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Metoudi M, Bauer A, Haffner T, Kassam S. A cross-sectional survey exploring knowledge, beliefs and barriers to whole food plant-based diets amongst registered dietitians in the United Kingdom and Ireland. J Hum Nutr Diet 2025; 38:e13386. [PMID: 39491806 PMCID: PMC11589407 DOI: 10.1111/jhn.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 10/02/2024] [Accepted: 10/07/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Plant-based diets (PBDs) have gained popularity in recent years due to their co-benefits for human and planetary health. Although clinical guidelines now recommend well-balanced PBDs, it remains unclear how dietitians in the United Kingdom (UK) and Republic of Ireland (ROI) view such diets and their implementation in practice. This study aimed to evaluate the perspectives of registered dietitians (RDs) on the role of a whole food plant-based diet (WFPBD) in clinical practice. METHODS A cross-sectional online survey was conducted amongst RDs in the UK and ROI between September and November 2023. RESULTS A total of 335 RDs participated in the survey. Most RDs (76%) agree that a well-planned WFPBD is suitable for all stages of life, with some (48%) expressing concerns over the risk of malnutrition and micronutrient deficiencies. Three-quarters of RDs (75%) incorrectly thought that plant protein is incomplete, necessitating protein combining. A WFPBD was on average ranked fourth out of 14 dietary strategies for managing some of the leading non-communicable diseases. Excluding dairy and eggs was the primary reason preventing RDs from personally adopting a WFPBD, whereas meal preparation and cost were the main barriers for their clients. The majority of RDs (79%) feel they did not receive sufficient education on WFPBDs, with 58% agreeing there are insufficient evidence-based resources available in their field. Only 33% feel supported when advocating for a WFPBD in their workplace. CONCLUSIONS Although many RDs view WFPBDs as viable and clinically relevant, significant barriers to their implementation exist, underscoring the need for enhanced education and support.
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Affiliation(s)
| | - Alexander Bauer
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburg im BreisgauGermany
| | | | - Shireen Kassam
- King's College LondonUniversity of WinchesterHampshireUK
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2
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Baroni L, Rizzo G, Zavoli M, Battino M. A Plant-Based Food Guide Adapted for Low-Fat Diets: The VegPlate Low-Fat (VP_LF). Foods 2024; 13:4050. [PMID: 39766992 PMCID: PMC11728239 DOI: 10.3390/foods13244050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 12/10/2024] [Accepted: 12/12/2024] [Indexed: 01/15/2025] Open
Abstract
Strong evidence supports the paramount importance of the composition of the diet for health. Not only diet should provide nutritional adequacy, but some foods and dietary components can also support the management of common chronic diseases, with mechanisms independent of nutritional adequacy. Among the various intervention diets, low-fat vegan diets have been shown to be effective for cardiometabolic health, mainly influencing insulin resistance, adiposity, and blood lipids. This type of diet relies on reducing or eliminating all added fats and choosing low-fat foods, mainly unprocessed whole-plant foods. We hereby propose a tool for planning low-fat vegan diets, the VegPlate Low-Fat (VP_LF), which has been obtained from a specific adaptation of the VegPlate method, which was already presented in previous publications for adults and some life stages and situations. The reduction in fats in the diet, which ranges between 10% and 15% of total energy, and the varied inclusion of foods from plant groups make it easier to provide adequate amounts of all nutrients with a normal- or lower-calorie intake, in comparison with diets that do not limit fat intakes. We expect that this new proposal will help nutrition professionals embrace low-fat diets as a first-line intervention for individuals affected by different health conditions who can benefit from these diets.
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Affiliation(s)
- Luciana Baroni
- Scientific Society for Vegetarian Nutrition—SSNV, Mestre, 30171 Venice, Italy; (L.B.); (M.Z.)
| | - Gianluca Rizzo
- Scientific Society for Vegetarian Nutrition—SSNV, Mestre, 30171 Venice, Italy; (L.B.); (M.Z.)
| | - Martina Zavoli
- Scientific Society for Vegetarian Nutrition—SSNV, Mestre, 30171 Venice, Italy; (L.B.); (M.Z.)
| | - Maurizio Battino
- Joint Laboratory on Food Science, Nutrition, and Intelligent Processing of Foods, Polytechnic University of Marche, Italy, Universidad Europea del Atlántico Spain and Jiangsu University, China, Via Pietro Ranieri 65, 60131 Ancona, Italy;
- International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu University, Zhenjiang 212013, China
- Department of Clinical Sciences, Polytechnic University of Marche, Via Pietro Ranieri 65, 60131 Ancona, Italy
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain
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3
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Brown FF, Oliver R, Eddy R, Causer AJ, Emery A, Collier-Bain HD, Dutton D, Crowe J, Augustine D, Graby J, Rees D, Rothschild-Rodriguez D, Peacock OJ, Moore S, Murray J, Turner JE, Campbell JP. A 16-week progressive exercise training intervention in treatment-naïve chronic lymphocytic leukaemia: a randomised-controlled pilot study. Front Oncol 2024; 14:1472551. [PMID: 39703835 PMCID: PMC11655450 DOI: 10.3389/fonc.2024.1472551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 11/05/2024] [Indexed: 12/21/2024] Open
Abstract
Background Chronic lymphocytic leukaemia (CLL) typically presents with asymptomatic, early-stage disease that is monitored until disease progression ('treatment-naïve' CLL). The objective of this pilot study was to assess the feasibility and preliminary safety of an exercise program in treatment-naïve CLL. We also sought to preliminarily assess the impact of the exercise program on disease activity, as it has been proposed that exercise training may reduce disease outgrowth in treatment-naïve CLL. Methods A total of 40 treatment-naïve CLL patients were recruited into this randomised-controlled pilot study, and after screening, n = 28 were randomised into a 16-week, home-based, partially supervised, personalised, progressive exercise intervention (n = 14: mean ± SD: age = 62 ± 12 years) or 16 weeks of usual care, control group (n = 14: mean ± SD: age = 61 ± 10 years). The primary outcome measures were safety (number and severity of adverse events) and feasibility (uptake, retention, and adherence to the trial). Disease activity (CD5+/CD19+ CLL cells clonally restricted to kappa or lambda) and other immune cell phenotypes, with a principal focus on T cells, were measured by flow cytometry. Other secondary outcomes included DEXA-derived body composition, cardiorespiratory and functional fitness, resting cardiovascular measures. Results Trial uptake was 40%, and the overall retention rate was 86%, with 79% of the exercise group and 93% of the control group completing the trial. Adherence to the exercise intervention was 92 ± 8%. One serious adverse event was reported unrelated to the trial, and one adverse event related to the trial was reported. The exercise intervention elicited a 2% increase in DEXA-derived lean mass in the exercise group compared with a 0.4% decrease in the control group (p = 0.01). No between-group differences were observed over time for whole-body mass, BMI, bone mineral density, body fat, blood pressure resting heart rate, or measures of cardiorespiratory or functional fitness (all p > 0.05). No between-group differences were observed over time for clonal CLL cells and CD4+ or CD8+ T-cell subsets (all p > 0.05). Conclusion The exercise training program used in this study was feasible in people with treatment-naïve CLL who passed pre-trial screening, and we preliminarily conclude that the exercise training program was safe and also resulted in an increase in lean mass. Clinical trial registration https://doi.org/10.1186/ISRCTN55166064, identifier ISRCTN 55166064.
