients mostly used acceptance, positive refocusing, putting into perspective and refocus on planning. Age was inversely correlated with refocus on planning. Patients with higher levels of education tended to use rumination and catastrophizing less frequently (p < 0.05). Adaptive cognitive strategies based on putting into perspective were more frequently used by professionally active patients (p < 0.05). Patients who lived in cities used positive refocusing and putting into perspective significantly often and patients who lived in villages more frequently used catastrophizing (p < 0.05). Among lung cancer patients, catastrophizing and rumination were popular (p < 0.05) and breast cancer patients rarely used non-adaptive cognitive strategies. Conclusion: Cancer patients tended to use adaptive cognitive strategies. Personalized psychological support should be focused on lung cancer patients and older, less educated, unemployed individuals and people who lived in the countryside.

Decisional balance, self-leadership, self-efficacy, planning, and stages of change in adopting exercise behaviors in patients with stomach cancer: A cross-sectional study

PURPOSE

Previous studies have suggested the benefits of regular exercise in motivating the survivors of cancer; however, most survivors are insufficiently active, showing high rates of nonadherence to physical activity guidelines. Using the I-Change model, this study sought to determine the association of decisional balance and self-efficacy for exercise, planning, and self-leadership with the stages of change in exercise behavior among patients with stomach cancer.

METHODS

This cross-sectional study was conducted in February 2021 and included 145 patients diagnosed with primary stomach cancer via quota sampling in South Korea. Sociodemographics, comorbidity, decisional balance for exercise, self-efficacy for exercise, planning, self-leadership, and stages of change in exercise behavior were assessed.

RESULTS

Of the participants, 4% were in the precontemplation stage of exercise behavior, 10% contemplation, 37% preparation, 23% action, and 27% maintenance. The male sex (p = 0.043), higher self-efficacy for resisting relapse (p < 0.0001), higher coping planning (p = 0.029), and higher self-leadership for behavior awareness and volition (p = 0.023) were associated with more readiness for changes in exercise behavior.

CONCLUSIONS

From the results obtained using the I-Change model, self-efficacy for resisting relapse to previous habits, coping planning, and behavior awareness and volition were associated with more readiness for changes in exercise behavior. These findings may help reduce stomach cancer survivors' nonadherence to physical activity guidelines.

Improving Social Support to Increase QoL in Lung Cancer Patients

Lung cancer is the most common cause of cancer deaths in the world. According to the World Health Organization, over 2 million new lung cancer cases were reported worldwide in 2018, and there were 1.76 million deaths from the disease. Due to its non-specific symptoms, the disease is usually detected at an advanced stage, which gives few treatment options and a short survival rate after diagnosis. That is why improving QoL in the last months of a patient's life is enormously important. The purpose of this study was to analyse original papers in order to determine whether an increase in social support is important in improving QoL for lung cancer patients. Both the direct influence of social support on QoL and indirect influences such as stigma or depression, etc. were taken into consideration. We conducted a review of 22 papers published in English in the period 2005-2020, which were selected using the following keywords: lung cancer, social support, quality of life. Evidence was found for the connections between the improvement of social support and an increase in the QoL of lung cancer patients. It is crucial, and worth whatever effort is required, to increase social support for lung cancer patients, as it is one of the most important factors in improving QoL. According to the studies, a good QoL and minimalised symptoms of the disease are much more important for lung cancer patients than the length of their life.

One-Year Quality of Life Trends in Early-Stage Lung Cancer Patients After Lobectomy

Objective: Quality of Life (QoL) is an important predictor of patient's recovery and survival in lung cancer patients. The aim of the present study is to identify 1-year trends of lung cancer patients' QoL after robot-assisted or traditional lobectomy and investigate whether clinical (e.g., pre-surgery QoL, type of surgery, and perioperative complications) and sociodemographic variables (e.g., age) may predict these trends.

Methods: An Italian sample of 176 lung cancer patients undergoing lobectomy completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire—Core 30 (QLQ-C30) at the pre-hospitalization (t0), 30 days (t1), 4 months (t2), 8 months (t3), and 12 months (t4) after surgery. Sociodemographic and clinical characteristics (age, gender, perioperative complications, and type of surgery) were also collected. The individual change over time of the 15 dimensions of the EORTC QLQ-C30 and the effects of pre-surgery scores of QoL dimensions, type of surgery, perioperative complications, and age on patients' QoL after surgery were studied with the individual growth curve (IGC) models.

Results: Patients had a good recovery after lobectomy: functioning subscales improved over time, while most of the symptoms became less severe over the care process. Perioperative complications, type of surgery, pre-surgery status, and age significantly affected these trends, thus becoming predictors of patients' QoL.

Conclusion: This study highlights different 1-year trends of lung cancer patients' QoL. The measurement of pre- and post-surgery QoL and its clinical and sociodemographic covariables would be necessary to better investigate patients' care process and implement personalized medicine in lung cancer hospital divisions.

Spirituality and Emotional Distress Among Lung Cancer Survivors

BACKGROUND

Emerging research is highlighting the importance of spirituality in cancer survivorship as well as the importance of early distress screening. The purpose of this study was to prospectively examine the relationships among spirituality, emotional distress, and sociodemographic variables during the early period of lung cancer survivorship.

PATIENTS AND METHODS

Eight hundred sixty-four lung cancer survivors completed the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, and the Short-Form-8 for emotional distress within the first year after lung cancer diagnosis, and 474 of these survivors completed the survey again 1 year later.

RESULTS

At baseline, spirituality was associated with lower prevalence of emotional distress, being married, fewer years of cigarette smoking, and better Eastern Cooperative Oncology Group performance status. Additionally, high baseline spirituality was associated with lower rates of high emotional distress at 1-year follow-up.

CONCLUSION

These findings suggest that spirituality might serve as a protective factor for emotional distress among lung cancer survivors. Further research is warranted to explore the role of spirituality in promoting distress management among lung cancer survivors.

Maximizing quality of life remains an ultimate goal in the era of precision medicine: exemplified by lung cancer

An ultimate goal of precision medicine in lung cancer treatment is to restore patient health with maximized quality of life (QOL). Results from Mayo Clinic studies show that a significant improvement in fatigue, dyspnea, and pain scales could lead to better overall QOL. Although treatments and guidelines for clinical implementation to alleviate these key symptoms are available, few cancer patients receive adequate therapy, mostly because of limitations in current care delivery systems and unclear clinicians’ roles. For optimal care of lung cancer survivors in different subpopulations, three barriers must be overcome: physicians’ lack of knowledge, unwarranted practice variation, and uncertainty regarding care provider roles. Appropriate culturally adapted, tested and validated tools for QOL measures must be developed, rather than directly translating existing tools between different languages and across cultures or diverse subpopulations. Finally, lack of sensitive, adequate, and relevant tools in measuring health-related QOL (HRQOL) has long been an issue for effective data collection, demanding a global consensus on a set of core components that reflect the needs of all critical parties for the best cure and care, supporting patients to achieve optimal HRQOL.