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Affiliation(s)
- Frankie F. Brown
- Department for Health, University of Bath, Bath, United Kingdom
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Rebecca Oliver
- Department for Health, University of Bath, Bath, United Kingdom
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Rachel Eddy
- Department for Health, University of Bath, Bath, United Kingdom
| | - Adam J. Causer
- Department for Health, University of Bath, Bath, United Kingdom
| | - Annabelle Emery
- Department for Health, University of Bath, Bath, United Kingdom
| | | | - David Dutton
- Department for Haematology, Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom
| | - Josephine Crowe
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Daniel Augustine
- Department for Health, University of Bath, Bath, United Kingdom
- Department for Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - John Graby
- Department for Health, University of Bath, Bath, United Kingdom
- Department for Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Daniel Rees
- Department for Health, University of Bath, Bath, United Kingdom
| | | | | | - Sally Moore
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - James Murray
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - James E. Turner
- Department for Health, University of Bath, Bath, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John P. Campbell
- Department for Health, University of Bath, Bath, United Kingdom
- School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia
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4
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Loeb S, Borin JF, Venigalla G, Narasimman M, Gupta N, Cole AP, Amin K. Plant-based diets and urological health. Nat Rev Urol 2024:10.1038/s41585-024-00939-y. [PMID: 39375468 DOI: 10.1038/s41585-024-00939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/09/2024]
Abstract
Plant-based diets have grown in popularity owing to multiple health and environmental benefits. Some evidence suggests that plant-based diets are associated with benefits for urological health. In genitourinary oncology, most research has focused on prostate cancer. Clinical trial results suggest a favourable influence of healthy lifestyle modifications including plant-based diets before and after prostate cancer treatment. Epidemiological evidence shows that a diet higher in plant-based and lower in animal-based food is associated with a lower risk of aggressive prostate cancer and better quality-of-life scores than a diet with less plant-based and more animal-based food. Studies on bladder and kidney cancer are scarce, but limited data suggest that vegetarian or plant-forward dietary patterns (increased consumption of fruits and vegetables and minimizing meat) are associated with a lower risk of development of these cancers than dietary patterns with fewer fruits and vegetables and more meat. With respect to benign urological conditions, epidemiological studies suggest that plant-based dietary patterns are associated with a lower risk of benign prostatic hyperplasia and urinary tract infections than non-plant-based dietary patterns. Compared with diets high in animal-based foods and low in plant-based foods, a substantial body of epidemiological evidence also suggests that increased consumption of healthy plant-based food is associated with a lower risk of erectile dysfunction. Plant-based dietary patterns that are high in fruits and vegetables with normal calcium intake, while limiting animal protein and salt, are associated with a lower risk of kidney stone development than dietary patterns that do not follow these parameters. Overall, increasing consumption of plant-based foods and reducing intake of animal-based foods has favourable associations with multiple urological conditions.
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Affiliation(s)
- Stacy Loeb
- Departments of Urology and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Surgery and Urology, Manhattan Veterans Affairs, New York, NY, USA.
| | - James F Borin
- Departments of Urology and Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Surgery and Urology, Manhattan Veterans Affairs, New York, NY, USA
| | - Greeshma Venigalla
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manish Narasimman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natasha Gupta
- Departments of Urology and Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Surgery and Urology, Manhattan Veterans Affairs, New York, NY, USA
| | - Alexander P Cole
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine Amin
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Tohi Y, Sahrmann JM, Arbet J, Kato T, Lee LS, Peacock M, Ginsburg K, Pavlovich C, Carroll P, Bangma CH, Sugimoto M, Boutros PC. De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium. Eur Urol Oncol 2024:S2588-9311(24)00179-2. [PMID: 39089946 DOI: 10.1016/j.euo.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/10/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND OBJECTIVE There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring. METHODS The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring. KEY FINDINGS AND LIMITATIONS Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation. CONCLUSIONS Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa. PATIENT SUMMARY We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.
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Affiliation(s)
- Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - John M Sahrmann
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA; Department of Human Genetics, University of California-Los Angeles, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Jaron Arbet
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA; Department of Human Genetics, University of California-Los Angeles, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital and Singapore General Hospital, Singapore
| | - Michael Peacock
- BC Cancer, University of British Columbia, Vancouver, Canada
| | - Kevin Ginsburg
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Christian Pavlovich
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Carroll
- Department of Urology, University California-San Francisco, San Francisco, CA, USA
| | - Chris H Bangma
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Paul C Boutros
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California-Los Angeles, Los Angeles, CA, USA; Department of Human Genetics, University of California-Los Angeles, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
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Baroni L, Rizzo G, Galchenko AV, Zavoli M, Serventi L, Battino M. Health Benefits of Vegetarian Diets: An Insight into the Main Topics. Foods 2024; 13:2398. [PMID: 39123589 PMCID: PMC11311397 DOI: 10.3390/foods13152398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Vegetarian diets are plant-based diets including all the edible foods from the Plant Kingdom, such as grains, legumes, vegetables, fruits, nuts, and seeds. Dairy and eggs can be added in small amounts in the lacto-ovo-vegetarian subtype, or not at all in the vegan subtype. The abundance of non-processed plant foods-typical of all well-planned diets, including vegetarian ones-can provide the body with numerous protective factors (fiber, phytocompounds), while limiting the intake of harmful nutrients like saturated fats, heme-iron, and cholesterol. The beneficial effects on health of this balance have been reported for many main chronic diseases, in both observational and intervention studies. The scientific literature indicates that vegetarians have a lower risk of certain types of cancer, overall cancer, overweight-obesity, type 2 diabetes, dyslipidemia, hypertension, and vascular diseases. Since the trend of following a vegetarian diet is increasing among citizens of developed countries, the knowledge in the field will benefit from further studies confirming the consistency of these findings and clarifying the effects of vegetarian diets on other controversial topics.
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Affiliation(s)
- Luciana Baroni
- Scientific Society for Vegetarian Nutrition—SSNV, 30171 Venice, Italy; (L.B.); (A.V.G.); (M.Z.)
| | - Gianluca Rizzo
- Scientific Society for Vegetarian Nutrition—SSNV, 30171 Venice, Italy; (L.B.); (A.V.G.); (M.Z.)
| | - Alexey Vladimirovich Galchenko
- Scientific Society for Vegetarian Nutrition—SSNV, 30171 Venice, Italy; (L.B.); (A.V.G.); (M.Z.)
- Earth Philosophical Society “Melodia Vitae”, International, Toronto, CA M9A4X9, Canada
| | - Martina Zavoli
- Scientific Society for Vegetarian Nutrition—SSNV, 30171 Venice, Italy; (L.B.); (A.V.G.); (M.Z.)
| | - Luca Serventi
- The New Zealand Institute for Plant and Food Research Limited, Lincoln 7608, New Zealand;
| | - Maurizio Battino
- Joint Laboratory on Food Science, Nutrition, and Intelligent Processing of Foods, Polytechnic University of Marche, Italy, Universidad Europea del Atlántico Spain and Jiangsu University, China, Via Pietro Ranieri 65, 60131 Ancona, Italy;
- International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu University, Zhenjiang 212013, China
- Department of Clinical Sciences, Polytechnic University of Marche, Via Pietro Ranieri 65, 60131 Ancona, Italy
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain
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Dinas PC, Karaventza M, Liakou C, Georgakouli K, Bogdanos D, Metsios GS. Combined Effects of Physical Activity and Diet on Cancer Patients: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1749. [PMID: 38892682 PMCID: PMC11175154 DOI: 10.3390/nu16111749] [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: 05/10/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The purpose of our systematic review was to examine the effects of any physical activity/exercise intervention combined with any diet/nutrition intervention on any biological/biochemical index, quality of life (QoL), and depression in breast, lung, colon and rectum, prostate, stomach, and liver cancer patients and/or cancer survivors. METHODS A systematic review and meta-analysis were undertaken, using PRISMA guidelines and the Cochrane Handbook. The systematic review protocol can be found in the PROSPERO database; registration number: CRD42023481429. RESULTS We found moderate-quality evidence that a combined intervention of physical activity/exercise and nutrition/diet reduced body mass index, body weight, fat mass, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, triglycerides, and depression, while it increased high-density lipoprotein, the physical component of QoL, and general functional assessment of cancer therapy. CONCLUSIONS We conclude that a combined intervention of physical activity/exercise and diet/nutrition may decrease body weight, fat mass, insulin levels, and inflammation, and improve lipidemic profile, the physical component of QoL, and depression in cancer patients and survivors. These outcomes indicate a lower risk for carcinogenesis; however, their applicability depends on the heterogeneity of the population and interventions, as well as the potential medical treatment of cancer patients and survivors.
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Affiliation(s)
- Petros C. Dinas
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
- FAME Laboratory, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece
| | | | - Marianthi Karaventza
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
| | - Christina Liakou
- School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece;
| | - Kalliopi Georgakouli
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
| | - Dimitrios Bogdanos
- Department of Internal Medicine, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece;
| | - George S. Metsios
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
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Harborg S, Kjærgaard KA, Thomsen RW, Borgquist S, Cronin-Fenton D, Hjorth CF. New Horizons: Epidemiology of Obesity, Diabetes Mellitus, and Cancer Prognosis. J Clin Endocrinol Metab 2024; 109:924-935. [PMID: 37552777 DOI: 10.1210/clinem/dgad450] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/30/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
The global prevalence of obesity and diabetes mellitus has increased in parallel with increasing cancer incidence, due to environmental and lifestyle factors and population aging. Metabolic diseases are associated with increased cancer risk, so a growing number of patients with cancer have coexistent obesity and/or diabetes mellitus. In this narrative review, we highlight recent evidence on the clinical impact of obesity and diabetes mellitus on the prognosis of prostate, breast, and colorectal cancer, and provide an overview of the underlying mechanisms. There is evidence that obesity is associated with increased risk of recurrence, and all-cause and cancer-specific mortality among adults with prostate, breast, and colorectal cancer. Diabetes mellitus is associated with increased all-cause and cancer-specific mortality for these 3 cancers, beyond any impact of obesity. Evidence also suggests increased risk of colorectal cancer recurrence in patients with diabetes mellitus. The underlying mechanisms are multifactorial and likely include hormonal imbalances and chronic inflammation that promote cancer cell growth. Obesity and diabetes mellitus are associated with increased risk of complications and side effects of cancer treatment. Associated comorbidities such as impaired kidney function, cardiovascular disease, and neuropathies may preclude the use of guideline cancer treatment and are competing causes of death. Cancer patients with metabolic diseases require a designated clinical program and a multidisciplinary approach involving oncologists, endocrinologists, surgeons, nutritionists, and physiotherapists, to ensure coordinated and optimized patient care.
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Affiliation(s)
- Sixten Harborg
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Kasper A Kjærgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
| | - Cathrine F Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark
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9
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Emery A, Moore S, Crowe J, Murray J, Peacock O, Thompson D, Betts F, Rapps S, Ross L, Rothschild-Rodriguez D, Arana Echarri A, Davies R, Lewis R, Augustine DX, Whiteway A, Afzal Z, Heaney J, Drayson MT, Turner JE, Campbell JP. The effects of short-term, progressive exercise training on disease activity in smouldering multiple myeloma and monoclonal gammopathy of undetermined significance: a single-arm pilot study. BMC Cancer 2024; 24:174. [PMID: 38317104 PMCID: PMC10840198 DOI: 10.1186/s12885-024-11817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly investigated the effects on MGUS/SMM disease activity. METHODS In this single-arm pilot study, N = 20 participants diagnosed with MGUS or SMM were allocated to receive a 16-week progressive exercise programme. Primary outcome measures were feasibility and safety. Secondary outcomes were pre- to post-exercise training changes to blood biomarkers of MGUS and SMM disease activity- monoclonal (M)-protein and free light chains (FLC)- plus cardiorespiratory and functional fitness, body composition, quality of life, blood immunophenotype, and blood biomarkers of inflammation. RESULTS Fifteen (3 MGUS and 12 SMM) participants completed the exercise programme. Adherence was 91 ± 11%. Compliance was 75 ± 25% overall, with a notable decline in compliance at intensities > 70% V̇O2PEAK. There were no serious adverse events. There were no changes to M-protein (0.0 ± 1.0 g/L, P =.903), involved FLC (+ 1.8 ± 16.8 mg/L, P =.839), or FLC difference (+ 0.2 ± 15.6 mg/L, P =.946) from pre- to post-exercise training. There were pre- to post-exercise training improvements to diastolic blood pressure (- 3 ± 5 mmHg, P =.033), sit-to-stand test performance (+ 5 ± 5 repetitions, P =.002), and energy/fatigue scores (+ 10 ± 15%, P =.026). Other secondary outcomes were unchanged. CONCLUSIONS A 16-week progressive exercise programme was feasible and safe, but did not reverse MGUS/SMM disease activity, contrasting a prior case study showing that five years of exercise training reversed SMM in a 44-year-old former athlete. Longer exercise interventions should be explored in a group of MGUS/SMM patients, with measurements of disease biomarkers, along with rates of disease progression (i.e., MGUS/SMM to MM). REGISTRATION https://www.isrctn.com/ISRCTN65527208 (14/05/2018).
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Affiliation(s)
- A Emery
- Department for Health, University of Bath, Bath, UK
| | - S Moore
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Crowe
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Murray
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - O Peacock
- Department for Health, University of Bath, Bath, UK
| | - D Thompson
- Department for Health, University of Bath, Bath, UK
| | - F Betts
- Department for Health, University of Bath, Bath, UK
| | - S Rapps
- Department for Health, University of Bath, Bath, UK
| | - L Ross
- Department for Health, University of Bath, Bath, UK
| | | | | | - R Davies
- Department for Health, University of Bath, Bath, UK
| | - R Lewis
- Department for Physiotherapy, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D X Augustine
- Department for Health, University of Bath, Bath, UK
- Department for Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - A Whiteway
- Department for Haematology, North Bristol NHS Trust, Bristol, UK
| | - Z Afzal
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jlj Heaney
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M T Drayson
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J E Turner
- Department for Health, University of Bath, Bath, UK
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - J P Campbell
- Department for Health, University of Bath, Bath, UK.
- School of Medical and Health Sciences, Edith Cowan University, WA, Joondalup, Australia.
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10
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Brassetti A, Cacciatore L, Bove AM, Anceschi U, Proietti F, Misuraca L, Tuderti G, Flammia RS, Mastroianni R, Ferriero MC, Chiacchio G, D’Annunzio S, Pallares-Mendez R, Lombardo R, Leonardo C, De Nunzio C, Simone G. The Impact of Physical Activity on the Outcomes of Active Surveillance in Prostate Cancer Patients: A Scoping Review. Cancers (Basel) 2024; 16:630. [PMID: 38339381 PMCID: PMC10854832 DOI: 10.3390/cancers16030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Active surveillance has emerged as a valid therapeutic option in patients with low-risk prostate cancer, allowing for the deferral of definitive treatment until the time of possible disease progression. Although it is known that physical activity plays a protective role in the onset and progression of this tumor, its impact on patients with low-risk disease who are managed with active surveillance remains unclear. Our scoping review aims to summarize the existing evidence on this subject. EVIDENCE ACQUISITION On 9 April 2023, a systematic search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("prostate cancer" OR "prostate tumor") AND ("active surveillance") AND ("physical activity" OR "physical exercise" OR "physical intensive activity" OR "intensive exercise") AND ("lifestyle"). Out of the 506 identified articles, 9 were used for the present scoping review, and their results were reported according to the PRISMA-ScR statement. EVIDENCE SYNTHESIS We discovered a lack of uniformity in the assessment of PA and its stratification by intensity. There was no consensus regarding what constitutes cancer progression in patients choosing expectant management. In terms of the impact of PA on AS outcomes, conflicting results were reported: some authors found no correlation, while others (six of total studies included) revealed that active men experience smaller increases in PSA levels compared to their sedentary counterparts. Additionally, higher levels of exercise were associated with a significantly reduced risk of PCa reclassification. CONCLUSION Due to the heterogeneity of the methodologies used in the available studies and the conflicting results reported, it is not possible to draw definitive conclusions concerning the role physical activity may play in the risk of prostate cancer progression in men managed with active surveillance.
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Affiliation(s)
- Aldo Brassetti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Loris Cacciatore
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Alfredo Maria Bove
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Umberto Anceschi
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Flavia Proietti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Leonardo Misuraca
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Gabriele Tuderti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Rocco Simone Flammia
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Maria Consiglia Ferriero
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Giuseppe Chiacchio
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Simone D’Annunzio
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Rigoberto Pallares-Mendez
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Riccardo Lombardo
- “Sapienza” University of Rome, Department of Urology, Via di Grottarossa 1035, 00189 Rome, Italy; (R.L.); (C.D.N.)
| | - Costantino Leonardo
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
| | - Cosimo De Nunzio
- “Sapienza” University of Rome, Department of Urology, Via di Grottarossa 1035, 00189 Rome, Italy; (R.L.); (C.D.N.)
| | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144 Rome, Italy; (A.B.); (A.M.B.); (U.A.); (F.P.); (L.M.); (G.T.); (R.S.F.); (R.M.); (M.C.F.); (G.C.); (S.D.); (R.P.-M.); (C.L.); (G.S.)