A study of the physical activity restriction in the cancer patients using hierarchical regression analysis

This study aimed to examine and analyze the relationship between the physical activity of cancer patients during the hospitalization and the change in exercise recognition and restrictions on physical activity in depth. In this study, adult cancer patients aged more than 20 years residing in the metropolitan area (such as Seoul, Gyeonggi, and Incheon) were selected as a population, and 194 cancer patients from five general hospitals located in metropolitan area were selected as subjects by the purposive sampling. The relative importance for the effect on the physical restriction was greater in the order of the time spent in sedentary activities and exercise positive recognition. The relative importance for cognitive psychological restriction was greater in the order of negative exercise recognition, positive exercise recognition, the time spent in sedentary activities, the time spent in ordinary daily activities and the time spent in intentional movement. In the hospital environment restriction, the facility had a statistically significant effect on the movement and positive exercise recognition. But, sociocultural restrictions were not affected by positive exercise recognition. As a result of this study, it was found that the physical activity restrictions of the cancer patients may affect differently depending on the physical activity level, exercise experience, and exercise recognition, requiring the interpretation of the physical activity restrictions in various ways.

The influence of environmental constraints within hospitals on physical activity level of cancer patients

This study aims to examine the influence of hospital environmental constraints on physical activity level of cancer patients. The subjects of this study were 194 cancer patients from five general hospitals in the Seoul metropolitan area (Seoul, Gyeonggi-do, and Incheon). The collected data was analyzed by using SPSS ver. 23.0. As a result of analyzing the effect of environmental constraints on the physical activity level of cancer patients, the constraints related to hospital facilities and programs had no effect on patients’ time spent in a hospital bed and their time spent on daily. However, the time cancer patients spend on intentional physical movements is affected by hospital facilities or programs. This means that hospital facilities or programs play an important role in patients’ intentional physical activities. In conclusion, for hospitalized cancer patients, physical activity levels are influenced by environmental constraints in the hospital. Therefore, it is important to improve the hospital environment to increase physical activities such as walking and physical exercise, which are an important factor for cancer recovery and prevention of recurrence.

High Stress and Negative Health Behaviors: A Five-Year Wellness Center Member Cohort Study

OBJECTIVE

The aim of this study was to examine the association between having a high stress level and health behaviors in employees of an academic medical center.

METHODS

Beginning January 1, 2009, through December 31, 2013, an annual survey was completed by 676 worksite wellness members.

RESULTS

Each year, about one-sixth of members had a high stress level, high stress individuals visited the wellness center less often, and most years there was a significant relationship (P < 0.05) between stress level and poor physical health behaviors (physical activity level and confidence, strength, climbing stairs), low mental health (quality of life, support, spiritual well-being and fatigue), poor nutritional habits (habits and confidence), and lower perceived overall health.

CONCLUSIONS

High stress is associated with negative health behavior, and future studies, therefore, should explore strategies to effectively engage high stress employees into comprehensive wellness programs.

Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population

Immigrants experience an escalation of negative health behaviors after arrival to the United States. Negative mood is associated with poorer health behaviors in the general population; however, this relationship is understudied in immigrant populations. Adolescent (n = 81) and adult (n = 70) participants completed a health behavior survey for immigrant families using a community-based participatory research approach. Data was collected for mood, nutrition, and physical activity. Adolescents with positive mood drank less regular soda, and demonstrated more minutes, higher levels, and greater social support for physical activity (all ps < .05). Adults with positive mood reported more snacking on fruits/vegetables, greater self-efficacy for physical activity, and better physical well-being (all ps < .05). Negative mood was associated with low physical activity level and poor nutritional habits in adolescent and adult immigrants. Designing community-based programs offering strategies for mood management and healthy lifestyle change may be efficacious for immigrant populations.

Emotional Problems, Quality of Life, and Symptom Burden in Patients With Lung Cancer

OBJECTIVES

Lung cancer is associated with a greater symptom burden than other cancers, yet little is known about the prevalence of emotional problems and how emotional problems may be related to the physical symptom burden and quality of life in newly diagnosed patients with lung cancer. This study aimed to identify the patient and disease characteristics of patients with lung cancer experiencing emotional problems and to examine how emotional problems relate to quality of life and symptom burden.

PATIENTS AND METHODS

A total of 2205 newly diagnosed patients with lung cancer completed questionnaires on emotional problems, quality of life, and symptom burden.

RESULTS

Emotional problems at diagnosis were associated with younger age, female gender, current cigarette smoking, current employment, advanced lung cancer disease, surgical or chemotherapy treatment, and a lower Eastern Cooperative Oncology Group performance score. Additionally, strong associations were found between greater severity of emotional problems, lower quality of life, and greater symptom burden.

CONCLUSION

Certain characteristics place patients with lung cancer at greater risk for emotional problems, which are associated with a reduced quality of life and greater symptom burden. Assessment of the presence of emotional problems at the time of lung cancer diagnosis provides the opportunity to offer tailored strategies for managing negative mood, and for improving the quality of life and symptom burden management of patients with lung cancer.

Patient reported outcomes following video assisted thoracoscopic (VATS) resection or stereotactic ablative body radiotherapy (SABR) for treatment of non-small cell lung cancer: protocol for an observational pilot study (LiLAC)

BACKGROUND

Lung cancer is increasingly a disease of the elderly and frail population with a median age of 70 years at diagnosis. Therefore, consideration of the impact of interventions on health-related quality of life (HRQOL) and not only absolute survival is especially important. For non-small cell lung cancer (NSCLC), video-assisted thoracoscopic surgery (VATS) has been gaining popularity over the last few decades, replacing traditional open lobectomies. For high-risk patients who are not deemed suitable for surgery, stereotactic ablative body radiotherapy (SABR) provides a potentially curative alternative. However, little is known about how VATS and SABR affect HRQOL measured using patient reported outcome measures (PROMs). The LiLAC study (Life after Lung Cancer) aims to explore HRQOL following intervention with VATS or SABR using validated PROMs and to pilot the use of an online questionnaire system (QTool) in this setting. We hope the results will aid both patients and clinicians in decision making and improve the management of post-intervention problems.

METHODS

In total, 300 patients (150 VATS and 150 SABR) patients will be recruited over the study period. Patients will be approached prior to intervention and asked to complete baseline HRQOL questionnaires. They will be given access to the QTool online system and then in the 12 months following intervention will be asked to complete questionnaires (paper or online) at 4-time points. Answers will available for patients and clinicians to view throughout the study period. Clinical information (age, gender, co-morbidity, current medications and smoking status along with treatment-specific information) will also be collected. Primary outcome will be to detect changes of PROs (HRQOL and patient satisfaction) after VATS lung resections or SABR in early stage lung cancer patients. Secondary outcomes include correlation of patient's clinical data with HRQOL results to identify predictors of poor outcomes and exploration of patient and clinician views on the usefulness of QOL measurements.