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11
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Powers-James C, Morse M, Narayanan S, Ramondetta L, Lopez G, Wagner R, Cohen L. Integrative Oncology Approaches to Reduce Recurrence of Disease and Improve Survival. Curr Oncol Rep 2024; 26:147-163. [PMID: 38180690 DOI: 10.1007/s11912-023-01467-5] [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] [Accepted: 10/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW After a cancer diagnosis, patients ask what they can do in addition to the recommended treatments to increase their survival. Many turn to integrative medicine modalities and lifestyle changes to improve their chances of survival. Numerous studies have demonstrated that lifestyle changes can significantly improve survival rates for cancer patients. Less support exists for the use of natural products or supplements to improve cancer survival. In this manuscript, we review key findings and evidence in the areas of healthy eating habits, physical activity, stress management and social support, and sleep quality, as well as natural products and supplements as they relate to the cancer recurrence and survival. RECENT FINDINGS While more research is needed to fully understand the mechanisms underlying the associations between lifestyle changes and cancer survival, findings suggest that lifestyle modifications in the areas of diet, physical activity, stress management and social support, and sleep quality improve clinical cancer outcomes. This is especially true for programs that modify more than one lifestyle habit. To date, outside of supplementing with vitamin D to maintain adequate levels, conflicting conclusion within the research remain regarding the efficacy of using natural products or supplement to improve cancer recurrence of disease or cancer survival. A call for further research is warranted. Lifestyle screening and counseling should be incorporated into cancer treatment plans to help improve patient outcomes. While the scientific community strives for the pursuit of high-quality research on natural products to enhance cancer survival, transparency, dialogue, and psychological safety between patients and clinicians must continue to be emphasized. Proactive inquiry by clinicians regarding patients' supplement use will allow for an informed discussion of the benefits and risks of natural products and supplements, as well as a re-emphasis of the evidence supporting diet and other lifestyle habits to increase survival.
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Affiliation(s)
- Catherine Powers-James
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Meroë Morse
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lois Ramondetta
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Richard Wagner
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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12
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Kumar NB. Contemporary Strategies for Clinical Chemoprevention of Localized Prostate Cancer. Cancer Control 2024; 31:10732748241302863. [PMID: 39573923 PMCID: PMC11583501 DOI: 10.1177/10732748241302863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2024] Open
Abstract
Prostate cancer (PCa) is the most common cancer among men in the United States and the second leading cause of cancer-related deaths. Metastatic castration-resistant PCa is still a fatal disease. On the other hand, between 2016 and 2020, about 70% of PCa cases were diagnosed at a localized stage. Evolving data demonstrates that men with low-grade cancers treated with definitive therapies may now be exposed to morbidities of overtreatment and poor quality of life, with little or no benefit in terms of cancer specific mortality. Active surveillance (AS) is thus the recommended management strategy for men with low-grade disease. Although this subgroup of men have reported anxiety during the AS period, they account to be highly motivated to make positive lifestyle changes to further reduce their risk of PCa progression, underscoring the urgent need to identify novel strategies for preventing progression of localized PCa to metastatic disease through pharmacologic means, an approach termed chemoprevention. Although several promising agents and approaches have been examined over the past 2 decades, currently, there are several limitations in the approach used to systematically examine agents for chemoprevention targeting men on AS. The goal of this review is to summarize the current agents and approaches evaluated, targeting men on AS, recognize the gaps, and identify a contemporary and comprehensive path forward. Results of these studies may inform the development of phase III clinical trials and ultimately provide a strategy for clinical chemoprevention in men on AS, for whom, currently, there are no options for reducing the risk of progression to metastatic disease.
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Affiliation(s)
- Nagi B Kumar
- Cancer Epidemiology Program, Population Sciences Division, Genitourinary Oncology and Breast Oncology Departments, Department of Oncologic Sciences, Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, FL, USA
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13
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Dovey Z, Horowitz A, Waingankar N. The influence of lifestyle changes (diet, exercise and stress reduction) on prostate cancer tumour biology and patient outcomes: A systematic review. BJUI COMPASS 2023; 4:385-416. [PMID: 37334023 PMCID: PMC10268595 DOI: 10.1002/bco2.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 06/20/2023] Open
Abstract
Background The mostly indolent natural history of prostate cancer (PCa) provides an opportunity for men to explore the benefits of lifestyle interventions. Current evidence suggests appropriate changes in lifestyle including diet, physical activity (PA) and stress reduction with or without dietary supplements may improve both disease outcomes and patient's mental health. Objective This article aims to review the current evidence on the benefits of all lifestyle programmes for PCa patients including those aimed at reducing obesity and stress, explore their affect on tumour biology and highlight any biomarkers that have clinical utility. Evidence acquisition Evidence was obtained from PubMed and Web of Science using keywords for each section on the affects of lifestyle interventions on (a) mental health, (b) disease outcomes and (c) biomarkers in PCa patients. PRISMA guidelines were used to gather the evidence for these three sections (15, 44 and 16 publications, respectively). Evidence synthesis For lifestyle studies focused on mental health, 10/15 demonstrated a positive influence, although for those programmes focused on PA it was 7/8. Similarly for oncological outcomes, 26/44 studies demonstrated a positive influence, although when PA was included or the primary focus, it was 11/13. Complete blood count (CBC)-derived inflammatory biomarkers show promise, as do inflammatory cytokines; however, a deeper understanding of their molecular biology in relation to PCa oncogenesis is required (16 studies reviewed). Conclusions Making PCa-specific recommendations on lifestyle interventions is difficult on the current evidence. Nevertheless, notwithstanding the heterogeneity of patient populations and interventions, the evidence that dietary changes and PA may improve both mental health and oncological outcomes is compelling, especially for moderate to vigorous PA. The results for dietary supplements are inconsistent, and although some biomarkers show promise, significantly more research is required before they have clinical utility.
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Affiliation(s)
- Zach Dovey
- Mount Sinai Health System, Department of UrologyIcahn Medical SchoolNew YorkNew YorkUSA
| | - Amir Horowitz
- Icahn School of MedicineThe Mount Sinai HospitalNew YorkNew YorkUSA
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14
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Feiertag N, Tawfik MM, Loloi J, Patel RD, Green B, Zhu M, Klyde D, Small AC, Watts KL. Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Forward Diets on Men's Health. Urology 2023; 176:7-15. [PMID: 36963667 DOI: 10.1016/j.urology.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To perform a systematic review of the literature on plant-based and plant-forward diets and the prevention/treatment of the following common men's health conditions: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system criteria were utilized to search PubMed and Medline databases for the following search terms: "Diet (Mesh)" OR "Diet Therapy (Mesh)" AND "Prostatic Hyperplasia (Mesh)" OR "Prostatic Neoplasm (Mesh)" OR "Erectile Dysfunction (Mesh)." Articles in English published from 1989 to 2022 using human participants were analyzed, data summarized, and assessed for bias. RESULTS Studies reporting on plant-based or vegetable-forward diets (Mediterranean) as an intervention were included. Cohort and cross-sectional studies using food frequency questionnaires or diet classification indices to quantify plant-based food intake patterns were included in the study. Ultimately, 12 PCa articles, 4 BPH articles, 6 ED articles, and 2 articles related to both BPH and ED were reviewed. Overall, the literature suggests plant-forward diets confer a protective effect on the men's health conditions reviewed. CONCLUSIONS Evaluation of the literature on the impact of plant-forward diets on urologic conditions includes a heterogenous range of dietary patterns and study designs. The greatest amount of research has evaluated the application of plant-forward diets for PCa. While there is currently a lack of high-quality evidence for the use of plant-forward diets as prevention and/or treatment for PCa, ED, or BPH, reported outcomes suggest a consistent small beneficial impact alongside well-established benefits for common chronic conditions.
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Affiliation(s)
| | | | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY
| | - Rutul D Patel
- Department of Urology, Montefiore Medical Center, Bronx, NY
| | | | - Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY
| | | | - Alexander C Small
- Department of Urology, Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - Kara L Watts
- Department of Urology, Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY.
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15
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Bhat S, Rotti H, Prasad K, Kabekkodu SP, Saadi AV, Shenoy SP, Joshi KS, Nesari TM, Shengule SA, Dedge AP, Gadgil MS, Dhumal VR, Salvi S, Satyamoorthy K. Genome-wide DNA methylation profiling after Ayurveda intervention to bronchial asthmatics identifies differential methylation in several transcription factors with immune process related function. J Ayurveda Integr Med 2023; 14:100692. [PMID: 37018893 PMCID: PMC10122039 DOI: 10.1016/j.jaim.2023.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/13/2022] [Accepted: 02/01/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The Indian traditional medicinal system, Ayurveda, describes several lifestyle practices, processes and medicines as an intervention to treat asthma. Rasayana therapy is one of them and although these treatment modules show improvement in bronchial asthma, their mechanism of action, particularly the effect on DNA methylation, is largely understudied. OBJECTIVES Our study aimed at identifying the contribution of DNA methylation changes in modulating bronchial asthma phenotype upon Ayurveda intervention. MATERIALS AND METHODS In this study, genome-wide methylation profiling in peripheral blood DNA of healthy controls and bronchial asthmatics before (BT) and after (AT) Ayurveda treatment was performed using array-based profiling of reference-independent methylation status (aPRIMES) coupled to microarray technique. RESULTS We identified 4820 treatment-associated DNA methylation signatures (TADS) and 11,643 asthma-associated DNA methylation signatures (AADS), differentially methylated [FDR (≤0.1) adjusted p-values] in AT and HC groups respectively, compared to BT group. Neurotrophin TRK receptor signaling pathway was significantly enriched for differentially methylated genes in bronchial asthmatics, compared to AT and HC subjects. Additionally, we identified over 100 differentially methylated immune-related genes located in the promoter/5'-UTR regions of TADS and AADS. Various immediate-early response and immune regulatory genes with functions such as transcription factor activity (FOXD1, FOXD2, GATA6, HOXA3, HOXA5, MZF1, NFATC1, NKX2-2, NKX2-3, RUNX1, KLF11), G-protein coupled receptor activity (CXCR4, PTGER4), G-protein coupled receptor binding (UCN), DNA binding (JARID2, EBF2, SOX9), SNARE binding (CAPN10), transmembrane signaling receptor activity (GP1BB), integrin binding (ITGA6), calcium ion binding (PCDHGA12), actin binding (TRPM7, PANX1, TPM1), receptor tyrosine kinase binding (PIK3R2), receptor activity (GDNF), histone methyltransferase activity (MLL5), and catalytic activity (TSTA3) were found to show consistent methylation status between AT and HC group in microarray data. CONCLUSIONS Our study reports the DNA methylation-regulated genes in bronchial asthmatics showing improvement in symptoms after Ayurveda intervention. DNA methylation regulation in the identified genes and pathways represents the Ayurveda intervention responsive genes and may be further explored as diagnostic, prognostic, and therapeutic biomarkers for bronchial asthma in peripheral blood.
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Affiliation(s)
- Smitha Bhat
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Harish Rotti
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Keshava Prasad
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Shama Prasada Kabekkodu
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Abdul Vahab Saadi
- Department of Biotechnology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Sushma P Shenoy
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Kalpana S Joshi
- Department of Biotechnology, Sinhgad College of Engineering, S. P. University of Pune, Pune Maharashtra, India
| | - Tanuja M Nesari
- Department of Dravyaguna, Tilak Ayurved Mahavidyalaya, Pune, Maharashtra, India
| | - Sushant A Shengule
- Department of Biotechnology, Sinhgad College of Engineering, S. P. University of Pune, Pune Maharashtra, India
| | - Amrish P Dedge
- Department of Dravyaguna, Tilak Ayurved Mahavidyalaya, Pune, Maharashtra, India
| | - Maithili S Gadgil
- Department of Biotechnology, Sinhgad College of Engineering, S. P. University of Pune, Pune Maharashtra, India
| | - Vikram R Dhumal
- Department of Dravyaguna, Tilak Ayurved Mahavidyalaya, Pune, Maharashtra, India
| | - Sundeep Salvi
- Department of Pulmonary Medicine, Chest Research Foundation, Pune, Maharashtra, India
| | - Kapaettu Satyamoorthy
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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16
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[Mind-body medicine in integrative uro-oncology : Studies and areas of application]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:27-33. [PMID: 36471013 DOI: 10.1007/s00120-022-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mind-body medicine (MBM) complements somatically oriented medical practice with behavioral and lifestyle-oriented approaches: Thus, health-promoting attitudes and behaviors are strengthened in everyday life. In integrative oncology, it helps promote emotional and physical well-being. RESEARCH QUESTION Guideline recommendations and the current study situation in integrative uro-oncology are presented. RESULTS During and after completion of primary therapy, mindfulness-based stress reduction (MBSR) shows positive effects on anxiety, stress, and fatigue. However, it appears that the offer needs to be better tailored to the needs of prostate cancer patients. The effects of yoga are well documented, especially on fatigue, quality of life, and sexual function. Prostate cancer patients also showed a significantly increased immune response after completing a yoga intervention. Tai Ji Quan/Qigong improve quality of life, fatigue, and other symptoms. Hypnosis-especially in the palliative setting-mitigates anxiety, and relaxation techniques alleviate sleep problems and nausea/vomiting. Multimodal services improve quality of life on numerous levels. Higher resilience correlates with better quality of life and stronger male self-esteem. CONCLUSIONS MBSR alleviates many symptoms but needs to be adapted to the needs of prostate cancer patients; yoga and Tai Ji Chuan/Qigong alleviate fatigue and improve quality of life. Hypnosis and relaxation training reduce nausea/vomiting, and improve sleep and anxiety. Resilience promotion is important to support oncological patients.
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Obro LF, Osther PJS, Ammentorp J, Pihl GT, Krogh PG, Handberg C. Healthcare Professionals' Experiences and Perspectives of Facilitating Self-Management Support for Patients with Low-Risk Localized Prostate Cancer via mHealth and Health Coaching. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:346. [PMID: 36612667 PMCID: PMC9819876 DOI: 10.3390/ijerph20010346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Introduction: Self-monitoring of self-management interventions with the use of mobile health (mHealth) can enhance patients' well-being. Research indicates that mHealth and health coaching act symbiotically to providing a more constructive outcome. Nurse coaches seem to have a significant role in translating the patients' tracked data. Objective: The objective was to explore healthcare professionals' experiences of an intervention offering self-management support through mHealth and health coaching for patients with prostate cancer. Methods: We used the interpretive description methodology, combining semi-structured individual and focus group interviews and participant observations of patient-coach interactions and use of mHealth in coaching sessions. The study was conducted between June 2017 and August 2020. Results: The nurse coaches experienced motivation and autonomy when possessing the right competences for coaching. Furthermore, the nurse coaches experienced conflicting expectations of their roles when having to integrate mHealth. Conclusion: The experience of being competent, autonomous, and confident is important for the nurse coaches to be mentally present during the coaching sessions. On the other hand, the findings indicate that having the sense of not being confident in one's own ability to perform leads to reduced motivation.
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Affiliation(s)
- Louise Faurholt Obro
- Urological Research Center, Vejle Hospital—Part of Lillebaelt Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Palle Jörn Sloth Osther
- Urological Research Center, Vejle Hospital—Part of Lillebaelt Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Jette Ammentorp
- Centre for Research in Patient Communication, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | | | - Peter Gall Krogh
- Department of Engineering, Aarhus University, 8200 Aarhus, Denmark
| | - Charlotte Handberg
- The National Rehabilitation Center for Neuromuscular Diseases, 8000 Aarhus, Denmark
- Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
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18
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Kucuk O. Walk More, Eat Less, Don't Stress. Cancer Epidemiol Biomarkers Prev 2022; 31:1673-1674. [PMID: 36052489 DOI: 10.1158/1055-9965.epi-22-0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Unhealthy diet, obesity, lack of physical activity, and psychologic stress are associated with increased inflammation, oxidative stress, insulin resistance, and DNA methylation, which are the main mechanisms of chronic diseases such as cancer, hypertension, diabetes, cardiovascular disease, and Alzheimer's disease. It has recently been found that healthy diet and physical activity can reduce inflammatory markers and improve insulin sensitivity resulting in better survivorship outcomes in patients with prostate cancer. An "anti-inflammatory" lifestyle, including physical activity, healthy body weight, healthy diet, and stress reduction, has been associated with decreased cancer risk and progression. Epigenetic changes due to DNA methylation and altered gene expression associated with unhealthy lifestyle can be modulated by healthy behaviors. National Center for Complementary and Integrative Health (NCCIH) focuses on healthy lifestyle, and it supports research on psychologic and physical approaches including dietary supplements and plant-based products, as well as mind and body approaches, such as yoga, massage, meditation, mindfulness-based stress reduction, and acupuncture. See related article by Langlais et al., p. 1760.