DISCUSSION

(I) This first study will primarily compare multiple patients reported outcomes for 12 months after VATS lobectomy and SABR in early stages NSCLC patients. We will explore the acceptability of an online assessment of the HRQOL in NSCLC patients. (II) The study is also focused on the patients' opinion during the shared decision-making process, which has rarely been investigated in surgical lung cancer patients. (III) This is not a randomised trial. As a consequence, inherent cohort selection bias and unknown or unaccounted confounders correlated with the outcome of interest may influence the results of the comparison between the treatment groups. (IV) LILAC is not looking at a direct comparison, but to depict the trajectory of recovery post-treatments and preservation or improvement of the HRQOL. This study has received ethical approval from NRES Yorkshire and the Humber- Leeds East Research Ethics Committee (REC Ref: 16/YH/0407). Results of this study will be shared with participating hospitals and made available to the academic community through submission for publication in international peer-reviewed journals and presentation at relevant national and international conferences.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02882750.

Optimal delivery of follow-up care following pulmonary lobectomy for lung cancer

Introduction

The rationale for oncologic surveillance following pulmonary lobectomy is to detect recurrent disease or a second primary lung cancer early enough so that an intervention can increase survival and/or improve quality of life. Therefore, we reviewed literature for international guidelines and reorganized these useful factors associated with non-small-cell lung cancer (NSCLC) recurrence as remedies in postoperative follow-up.

Method

The population of interest for this review was patients who had been treated with complete resection for primary NSCLC and were in follow-up.

Result

Guidelines on follow-up care for NSCLC vary internationally. Because of the production of progressive medical modalities, the current follow-up care should be corrected.

Conclusion

The specific follow-up schedule for computed tomography imaging may be more or less frequent, depending upon risk factors for recurrence. Many different predictors of postoperative recurrence may help to optimize the patient selection for specified surveillance guidelines and personalized adjuvant therapies to prevent possibly occult micrometastases and to get a better outcome.

Effects of Walking on Quality of Life Among Lung Cancer Patients: A Longitudinal Study

BACKGROUND

Walking is typically the preferred form of physical activity among lung cancer patients. Physical activity can promote and maintain the health of such patients.

OBJECTIVE

We examined how walking affected the quality of life (QOL) of lung cancer patients, evaluating the factors that predicted changes in walking during a 6-months study.

METHODS

This study involved a longitudinal and correlational design, and the instruments comprised the Godin Leisure-Time Exercise Questionnaire, the Functional Assessment of Cancer Therapy-Lung Cancer, and social support and self-efficacy scales.

RESULTS

In total, 107 patients were evaluated for 6 months; the results indicated that the patients completed approximately 217 to 282 minutes of walking per week. The data demonstrated that the frequency of walking exercise decreased or stopped among 36% patients during the 6-month study. A generalized estimating equation analysis indicated significant differences between the Functional Assessment of Cancer Therapy-Lung Cancer scores and levels of physical and functional well-being among the lung cancer patients who did and did not engage in walking. Social support, self-efficacy, and patient treatment status can be used to predict the change in walking among lung cancer patients.

CONCLUSION

Patient QOL can be improved by engaging in walking exercise for 6 months. Regarding lung cancer patients, social support and self-efficacy are the key factors in maintaining walking exercise.

IMPLICATIONS FOR PRACTICE

Integrating psychological strategies may be required to strengthen the positive effects of walking exercise on the QOL of lung cancer patients.

Understanding factors influencing physical activity and exercise in lung cancer: a systematic review

PURPOSE

Despite evidence and clinical practice guidelines supporting physical activity (PA) for people with lung cancer, this evidence has not translated into clinical practice. This review aims to identify, evaluate and synthesise studies examining the barriers and enablers for patients with lung cancer to participate in PA from the perspective of patients, carers and health care providers (HCPs).

METHODS

Systematic review of articles using electronic databases: MEDLINE (1950-2016), CINAHL (1982-2016), EMBASE (1980-2016), Scopus (2004-2016) and Cochrane (2016). Quantitative and qualitative studies, published in English in a peer-reviewed journal, which assessed the barriers or enablers to PA for patients with lung cancer were included. Registered-PROSPERO (CRD4201603341).

RESULTS

Twenty-six studies (n = 9 cross-sectional, n = 4 case series, n = 11 qualitative) including 1074 patients, 23 carers and 169 HCPs were included. Barriers and enablers to PA were identified (6 major themes, 18 sub-themes): Barriers included patient-level factors (physical capability, symptoms, comorbidities, previous sedentary lifestyle, psychological influences, perceived relevance), HCP factors (time/knowledge to deliver information) and environmental factors (access to services, resources, timing relative to treatment). Enablers included anticipated benefits, opportunity for behaviour change and influences from HCPs and carers.

CONCLUSION

This systematic review has identified the volume of literature demonstrating that barriers and enablers to PA in lung cancer are multidimensional and span diverse factors. These include patient-level factors, such as symptoms, comorbidities, sedentary lifestyle, mood and fear, and environmental factors. These factors should be considered to identify and develop suitable interventions and clinical services in attempt to increase PA in patients with lung cancer.

Physical Activity and Self-Rated Health Status Among Older Adult Cancer Survivors: Does Intensity of Activity Play a Role?

PURPOSE/OBJECTIVES

To examine the association between routine physical activity and self-rated health status in older adults with cancer..

DESIGN

Cross-sectional.

SETTING

Community-dwelling older adult survivors who completed a screening tool and subsequent detailed interview from the 2004 wave of the National Long-Term Care Survey, a nationally representative study of Medicare beneficiaries aged 65 years or older.


SAMPLE

251 older adult cancer survivors who regularly engaged in routine physical activity.

METHODS

Participants were asked about chronic health conditions, depression, activities of daily living, participation in physical activities, self-rated health status, and sociodemographic characteristics. A weighted ordered probit model was used to estimate variables that predict self-reported health status.

MAIN RESEARCH VARIABLES

Self-rated health status and participation in physical activity.


FINDINGS

Age and higher education level were found to be significant correlates of health status (p < 0.05) in the first model. Although education was not significant in subsequent models, age, functional disability, and depression all were identified as significant correlates of health status (p < 0.01). In the final model, in which moderate and vigorous activity participation were entered, older adult survivors who engaged in vigorous physical activity showed higher levels of health status than those who engaged in light physical activity (p < 0.05), but number of chronic health conditions was not significantly associated with health status.

CONCLUSIONS

The association between vigorous activity and health status points to the primacy of physical activity within a post-cancer treatment health regimen.
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IMPLICATIONS FOR NURSING

Health programs and policies need to address physical activity to improve the overall well-being of older adult cancer survivors.

Prognostic value of quality of life score in disease-free survivors of surgically-treated lung cancer

BACKGROUND

We aimed to evaluate the prognostic value of quality of life (QOL) for predicting survival among disease-free survivors of surgically-treated lung cancer after the completion of cancer treatment.

METHODS

We administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Quality of Life Questionnaire Lung Cancer Module (QLQ-LC13), Hospital Anxiety and Depression Scale (HADS), and Posttraumatic Growth Inventory (PTGI) to 809 survivors who were surgically-treated for lung cancer at two hospitals from 2001 through 2006. We gathered mortality data by linkage to the National Statistical Office through December 2011. We used Cox proportional hazard models to compute adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs) to estimate the relationship between QOL and survival.