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Affiliation(s)
- Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine and the Winship Cancer Institute of Emory University, Atlanta, Georgia
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19
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Active Surveillance in Intermediate-Risk Prostate Cancer: A Review of the Current Data. Cancers (Basel) 2022; 14:cancers14174161. [PMID: 36077698 PMCID: PMC9454661 DOI: 10.3390/cancers14174161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary AS is an option for the initial management of selected patients with intermediate-risk PC. The proper way to predict which men will have an aggressive clinical course or indolent PC who would benefit from AS has not been unveiled. Genetics and MRI can help in the decision-making, but it remains unclear which men would benefit from which tests. In addition, there are several differences between AS protocols in inclusion criteria, monitoring follow-up, and triggers for active treatment. Large series and a few RCTs are under investigation, and more research is needed to establish an optimal therapeutic strategy for patients with intermediate-risk PC. This study summarizes the current data on patients with intermediate-risk PC under AS, recent findings, and discusses future directions. Abstract Active surveillance (AS) is a monitoring strategy to avoid or defer curative treatment, minimizing the side effects of radiotherapy and prostatectomy without compromising survival. AS in intermediate-risk prostate cancer (PC) has increasingly become used. There is heterogeneity in intermediate-risk PC patients. Some of them have an aggressive clinical course and require active treatment, while others have indolent disease and may benefit from AS. However, intermediate-risk patients have an increased risk of metastasis, and the proper way to select the best candidates for AS is unknown. In addition, there are several differences between AS protocols in inclusion criteria, monitoring follow-up, and triggers for active treatment. A few large series and randomized trials are under investigation. Therefore, more research is needed to establish an optimal therapeutic strategy for patients with intermediate-risk disease. This study summarizes the current data on patients with intermediate-risk PC under AS, recent findings, and discusses future directions.
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20
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Shah UA, Iyengar NM. Plant-Based and Ketogenic Diets As Diverging Paths to Address Cancer: A Review. JAMA Oncol 2022; 8:1201-1208. [PMID: 35797039 PMCID: PMC10184023 DOI: 10.1001/jamaoncol.2022.1769] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance As the incidence of cancer and metabolic disorders, such as obesity, concurrently rise, there has been increasing awareness of the pervasive effect of nutrition. The whole foods plant-based diet (WFPBD) and ketogenic diet (KD) have gained popularity in oncology, and this topic is increasingly permeating clinical dialogue. Observations Dietary intake is associated with multiple pathways involved in carcinogenesis and tumor progression. Consumption of a plant-enriched diet is associated with reduced cancer incidence and is recommended by dietary guidelines for cancer prevention. Despite a starkly different nutrient composition, a WFPBD and KD can be associated with weight loss, decreased inflammation, and decreased insulin levels. In addition, a WFPBD is associated with increased fiber, phytochemicals, and butyrate levels and decreased insulin-like growth factor 1 levels, whereas a KD exerts potential anticancer effects by increasing β hydroxybutyrate levels. A KD may be of interest in select, less common settings, such as tumors treated with phosphatidylinositol 3-kinase inhibitors, which induce hyperinsulinemia and hyperglycemia. Completed interventional trials have focused on increasing fruit and vegetable intake or reducing fat intake but have not specifically tested WFPBD or KD for cancer prevention or treatment. Currently available data support plant-based diets as opposed to KD as part of a lifestyle associated with reduced cancer risk. In the postdiagnosis setting, there are currently no rigorously tested approaches that support the recommendation of any diet to treat cancer. Conclusions and Relevance The results of this review suggest that the collective evidence supports plant-enriched diets vs KD for the reduction of cancer risk and the improvement of metabolic disorders in survivors. Additional prospective randomized clinical trials are needed to encourage use of dietary modification across the cancer continuum. Rigorous trial designs that adapt classical oncologic end points may identify populations that are likely to benefit from starkly contrasting diets. Current data support prioritization of plant-based diets, and future data could further personalize dietary recommendations in cancer populations.
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Affiliation(s)
- Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Neil M Iyengar
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Gupta N, Patel HD, Taylor J, Borin JF, Jacobsohn K, Kenfield SA, Eggener SE, Price C, Davuluri M, Byrne N, Bivalacqua TJ, Loeb S. Systematic review of the impact of a plant-based diet on prostate cancer incidence and outcomes. Prostate Cancer Prostatic Dis 2022; 25:444-452. [PMID: 35790788 DOI: 10.1038/s41391-022-00553-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/26/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Plant-based diets are increasingly popular and have many well-established benefits for health and environmental sustainability. Our objective was to perform a systematic review of plant-based diets and prostate cancer. METHODS We performed a systematic database and citation search in February 2022. Studies were included if they reported primary data on plant-based dietary patterns (i.e., vegan, vegetarian, plant-based) and incidence among at-risk men for prostate cancer, or oncologic, general health/nutrition, or quality of life outcomes among patients with prostate cancer or caregivers. RESULTS A total of 32 publications were eligible for the qualitative synthesis, representing 5 interventional and 11 observational studies. Interventional studies primarily focused on lifestyle modification including plant-based diets for men on active surveillance for localized prostate cancer or with biochemical recurrence after treatment, showing improvements in short-term oncologic outcomes alongside improvements in general health and nutrition. Observational studies primarily focused on prostate cancer risk, showing either protective or null associations for plant-based dietary patterns. Studies of the vegan diet consistently showed favorable associations with risk and/or outcomes. Gaps in the current literature include impact for long-term disease-specific outcomes. CONCLUSIONS Interventional studies showed generally favorable results of lifestyle modifications incorporating a plant-based diet with prostate cancer outcomes as well as improvements in nutrition and general health. Observational studies demonstrated either a lower risk of prostate cancer or no significant difference. These results are encouraging in light of the many benefits of plant-based diets for overall health, as well as environmental sustainability and animal welfare.
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Affiliation(s)
- Natasha Gupta
- Department of Urology, NYU Langone Health and Manhattan Veterans Affairs, New York, NY, USA. .,Population Health, NYU Langone Health, New York, NY, USA.
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Jacob Taylor
- Department of Urology, NYU Langone Health and Manhattan Veterans Affairs, New York, NY, USA
| | - James F Borin
- Department of Urology, NYU Langone Health and Manhattan Veterans Affairs, New York, NY, USA
| | - Kenneth Jacobsohn
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stacey A Kenfield
- Departments of Urology and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Carrie Price
- Albert S. Cook Library, Towson University, Towson, MD, USA
| | - Meena Davuluri
- Department of Urology, Weill Cornell Medical Center, New York, NY, USA
| | - Nataliya Byrne
- Department of Urology, NYU Langone Health and Manhattan Veterans Affairs, New York, NY, USA.,Population Health, NYU Langone Health, New York, NY, USA
| | | | - Stacy Loeb
- Department of Urology, NYU Langone Health and Manhattan Veterans Affairs, New York, NY, USA.,Population Health, NYU Langone Health, New York, NY, USA
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22
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Storz MA. What makes a plant-based diet? a review of current concepts and proposal for a standardized plant-based dietary intervention checklist. Eur J Clin Nutr 2022; 76:789-800. [PMID: 34675405 PMCID: PMC9187516 DOI: 10.1038/s41430-021-01023-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022]
Abstract
Within the last decades, plant-based diets have received increasing interest for their potential benefits to human and environmental health. The concept of plant-based diet, however, varies widely in its definition. Current definitions range from the exclusion of all animal products to diets that include meat, fish, and dairy in varying quantities. Therefore, the main objectives of this review were twofold: (a) to investigate how researchers use the term plant-based diet in nutrition intervention studies and (b) what types of food a plant-based diet may include. Searching two databases, we found that the term "plant-based diet" evokes varying ideas to researchers and clinicians. Fifty percent of the retrieved studies that included a plant-based dietary intervention completely proscribed animal products and used the term plant-based diet interchangeably with a vegan diet. In contrast, an ~33% of trials included dairy products and 20% of dietary interventions emphasized a semi-vegetarian dietary pattern. Based on specific examples, we point out how the usage of the umbrella term "plant-based diet" may cause significant ambiguity. We often encountered incomplete descriptions of plant-based dietary interventions, which makes comparison and reproducibility of studies difficult. As a consequence, we urge others to use the term "plant-based diet" only in conjunction with a detailed dietary description. To facilitate this process, we provide a template of a standardized plant-based intervention reporting checklist. Finally, the present review also highlights the urgent need for a consensus definition of the term plant-based diet and its content.
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Affiliation(s)
- Maximilian Andreas Storz
- Center for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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23
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Block KI, Gyllenhaal C, Grutsch JF, Block PB, Kazlausky T, Blask D, Carome E, Reynolds J, Huff DFQ, Hrushesky W. Advanced cancer patients in a randomized clinical trial of night-simulating eyeglasses observed to have a normal 24-h circadian rhythm during chemotherapy. SAGE Open Med 2022; 10:20503121221100137. [PMID: 35646366 PMCID: PMC9134428 DOI: 10.1177/20503121221100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: Cancer patients routinely exhibit dysfunctional circadian organization.
Indeed, a dysfunctional circadian organization is a hallmark of advanced
cancer. A cohort of advanced cancer patients undergoing chemotherapy was
recruited to investigate whether manipulating exposure to blue light could
restore or ameliorate their circadian organization. Methods: Thirty advanced metastatic cancer patients participated in a randomized
crossover trial to evaluate whether blue light-blocking night-simulating
eyeglasses could ameliorate a disrupted circadian organization better than
sham eyeglasses. Circadian organization was evaluated by actigraphy and
patients’ self-reports of sleep, fatigue, and quality of life.
Kruskal–Wallis tests compared patients’ outcomes in circadian organization
with a cohort of non-cancer, disease-free individuals with normal sleep as a
negative control, and with advanced cancer patients with disrupted circadian
organization as a positive control. Quality-of-life outcomes of the patients
were compared with population-based controls (negative controls) and with
cohorts of advanced cancer patients (positive controls). Results: Actigraphy measurements, self-reported sleep, fatigue levels, and
quality-of-life outcomes of trial participants were similar to those of
negative controls with a normal circadian organization, in spite of the
trial patients’ concurrent chemotherapy. Night-simulating glasses did not
improve circadian organization. The 24-h correlation of day-to-day rhythms
of rest and activity was 0.455 for the experimental eyeglasses and 0.476 for
the sham eyeglasses (p = 0.258). Actigraphic and
patient-reported outcomes compared favorably to outcomes of positive
controls. Conclusion: The circadian organization of patients in this study unexpectedly resembled
that of healthy controls and was better than comparison populations with
disrupted circadian organization. The study clinic implements
chronomodulated chemotherapy and a systematic, supportive integrative
treatment protocol. Results suggest a need for further research on
interventions for circadian rhythm. Although the study intervention did not
benefit the participants, this work highlights the value of supporting
circadian time structure in advanced cancer patients.
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Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Charlotte Gyllenhaal
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | | | - Penny B Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
| | | | - David Blask
- Tulane Cancer Center and Louisiana Cancer Research Consortium, Tulane Center for Circadian Biology, Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Justin Reynolds
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
- Wellmont Cancer Institute, Bristol, TN, USA
| | | | - William Hrushesky
- Rhythmalytics, LLC, Columbia, SC, USA
- Ambulatory Monitoring, Inc., Ardsley, NY, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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24
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Emery A, Moore S, Turner JE, Campbell JP. Reframing How Physical Activity Reduces The Incidence of Clinically-Diagnosed Cancers: Appraising Exercise-Induced Immuno-Modulation As An Integral Mechanism. Front Oncol 2022; 12:788113. [PMID: 35359426 PMCID: PMC8964011 DOI: 10.3389/fonc.2022.788113] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2022] [Indexed: 12/13/2022] Open
Abstract
Undertaking a high volume of physical activity is associated with reduced risk of a broad range of clinically diagnosed cancers. These findings, which imply that physical activity induces physiological changes that avert or suppress neoplastic activity, are supported by preclinical intervention studies in rodents demonstrating that structured regular exercise commonly represses tumour growth. In Part 1 of this review, we summarise epidemiology and preclinical evidence linking physical activity or regular structured exercise with reduced cancer risk or tumour growth. Despite abundant evidence that physical activity commonly exerts anti-cancer effects, the mechanism(s)-of-action responsible for these beneficial outcomes is undefined and remains subject to ongoing speculation. In Part 2, we outline why altered immune regulation from physical activity - specifically to T cells - is likely an integral mechanism. We do this by first explaining how physical activity appears to modulate the cancer immunoediting process. In doing so, we highlight that augmented elimination of immunogenic cancer cells predominantly leads to the containment of cancers in a 'precancerous' or 'covert' equilibrium state, thus reducing the incidence of clinically diagnosed cancers among physically active individuals. In seeking to understand how physical activity might augment T cell function to avert cancer outgrowth, in Part 3 we appraise how physical activity affects the determinants of a successful T cell response against immunogenic cancer cells. Using the cancer immunogram as a basis for this evaluation, we assess the effects of physical activity on: (i) general T cell status in blood, (ii) T cell infiltration to tissues, (iii) presence of immune checkpoints associated with T cell exhaustion and anergy, (iv) presence of inflammatory inhibitors of T cells and (v) presence of metabolic inhibitors of T cells. The extent to which physical activity alters these determinants to reduce the risk of clinically diagnosed cancers - and whether physical activity changes these determinants in an interconnected or unrelated manner - is unresolved. Accordingly, we analyse how physical activity might alter each determinant, and we show how these changes may interconnect to explain how physical activity alters T cell regulation to prevent cancer outgrowth.
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Affiliation(s)
- Annabelle Emery
- Department for Health, University of Bath, Bath, United Kingdom
| | - Sally Moore
- Department of Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - James E Turner
- Department for Health, University of Bath, Bath, United Kingdom
| | - John P Campbell
- Department for Health, University of Bath, Bath, United Kingdom
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25
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Prostate cancer management with lifestyle intervention: From knowledge graph to Chatbot. CLINICAL AND TRANSLATIONAL DISCOVERY 2022. [DOI: 10.1002/ctd2.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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26
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More evidence that physical activity is beneficial for prostate cancer. Prostate Cancer Prostatic Dis 2022; 25:383-384. [PMID: 35181745 DOI: 10.1038/s41391-022-00509-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/08/2022]
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27
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Ide H, Tsukada S, Asakura H, Hattori A, Sakamaki K, Lu Y, Okada H, Maeda-Yamamoto M, Horie S. A Japanese Box Lunch Bento Comprising Functional Foods Reduce Oxidative Stress in Men: A Pilot Study. Am J Mens Health 2022; 16:15579883221075498. [PMID: 35135369 PMCID: PMC8832604 DOI: 10.1177/15579883221075498] [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] [Indexed: 11/16/2022] Open
Abstract
The elder population has increased, introducing the profound medical and social challenge of maintaining health in aging seniors and the need for a medical approach to sustaining physical and mental health. The relationship between diseases and lifestyle-related factors such as diet and exercise are important. A health-conscious lifestyle improves one's health condition from a medical perspective, as indicated by new wellness monitoring using health devices and recent research into the efficacy of functional lunches incorporating utilitarian agricultural, forestry, and fishery products and foods. For a period of 3 months, and solely at lunchtime, 21 participants consumed the contents of a bento (Japanese box lunch), which incorporated functional (healthy) foods. A variety of factors were analyzed, including: weight, weight fluctuation rate, abdominal girth, triglycerides, total cholesterol value, and 8-OHdG (8-hydroxy-2'-deoxyguanosine). The bento comprising functional foods resulted in a reduction in both weight and abdominal girth without calorie restrictions. A reduction over time was observed in 8-OHdG, an oxidative stress marker, as compared to values prior to initiation of the study. Usage of a health device, exercise/dietary advice from a physician and nutritionist, and the availability of meals incorporating functional agricultural products might help prevent lifestyle disease and lead to improved health management.
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Affiliation(s)
- Hisamitsu Ide
- Department of Urology, Saitama Medical Center, Dokkyo Medical University, Saitama, Japan
| | | | - Hitomi Asakura
- Department of Nutrition, Teikyo University Hospital, Tokyo, Japan
| | - Ayaka Hattori
- Department of Nutrition, Teikyo University Hospital, Tokyo, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Yan Lu
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Okada
- Department of Urology, Saitama Medical Center, Dokkyo Medical University, Saitama, Japan
| | - Mari Maeda-Yamamoto
- Institute of Food Research, National Agriculture and Food Research Organization, Tsukuba, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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28
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Laser Ablation ICP-MS Analysis of Chemically Different Regions of Rat Prostate Gland with Implanted Cancer Cells. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The comparison of tissues analyzed by LA-ICP-MS is challenging in many aspects, both medical and mathematical. The concept of distinguishing regions of interest (ROIs) was proposed in the literature, allowing for data reduction and targeted comparative analysis. ROIs can be drawn before any analysis, by indicating the anatomical parts of tissue, or after the first step of analysis, by using elemental distribution maps and characteristic regions of enrichment in selected elements. A simple method for identifying different regions, without the manual extraction of image fragments, is highly needed in biological experiments, where large groups of individuals (with samples taken from each of them) is very common. In the present study, two ROIs were distinguished: (1) tissue-rich in fat (and tissue-poor in water); and (2) tissue-rich in water (and tissue-poor in fat). ROIs were extracted mathematically, using an algorithm based on the relationship between 13C and 23Na signal intensities. A cut-off point was indicated in the point of the simultaneous decrease in 13C and increase in 23Na signal intensity. Separate analyses of chemically different ROIs allow for targeted comparison, which is a great advantage of laser ablation over liquid introductions to ICP-MS. In the present experiment, tissues were provided from animals with implanted prostate cancer cells as well as supplemented with mineral compounds particularly important both for prostate gland functions (Zn and Se) and neoplastic processes (Ca, Fe, and Cu). One of the goals was to try to determine whether dietary supplementation qualitatively and quantitatively affects the mineral composition of the prostate gland.