RESULTS

Analyses of QOL items adjusted for age, sex, stage, body mass index, and physical activity showed that scores for poor physical functioning, dyspnea, anorexia, diarrhea, cough, personal strength, anxiety, and depression were associated with poor survival. With adjustment for the independent indicators of survival, final multiple proportional hazard regression analyses of QOL show that physical functioning (aHR, 2.39; 95 % CI, 1.13-5.07), dyspnea (aHR, 1.56; 95 % CI, 1.01-2.40), personal strength (aHR, 2.36; 95 % CI, 1.31-4.27), and anxiety (aHR, 2.13; 95 % CI, 1.38-3.30) retained their independent prognostic power of survival.

CONCLUSION

This study suggests that patient-reported QOL outcomes in disease-free survivors of surgically-treated lung cancer after the completion of active treatment has independent prognostic value for long-term survival.

Psychological interventions to improve the quality of life in Indian lung cancer patients: A neglected area

The incidence of lung cancer is very high and evidence suggests that patients experience imbalanced emotional capabilities due to less survival rate compared to other cancers. Direct and indirect psychological interventions are mandatory to improve the outcome of lung cancer treatment. Although such interventions are being practiced in developed nations, the effects of psychological interventions on the treatment outcome in the Indian context are lacking. Since there is a definite correlation between treatment outcome and psychological issues, it is high time that clinicians in developing countries including India adopt practices to enhance the quality of life of lung cancer patients.

Impact of self-reported physical activity and health promotion behaviors on lung cancer survivorship

Background

There is some initial evidence that an enhanced physical activity level can improve fquality of life, and possibly survival among patients with lung cancer. The primary aim of this project was to evaluate the impact of physical activity on the quality and quantity of life of lung cancer survivors.

Methods

Between January 1, 1997, and December 31, 2009, a total of 1466 lung cancer survivors completed a questionnaire with patient-reported outcomes for quality of life (QOL), demographics, disease and clinical characteristics, and a measure of physical activity (Baecke Questionnaire). Chi-square tests compared lung cancer survivors who reported being physically active versus not on a variety of the other covariates. Kaplan-Meier estimates and Cox models evaluated the prognostic importance of physical activity level on Overall Survival (OS).

Results

Roughly half of the lung cancer survivors had advanced stage disease at the time of survey. Treatment prevalence rates were 61, 54, and 33 % for surgery, chemotherapy and radiotherapy, respectively. The majority (77 %) of survivors reported themselves as physically active. Physically active survivors reported greater activity across all individual Baecke items. Lung cancer survivor-reported QOL indicated the benefits of physical activity in all domains. Survivors receiving chemotherapy or radiation at the time of questionnaire completion were less likely to be physically active (74 and 73 % respectively). In contrast, 84 % of surgical patients were physically active. Disease recurrence rates were the same for physically active and inactive patients (81 % vs 82 %, p = 0.62). Physically active patients survived an average of 4 more years than those who were not physically active (8.4 years versus 4.4 years respectively, log rank p < 0.0001).

Conclusions

Being physically active was related to profound advantages in QOL and survival in a large sample of lung cancer survivors.

Beliefs about physical activity in sedentary cancer patients: an in-depth interview study in France

This study was designed to identify beliefs about physical activity in cancer patients. Semi- structured interviews were conducted with 20 patients under treatment, who were invited to identify perceived barriers for not adopting a physically active lifestyle and to express their beliefs about physical activity. Content analyses revealed five main categories of beliefs including four types of barriers: (a) barriers related to the side effects of treatment; (b) barriers related to a lack of perceived physical abilities; (c) barriers related to a lack of interest for physical activity; (d) beliefs about the negative effects of physical activity, and (e) beliefs about the positive effects of physical activity. These findings extend the existing literature by indicating how stereotypes may play a role in explaining sedentary lifestyles in cancer patients.

Improving Spiritual Well-Being in Patients with Lung Cancers

Patients with lung cancer report more disease burden and lower spiritual well-being (SWB) compared with other cancer patients. Understanding variables that lessen disease burden and improve SWB is essential. The aim of this study was to explore the relationship between motivational level for physical activity and SWB in patients with lung cancer. Linear regression showed increased SWB as stage of change for physical activity increased (p < 0.0001), even after adjusting for multiple demographic variables.

The association of physical activity and colorectal and breast cancer: The Fifth Korea National Health and Nutrition Examination Survey (2008-2011)

Therapeutic importance of physical activity during and after cancer treatment has been supported. To examine the patterns of physical activity according to the stages of breast and colorectal cancer survivor-ship in Korean, Korean National Health and Nutrition Examination Survey data from 2008 to 2011 were used. International Physical Activity Questionnaire (IPAQ) was utilized to estimate weekly time spent in vigorous- and moderate-intensity physical activity, and walking, and to calculate MET-minute/week. Depending on the survivorship, the subjects were categorized into “never diagnosed with cancer” (group 1), “0–4 yr since cancer diagnosis” (group 2), and “5 or more years since cancer diagnosis” (group 3), separately for colorectal and breast cancer. The associations between physical activity and the cancer survivorship were studied. Following results were obtained: (1) Breast cancer (n=10,167, mean age=48.55±16.27): The mean physical activity levels expressed in MET-minutes/week were 2,064.83, 1748.82, and 1998.36 in groups 1, 2, and 3, respectively. Even though cancer survivors tended to be less active compared to people without cancer, there were no statistically significant difference among the three groups. (2) Colorectal cancer (n=17,270, mean age=48.62): MET-minutes/week was 2064.30, 1084.83, and 709.04 36 in groups 1, 2, and 3, respectively. The differences were significant between group 1 and 2 (F=5.87, P=0.016) and group 1 and 3 (F=28.99, P<0.001). Despite potential therapeutic benefits of physical activity, colorectal cancer survivors were less active than people without cancer in Korea.

Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life

OBJECTIVE

The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life.

METHODS

A population-based cohort of 463 prostate cancer survivors who were on 10.8 months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life.

RESULTS

Only 57 men (12.3%) reported sufficient exercise levels (150 min of moderate intensity or 75 min of strenuous exercise per week and twice weekly resistance exercise), 186 (40.2%) were insufficiently active, and 220 (47.5%) were inactive. Among inactive men, 99 (45.0%) were in the contemplation or preparation stage of motivation readiness. Inactive men had higher global distress (p = 0.01) and Brief Symptom Inventory-Anxiety (p < 0.05) than those who were insufficiently active. Total Supportive Care Needs and International Prostate Cancer Symptom scores were higher in inactive than insufficiently and sufficiently active men (p < 0.05). Lack of physical activity contributed to poorer quality of life.

CONCLUSIONS

Only a small proportion of Australian prostate cancer survivors met contemporary exercise-oncology recommendations despite increasing recognition of exercise to improve patient outcomes. Strategies are urgently required to increase prostate cancer survivors' participation in aerobic and resistance exercise training.Copyright © 2015 John Wiley & Sons, Ltd.

Quantitative gastrointestinal and psychological traits associated with obesity and response to weight-loss therapy

BACKGROUND & AIMS

Weight loss after pharmacotherapy varies greatly. We aimed to examine associations of quantitative gastrointestinal and psychological traits with obesity, and to validate the ability of these traits to predict responses of obese individuals to pharmacotherapy.

METHODS

In a prospective study, we measured gastric emptying of solids and liquids, fasting and postprandial gastric volume, satiation by nutrient drink test (volume to fullness and maximal tolerated volume), satiety after an ad libitum buffet meal, gastrointestinal hormones, and psychological traits in 328 normal-weight, overweight, or obese adults. We also analyzed data from 181 previously studied adults to assess associations betwecen a subset of traits with body mass index and waist circumference. Latent dimensions associated with overweight or obesity were appraised by principal component analyses. We performed a proof of concept, placebo-controlled trial of extended-release phentermine and topiramate in 24 patients to validate associations between quantitative traits and response to weight-loss therapy.

RESULTS

In the prospective study, obesity was associated with fasting gastric volume (P = .03), accelerated gastric emptying (P < .001 for solids and P = .011 for liquids), lower postprandial levels of peptide tyrosine tyrosine (P = .003), and higher postprandial levels of glucagon-like peptide 1 (P < .001). In a combined analysis of data from all studies, obesity was associated with higher volume to fullness (n = 509; P = .038) and satiety with abnormal waist circumference (n = 271; P = .016). Principal component analysis identified latent dimensions that accounted for approximately 81% of the variation among overweight and obese subjects, including satiety or satiation (21%), gastric motility (14%), psychological factors (13%), and gastric sensorimotor factors (11%). The combination of phentermine and topiramate caused significant weight loss, slowed gastric emptying, and decreased calorie intake; weight loss in response to phentermine and topiramate was significantly associated with calorie intake at the prior satiety test.

CONCLUSIONS

Quantitative traits are associated with high body mass index; they can distinguish obesity phenotypes and, in a proof of concept clinical trial, predicted response to pharmacotherapy for obesity. ClinicalTrials.gov Number: NCT01834404.

Development and validation of the Cancer Exercise Stereotypes Scale

The objective of this study was to develop and validate a French-language questionnaire measuring stereotypes related to exercise in cancer patients: The Cancer Exercise Stereotypes Scale (CESS). Four successive steps were carried out with 806 participants. First, a preliminary version was developed on the basis of the relevant literature and qualitative interviews. A test of clarity then led to the reformulation of six of the 30 items. Second, based on the modification indices of the first confirmatory factorial analysis, 11 of the 30 initial items were deleted. A new factorial structure analysis showed a good fit and validated a 19-item instrument with five subscales. Third, the stability of the instrument was tested over time. Last, tests of construct validity were conducted to examine convergent validity and discriminant validity. The French-language CESS appears to have good psychometric qualities and can be used to test theoretical tenets and inform intervention strategies on ways to foster exercise in cancer patients.

The effectiveness of wellness coaching for improving quality of life

OBJECTIVE

To learn more about the potential psychosocial benefits of wellness coaching. Although wellness coaching is increasing in popularity, there are few published outcome studies.

PATIENTS AND METHODS

In a single-cohort study design, 100 employees who completed the 12-week wellness coaching program were of a mean age of 42 years, 90% were women, and most were overweight or obese. Three areas of psychosocial functioning were assessed: quality of life (QOL; 5 domains and overall), depressive symptoms (Patient Health Questionnaire-9), and perceived stress level (Perceived Stress Scale-10). Participants were recruited from January 1, 2011, through December 31, 2011; data were collected up to July 31, 2012, and were analyzed from August 1, 2012, through October 31, 2013.

RESULTS

These 100 wellness coaching completers exhibited significant improvements in all 5 domains of QOL and overall QOL (P<.0001), reduced their level of depressive symptoms (P<.0001), and reduced their perceived stress level (P<.001) after 12 weeks of in-person wellness coaching, and they maintained these improvements at the 24-week follow-up.

CONCLUSION

In this single-arm cohort study (level 2b evidence), participating in wellness coaching was associated with improvement in 3 key areas of psychosocial functioning: QOL, mood, and perceived stress level. The results from this single prospective cohort study suggest that these areas of functioning improve after participating in wellness coaching; however, randomized clinical trials involving large samples of diverse individuals are needed to establish level 1 evidence for wellness coaching.

Effects of physical activity on the quality of life in taiwanese lung cancer patients receiving active treatment or off treatment

BACKGROUND

Lung cancer is the leading cause of cancer deaths in the world. Physical activity can enhance the quality of life (QOL) of cancer patients. However, the best timing according to cancer therapy to implement physical activities for lung cancer patients is not yet clear.

OBJECTIVE

The purpose of our study was to examine the relationship between physical activity and QOL in different cancer-treatment periods among lung cancer patients.

METHODS

This study used a cross-sectional design. Instruments included the Functional Assessment of Cancer Therapy-Lung Cancer and the Godin Leisure-Time Exercise Questionnaire.

RESULTS

In total, 185 patients participated in this study, and results showed that only 25% of participants achieved recommended physical-activity guidelines. Of all patients, 50.3% engaged in light physical activity, such as walking. During active-treatment periods, lung cancer patients who engaged in light or moderate activity had significantly higher scores for the overall QOL than did those who were completely sedentary. However, during off-treatment periods, there were no significant differences in the overall QOL with different activity levels.

CONCLUSIONS

The QOL may be improved by engaging in light or moderate physical activity during active-treatment periods among lung cancer patients.

IMPLICATIONS FOR PRACTICE

It is important for healthcare providers to consider promoting physical activity based on different cancer treatments to improve the QOL of Taiwanese lung cancer patients.

The integration of studio cycling into a worksite stress management programme

High stress is a prevalent problem in the worksite. To reduce stress, improve productivity, reduce absenteeism, and lower healthcare costs, many companies offer exercise classes or stress management programmes. Although physical activity is an important component of stress management, few worksites have integrated physical activity into their comprehensive stress reduction programmes. The purpose of this single-arm pilot project was to examine the potential effectiveness of an integrated exercise (studio cycling) and cognitive-behavioural stress management programme. Eighty-four adults, 75% female, mostly aged 40+ years, participated in an integrated 12-week cycling studio and cognitive-behavioural stress management programme. Participants experienced a significant and clinically meaningful reduction on the Perceived Stress Scale (p < 0.01), rating of current stress level and confidence to manage stress at the programme's end and at a 1-month follow-up. Participants also reported having significantly improved overall health, improved nutritional habits, higher physical activity level, greater confidence in their ability to follow a healthy diet, higher spiritual well-being, improved sleep, receiving more support for maintaining healthy living and improved quality of life at the completion of the 12-week programme and 1-month follow-up. These findings provide further support for an integrated exercise and stress management programme.

Impact of bariatric surgery on quality of life, functional capacity, and symptoms in patients with heart failure

Obesity is a risk factor for heart failure (HF), but the benefit of weight loss in HF is unknown. We assessed the effects of bariatric surgery (BSx) compared to non-operative treatment for morbid obesity on overall quality of life (QoL), functional capacity, and symptoms in 13 HF patients undergoing BSx and six HF patients treated without surgery. In the BSx group, median age was 62, body mass index (BMI) was 55 kg/m(2), and 5/13 were males; in the non-operative group, median age was 69, BMI was 42 kg/m(2), and 1/6 were male. Median follow-up was 4.3 and 2.7 years, respectively. At follow-up, BMI was less in the BSx group (35 vs 47 kg/m(2), p < 0.001); QoL (p < 0.01), frequency of exertional dyspnea (p = 0.01), and leg edema (p = 0.04) improved only in the BSx group. BSx induced weight loss and improved QoL and symptoms in morbidly obese patients with HF.

Impact of physiotherapy on patients with advanced lung cancer

Patients with lung cancer have high mortality and high morbidity. Lung cancer-related symptoms and problems such as dyspnea, fatigue, pain, and cachexia that begin in the early phase later result in poor physical functioning, psychosocial, and quality of life status. In addition, advancing age is associated with significant comorbidity. These patients may benefit from multidisciplinary therapy to reduce the perceived severity of dyspnea and fatigue and increase physical functioning and quality of life. Based on management of symptoms and problems such as dyspnea, physical inactivity, cancer-related fatigue, respiratory secretions, pain, and anxiety–depression of these patients, it is thought that physiotherapy techniques can be used on advanced lung cancer patients following a comprehensive evaluation. However, well-designed, prospective, and randomized-controlled trials are needed to prove the efficacy of physiotherapy and pulmonary rehabilitation in general for patients with advanced lung cancer.

Evidence-based risk assessment and recommendations for physical activity clearance: cancer

Physical activity is becoming increasingly acknowledged as an integral component of in the multidisciplinary management of cancer patients. Intensive inquiry in this area is likely to increase further over the next decade; however, cancer-specific, evidence-based risk assessment and recommendations for physical activity are not available. A systematic literature review was performed of all studies conducting an exercise training intervention and (or) any form of objective exercise test among adults diagnosed with cancer. Studies were assessed according to evaluation criteria developed by a panel of experts. A total of 118 studies involving 5529 patients were deemed eligible. Overall, the results suggest that exercise training and maximal and submaximal exercise testing are relatively safe procedures with a total nonlife-threatening adverse event rate of <2%. There was only 1 exercise training-related death. However, the quality of exercise testing methodology and data reporting is less than optimal. Thus, whether the low incidence of events reflects the true safety of exercise training and exercise testing in cancer patients or less than optimal methodology and (or) data reporting remains to be determined. Evidence-based absolute and relative contraindications to physical activity and exercise training and testing are provided as well as probing decision-trees to optimize the adoption and safety of physical activity in persons diagnosed with cancer.

Physical activity preferences of early-stage lung cancer survivors

PURPOSE

Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors.

METHOD

As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected.

RESULTS

The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics.

CONCLUSIONS

The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.

Is Usage of a Wellness Center Associated with Improved Quality of Life?

Purpose.

There is limited documentation regarding the potential quality of life (QOL) benefits associated with use of a worksite wellness center. Therefore, the aim of this study was to examine the relationship between potential QOL change and use of a worksite wellness center during a 12-month period.

Design.

Analysis of an annual QOL wellness center member survey and wellness center use during a 12-month time period.

Setting.

A worksite wellness center.

Participants.

A total of 1151 employee wellness center members, average age of 39.5 years, 69.7% female, and 43.5% reported being overweight.

Intervention.

Members of the worksite wellness center have access to a range of fitness options, including exercise classes, water aerobics, an indoor track, strength training, and aerobic conditioning equipment. Additionally, nutritional classes are offered, and there is a wellness café. For resiliency, members can participate in wellness coaching or a stress-reduction group program.

Method.

Participants completed a baseline QOL survey and a second QOL survey 1 year later. An electronic entry system tracked use of the wellness center.

Results.

Participants were divided into four wellness center use quartiles: low users (less than once every 2 weeks), below-average users, above-average users, and high users (two to three visits per week). High users reported experiencing improvements in their physical QOL (p < .0001) compared with the low users. Additionally, low users experienced a greater decline in their mental QOL (p = .05) compared with high users.

Conclusion.

In a large sample of employees, use of a wellness center during a 12-month period was associated with benefits for physical QOL. QOL is an important domain of wellness; therefore, in addition to measuring physiologic changes, examining potential QOL changes may be another important outcome measure for wellness centers.

Health behaviors, readiness to change, and interest in health promotion programs among smokers with lung cancer and their family members: a pilot study

BACKGROUND

The diagnosis of lung cancer presents an opportunity to motivate individuals to adopt health-promoting behavior. Little attention has been given to using this opportunity to also motivate relatives to change their health behaviors.

OBJECTIVES

The objectives of this study were to describe health behaviors and readiness to change lifestyle, identify interest in health promotion programs, and examine concordance of health behaviors among smokers with lung cancer and their family members.

METHODS

Cross-sectional data were collected once from 37 lung cancer patient-family member dyads. Standardized questionnaires were used to collect data. Descriptive statistics and percent agreement were used for analyses.

RESULTS

Lung cancer patients and their family members had high rates of continued smoking (43% vs 30%), low intake of fruits and vegetables (92% vs 95%), and high rates of physical inactivity (84% vs 84%). Patients and family members indicated readiness to change behaviors within the next 6 months ranging from 63% for physical activity, 73% for diet, and 88% to quit smoking for patients and 81% for physical activity, 58% for diet, and 91% to quit smoking for family members. Interest in participating in a multiple behavioral risk reduction program was high for patients and family members.

CONCLUSIONS

The majority of patients and their family members have multiple behavioral risk factors placing them at risk for poor health outcomes.

IMPLICATIONS FOR PRACTICE

Oncology nurses are in a unique position to provide leadership in assessing health behaviors and implementing evidence-based interventions to enhance outcomes for patient-family member dyads with lung cancer.

Caregivers of patients with cancer fatigue: a high level of symptom burden

Fatigue is the problematic symptom identified by patients with cancer. However, fatigue has not been widely examined in caregivers of patients with cancer. In this study, 131 caregivers of patients diagnosed with advanced stage cancer and actively receiving radiotherapy reported experiencing the most difficulties with fatigue (mean 46.9; on a 0-100 scale, with a 10-point difference having clinical meaning) at baseline and at a 6-month follow-up (mean 48.3). This is in sharp contrast to other domains of quality of life and functioning being rated in the 60s, 70s and 80s by the caregivers of patients with cancer. Given the level of fatigue reported by the caregivers of patients with cancer, if confirmed by other investigators in larger and more diverse samples, interventions targeting caregiver fatigue should be explored.

Explorations of lung cancer stigma for female long-term survivors

Lung cancer is the leading cause of cancer death in women, accompanied by greater psychological distress than other cancers. There is minimal but increasing awareness of the impact of lung cancer stigma (LCS) on patient outcomes. LCS is associated with increased symptom burden and decreased quality of life. The purpose of this study was to explore the experience of female long-term lung cancer survivors in the context of LCS and examine how participants discursively adhere to or reject stigmatizing beliefs. Findings situated within Cataldo and colleagues' theoretical model include: (1) addiction and tobacco marketing as possible precursors for LCS, (2) the possible role of expert providers as LCS enhancers, (3) response of overlapping complicated identity shifts, (4) simultaneous rejection and assumption of LCS, and (5) information control via advocacy activities as a LCS mitigation response. These findings expand the current understanding of LCS, and call for future conceptual exploration and theoretical revision, particularly with respect to the possibility of interaction between relevant/related stigma(s) and LCS. As the number of women living with lung cancer increases, with longer survival times, the effect of LCS and other experiences of discrimination on patient outcomes could be substantial.

Physical activity level and quality of life in long term lung cancer survivors

PURPOSE

Lung cancer is associated with a multitude of challenges, and lung cancer survivors report significantly lower quality of life (QOL) than other cancer survivors.

METHODS

This study aimed to examine the relationship between physical activity level and QOL in a large sample of long term lung cancer survivors (N=1937). Average age at diagnosis was 65 years, 92% were Caucasian, and 51% male. Surveys were completed at lung cancer diagnosis and then average 4.2 years post-diagnosis.

RESULTS

Most survivors reported having a sedentary lifestyle at both timepoints. However, 256 survivors reported a change in physical activity level from diagnosis to follow-up. Decreased physical activity (n=140) was associated with decreased overall, mental, physical, emotional, social, and spiritual QOL (all ps<.001) and decreased symptom control as seen in reported pain, dry coughing, coughing with phlegm, shortness of breath, and level of fatigue (all ps<.05). In contrast, increased physical activity (n=116) was associated with improved QOL (all ps<.05), and improved symptom control as seen in frequency and severity of pain (p<.01). For all participants, those engaging in regular physical activity (30 min or more per day, at least five days per week) reported significantly higher QOL scores (all ps<.001), and better symptom control than more sedentary survivors.

CONCLUSIONS

Results indicate a significant association between change in physical activity and QOL and symptom control for long term lung cancer survivors, and research exploring interventions designed to improve activity level for lung cancer survivors is further warranted.

Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer

BACKGROUND

Psychosocial interventions often address only 1 domain of quality of life (QOL), are offered to patients with early-stage cancer, do not include the caregiver, and are delivered after cancer treatment has been completed.

METHODS

In the current randomized controlled trial, 131 patients with advanced cancer who received radiotherapy and their caregivers were randomly assigned to either a 6-session, structured, multidisciplinary intervention arm or a standard care arm. The average age of the patients was 58 years, the majority were male (63%), and tumor types varied (gastrointestinal [37%], brain [22%], head and neck [16%], lung [13%], and other [12%]). The six 90-minute sessions addressed the 5 domains of QOL: cognitive, physical, emotional, social, and spiritual. The in-person intervention was followed by 10 brief telephone counseling sessions that took place over the next 6 months.

RESULTS

Of the 117 patients who completed the study, overall QOL (assessed by Functional Assessment of Cancer Therapy-General [FACT-G]) at week 4 was significantly higher in the intervention group (n = 54) compared with the standard arm control group (n = 63) (75.2 vs 68.7; P = .02). The 10 brief telephone contacts did not appear to impact QOL because at week 27 the groups had identical QOL (means of 77.6 and 77.7, respectively). There was no effect of the intervention noted on caregiver QOL.

CONCLUSIONS

Participating in a 6-session multidisciplinary intervention was found to be effective in maintaining the QOL of patients with advanced cancer who were actively receiving radiotherapy. The QOL and symptom burden of this population is striking, making it important to identify effective QOL strategies to implement in conjunction with cancer care.

Genetic variations and patient-reported quality of life among patients with lung cancer

PURPOSE

Recent evidence has suggested a relationship between the baseline quality of life (QOL) self-reported by patients with cancer and genetic disposition. We report an analysis exploring relationships among baseline QOL assessments and candidate genetic variations in a large cohort of patients with lung cancer.

PATIENTS AND METHODS

QOL data were provided by 1,299 patients with non-small-cell lung cancer observed at the Mayo Clinic between 1997 and 2007. Overall QOL and subdomains were assessed by either Lung Cancer Symptom Scale or Linear Analog Self Assessment measures; scores were transformed to a scale of 0 to 10, with higher scores representing better status. Baseline QOL scores assessed within 1 year of diagnosis were dichotomized as clinically deficient (CD) or not. A total of 470 single nucleotide polymorphisms (SNPs) in 56 genes of three biologic pathways were assessed for association with QOL measures. Logistic regression with training/validation samples was used to test the association of SNPs with CD QOL.

RESULTS

Six SNPs on four genes were replicated using our split schemes. Three SNPs in the MGMT gene (adjusted analysis, rs3858300; unadjusted analysis, rs10741191 and rs3852507) from DNA repair pathway were associated with overall QOL. Two SNPs (rs2287396 [GSTZ1] and rs9524885 [ABCC4]) from glutathione metabolic pathway were associated with fatigue in unadjusted analysis. In adjusted analysis, two SNPs (rs2756109 [ABCC2] and rs9524885 [ABCC4]) from glutathione metabolic pathway were associated with pain.

CONCLUSION

We identified three SNPs in three glutathione metabolic pathway genes and three SNPs in two DNA repair pathway genes associated with QOL measures in patients with non-small-cell lung cancer.

Relationship between deficits in overall quality of life and non-small-cell lung cancer survival

PURPOSE

Evidence has suggested a clinically meaningful relationship between self-reported quality of life (QOL) of a patient with cancer at the time of receiving a cancer diagnosis and overall survival (OS). This study evaluated the prognostic value of QOL assessments with regard to OS in a large cohort of patients with lung cancer.

PATIENTS AND METHODS

A total of 2,442 patients with non-small-cell lung cancer were observed between 1997 and 2007 and completed a single-item measure of overall QOL within the first 6 months of receiving a lung cancer diagnosis; these were dichotomized using an a priori definition of a clinically deficient score (CDS; ≤ 50 v > 50). Kaplan-Meier estimates and Cox models were used to evaluate the prognostic importance of QOL on OS alone and in the presence of covariates. Logistic regression modeling was used to identify which clinical and patient characteristics were related to a clinically meaningful deficit in QOL.

RESULTS

QOL deficits at time of lung cancer diagnosis were significantly associated with OS (hazard ratio [HR], 1.55; P < .001), as were performance status, older age, smoking history, male sex, treatment factors, and stage of disease. The median survival for patients with CDS QOL was 1.6 years versus 5.6 years for patients with non-CDS QOL. After controlling for all these covariates, the indication of a clinically deficient baseline QOL still contributed significantly to the prediction of patient survival (HR, 0.67; P < .001).

CONCLUSION

Overall QOL measured by a simple single item at the time of lung cancer diagnosis is a significant and independent prognostic factor for survival in patients with lung cancer.

Health behaviors among cancer survivors receiving screening mammography

OBJECTIVES

The purpose of this study was to evaluate the prevalence of cancer-related behavioral risk factors among female cancer survivors, relative to women without a previous diagnosis of cancer.

METHODS

In a large cohort of 19,948 women presenting for screening mammography, questionnaires on health behaviors were administered.

RESULTS

A total of 18,510 had detailed history on health behaviors and previous cancer history. Overall 2713 (14.7%) reported a previous cancer history. We found statistically significant results indicating that cancer survivors were less likely than those with no cancer history to: report their overall health as "excellent" (13.6% vs. 21.5%), to engage in moderate or strenuous exercise (56.5% vs. 63.3%), and to use complementary and alternative medicine (57.4% vs. 60.2%). Conversely, cancer survivors were more likely to be current smokers (6.3% vs. 5.5%), rate their overall health as "poor" (15.8% vs. 9.1%), and to report more weight gain over time. Among cancer survivors, differences also emerged by the type of primary cancer. For example, cervical cancer survivors (n = 370) were most likely to report being current smokers (15.7%) and regular alcohol users (71.7%) compared with other survivors. Ovarian (n = 185) and uterine (n = 262) cancer survivors most frequently reported being obese (41% and 34.4%, respectively). Cervical cancer survivors reported the largest weight gain (4.9 lbs at 5 y and 13.4 lbs at 10 y).

CONCLUSIONS

These results suggest opportunities for tailored behavioral health risk factor interventions for specific populations of cancer survivors.

Stress level, health behaviors, and quality of life in employees joining a wellness center

PURPOSE

Examine the relationship between stress level and quality of life at a worksite wellness center.

DESIGN

A survey completed when joining the wellness center. Setting . Employee wellness center.

SUBJECTS

Survey that inquired about stress, health behaviors, and quality of life of more than 13,000 employees joining a wellness center.

MEASURES

A series of questions about current health status and health behaviors.

ANALYSIS

Two-sample t-tests assuming unequal variances.

RESULTS

A total of 2147 of these employees reported having high stress levels. Employees with high stress levels had statistically significant lower quality of life, more fatigue, and poorer health compared with employees with low stress levels. In terms of their ability and motivation to participate in wellness programs, the high-stress employees were also less active and had less healthy nutritional habits, less support, and less confidence in their ability to be active. They also reported having more health problems, including high blood pressure, high blood sugar, high cholesterol, and overweight.

CONCLUSIONS

It appears that employees with high stress levels--those who might most benefit from participation in wellness programs--may experience the greatest difficulty participating actively in wellness programs because of their lack of support, low confidence, and numerous health problems. Perhaps offering tailored stress reduction programs for these employees would be beneficial.

The effect of combined aerobic and resistance exercises on quality of life of women surviving breast cancer

BACKGROUND

Breast cancer is one of the most common cancers amongst women in developed and developing countries. It is associated with the highest mortality rate in low to average-income countries. Breast cancer investigation amongst Iranian women reveals that the number of its incidence is yet the highest in all cancer types. Despite recent longer survival time of women with breast cancer, most of the patients suffer from long term physical and mental distress due to combined treatments. Exercise interventions are among new approaches to promote the better quality of life of the patients, which has only recently been considered by researchers. This study aimed to investigate the effect of exercise intervention on the quality of life of breast cancer survivors.

MATERIALS AND METHODS

This is a clinical trial conducted on 80 women with I-III breast cancer, at 18-55 years of age mostly two years after the completion of their treatment in Seyed al Shohada hospital in Isfahan. They were randomly divided into two groups of study and control. Exercise intervention went on for 8 weeks in the study group (three sessions a week, 60 minutes). Quality of life in both groups was measured a day before, and at the end of the eight weeks period by the instrument of the National Medical Center and Beckman Research Institute. The data were analyzed by descriptive and inferential statistical tests of X2, t-test and Mac Hammer test.

FINDINGS

Results showed that there was no significant difference in the mean score of the physical dimension of quality of life in the study group before and after intervention while the score of physical health was significantly better in the control group (p < 0.00).The mean score of mental dimension had increased in the study group, while it had decreased in the control group. The mean score of social health showed no significant difference before and after intervention. The mean score of spiritual health had significantly decreased in the control group, while it had significantly increased in the study group (p = 0.004). Generally, the total mean score of the quality of life showed no significant difference before and after intervention. However, the percentage of the quality of life score increased in the study group, but decreased in the control group.

CONCLUSIONS

The results of this study showed that exercise interventions can promote a better quality of life for the patients, and increase the total score of quality of life. Although, the total score of quality of life was not significantly different, it was concluded that exercise can promote the quality of life amongst patients with breast cancer.

Validity of weight loss to estimate improvement in body composition in individuals attending a wellness center

The accuracy of weight loss in estimating successful changes in body composition (BC), namely fat mass (FM) loss, is not known and was addressed in our study. To assess the correlation between change in body weight and change in FM, fat% and fat-free mass (FFM), 465 participants (41% male; 41 ± 13 years), who met the criteria for weight change assessment at a wellness center, underwent air-displacement plethysmography (ADP). Body weight and BC were measured at the same time. We categorized the change in body weight, FM and FFM as an increase if there was >1 kg gain, a decrease if there was >1 kg loss and no change if the difference was ≤1 kg. We estimated the diagnostic performance of weight change to identify improvement in BC. After a median time of 132 days, there was a mean weight change was 2.4 kg. From the 255 people who lost >1 kg of weight, 216 (84.7%) had lost >1 kg of FM, but 69 (27.1%) had lost >1 kg of FFM. Of the 143 people with no weight change, 42 (29.4%) had actually lost >1 kg of FM. Of the 67 who gained >1 kg of weight at follow-up, in 23 (34.3%) this was due to an increase in FFM but not in FM. Weight change had a NPV of 73%. Our results indicate that favorable improvements in BC may go undetected in almost one-third of people whose weight remains the same and in one-third of people who gain weight after attending a wellness center. These results underscore the potential role of BC measurements in people attempting lifestyle changes.

The purported effects of alcohol on appetite and weight in lung cancer patients

Loss of appetite and weight predict poor outcomes in patients with advanced cancer. Effective and affordable palliative strategies are lacking; but because an emerging non-cancer literature suggests that alcohol can increase appetite and weight, this study explored associations between alcohol and clinical outcomes in lung cancer patients. Among 404 consecutive lung cancer patients enrolled in the Mayo Clinic Lung Cancer Cohort between 2004 and 2008, alcohol consumption (within 6 mo of diagnosis) was as follows: 199 (49%) used none, 158 (14%) were moderate users (7 drinks per wk or less), and 47 (12%) were heavier consumers (more than 7 drinks per wk). Only heavier consumers had a lower likelihood of anorexia (odds ratio: 0.49; 95% CI: 0.25, 0.94; P = 0.03) and weight loss (odds ratio: 0.43; 95% CI: 0.20, 0.91; P = 0.03) compared to those who consumed no alcohol. These conclusions were sustained in multivariate analyses. Neither moderate nor heavier consumption was associated with better or worse survival, although, in univariate analyses, a drop in alcohol consumption was associated with worse survival. This report suggests a need for further study of alcohol as a palliative agent for cancer-associated loss of appetite and weight.