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29
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Kucuk O. EDITORIAL COMMENT. Urology 2021; 156:209-210. [PMID: 34758559 DOI: 10.1016/j.urology.2021.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Omer Kucuk
- Departments of Hematology-Oncology and Urology, Winship Cancer Institute, and Integrative Health and Medicine Center, Emory University, Atlanta, GA
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30
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Freeman KJ, Grega ML, Friedman SM, Patel PM, Stout RW, Campbell TM, Tollefson ML, Lianov LS, Pauly KR, Pollard KJ, Karlsen MC. Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111632. [PMID: 34770148 PMCID: PMC8583485 DOI: 10.3390/ijerph182111632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/18/2022]
Abstract
Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, LM practitioners have found reimbursement challenging. The objectives of this paper are to present the results of a cross-sectional survey of LM practitioners regarding lifestyle medicine reimbursement and to propose policy priorities related to the ability of practitioners to implement and achieve reimbursement for these necessary services. Results from a closed, online survey in 2019 were analyzed, with a total of n = 857 included in this analysis. Results were descriptively analyzed. This manuscript articulates policy proposals informed by the survey results. The study sample was 58% female, with median age of 51. A minority of the sample (17%) reported that all their practice was LM, while 56% reported that some of their practice was LM. A total of 55% of practitioners reported not being able to receive reimbursement for LM practice. Of those survey respondents who provided an answer to the question of what would make the practice of LM easier (n = 471), the following suggestions were offered: reimbursement overall (18%), reimbursement for more time spent with patients (17%), more support from leadership (16%), policy measures to incentivize health (13%), education in LM for practitioners (11%), LM-specific billing codes and billing knowledge along with better electronic medical record (EMR) capabilities and streamlined reporting/paperwork (11%), and reimbursement for the extended care team (10%). Proposed policy changes focus on three areas of focus: (1) support for the care process using a LM approach, (2) reimbursement emphasizing outcomes of health, patient experience, and delivering person-centered care, and (3) incentivizing treatment that produces disease remission/reversal. Rectifying reimbursement barriers to lifestyle medicine practice will require a sustained effort from health systems and policy makers. The urgency of this transition towards lifestyle medicine interventions to effectively address the epidemic of chronic diseases in a way that can significantly improve outcomes is being hindered by current reimbursement policies and models.
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Affiliation(s)
- Kelly J. Freeman
- Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
- Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA
- Correspondence:
| | - Meagan L. Grega
- Department of Lifestyle Medicine, Kellyn Foundation, Tatamy, PA 18015, USA;
| | - Susan M. Friedman
- School of Medicine and Dentistry, Department of Medicine, University of Rochester, Rochester, NY 14642, USA;
| | - Padmaja M. Patel
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (P.M.P.); (L.S.L.)
- Lifestyle Medicine Center, Midland Health, Midland, TX 79703, USA
| | - Ron W. Stout
- Ardmore Institute of Health, Ardmore, OK 73401, USA;
| | - Thomas M. Campbell
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Michelle L. Tollefson
- Department of Health Professions, Lifestyle Medicine Program, Metropolitan State University of Denver, Denver, CO 80204, USA;
| | - Liana S. Lianov
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (P.M.P.); (L.S.L.)
- Global Positive Health Institute, Sacramento, CA 95825, USA
| | - Kaitlyn R. Pauly
- Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
| | - Kathryn J. Pollard
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.J.P.); (M.C.K.)
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.J.P.); (M.C.K.)
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García-Perdomo HA, Gómez-Ospina JC, Chaves-Medina MJ, Sierra JM, Gómez AMA, Rivas JG. Impact of lifestyle in prostate cancer patients. What should we do? Int Braz J Urol 2021; 48:244-262. [PMID: 34472770 PMCID: PMC8932020 DOI: 10.1590/s1677-5538.ibju.2021.0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: This review aimed to analyze interventions raised within primary and tertiary prevention concerning the disease's incidence, progression, and recurrence of Prostate Cancer (PCa). Priority was given to the multidisciplinary approach of PCa patients with an emphasis on modifiable risk factors. Materials and Methods: We conducted a comprehensive literature review in the following databases: Embase, Central, and Medline. We included the most recent evidence assessing cohort studies, case-control studies, clinical trials, and systematic reviews published in the last five years. We only included studies in adults and in vitro or cell culture studies. The review was limited to English and Spanish articles. Results: Preventive interventions at all levels are the cornerstone of adherence to disease treatment and progression avoidance. The relationship in terms of healthy lifestyles is related to greater survival. The risk of developing cancer is associated to different eating habits, determined by geographic variations, possibly related to different genetic susceptibilities. Discussion: PCa is the second most common cancer in men, representing a leading cause of death among men in Latin America. Prevention strategies and healthy lifestyles are associated with higher survival rates in PCa patients. Also, screening for anxiety and the presence of symptoms related to mood disorders is essential in the patient's follow-up concerning their perception of the condition.
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Affiliation(s)
- Herney Andrés García-Perdomo
- Division of Urology/Uroooncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia.,UROGIV Research Group, School of Medicine, Universidad Del Valle, Cali, Colombia
| | | | | | | | | | - Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
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Hirano H, Ide H, Lu Y, Inoue Y, Okada H, Horie S. Impact of Pretreatment Total Cholesterol Level Is Associated With Metastasis of Prostate Cancer. Am J Mens Health 2021; 14:1557988320918788. [PMID: 32349610 PMCID: PMC7233000 DOI: 10.1177/1557988320918788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Metabolic syndrome is reported to play a role in the genesis and development not
only of angina, arteriosclerosis, diabetes, and osteoporosis but also of
prostate cancer. Hypercholesterolemia is a strong risk factor in prostate cancer
development. The current study was conducted to analyze whether pretreatment
serum levels of cholesterol correlate with prostate cancer metastasis. Three
hundred fifty-one subjects who received a histopathological diagnosis of
prostate cancer were evaluated by clinical factors such as age, body mass index
(BMI), disease stage, Gleason score, prostate-specific antigen (PSA), total
cholesterol, Luteinizing hormone (LH), testosterone, and free testosterone. A
multivariate analysis was performed on these factors, and a statistically
significant difference was identified in total cholesterol level
(p =.01) and PSA (p < .001). The total
cholesterol level was higher in cases of metastatic prostate cancer compared to
nonmetastatic prostate cancer in this study and therefore may be a predictive
factor for poor prognosis.
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Affiliation(s)
- Hisashi Hirano
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yan Lu
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yasuyuki Inoue
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Hiroshi Okada
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Brassetti A, Ferriero M, Napodano G, Sanseverino R, Badenchini F, Tuderti G, Anceschi U, Bove A, Misuraca L, Mastroianni R, Proietti F, Gallucci M, Simone G. Physical activity decreases the risk of cancer reclassification in patients on active surveillance: a multicenter retrospective study. Prostate Cancer Prostatic Dis 2021; 24:1151-1157. [PMID: 34007014 DOI: 10.1038/s41391-021-00375-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Physical activity (PA) is associated with favorable outcomes in prostate cancer (PCa) patients. We assessed its effect on the risk of PCa reclassification (PCaR) during active surveillance. METHODS Anthropometric, demographic, and clinical data concerning men diagnosed with a low-risk PCa and initially managed with active surveillance at the two participating institutions were retrospectively collected. The Physical Activity Scale for the Elderly (PASE) was used for patients' self-assessment of their daily exercise and their consequent stratification into three groups: sedentary (PASE ≤ 65), moderately active (65 < PASE < 125), active (PASE ≥ 125). Kaplan-Meier model was used to evaluate the predictive role of PA on PCaR, computed at 2, 5, 10 years after diagnosis; differences between lifestyle groups were assessed using the log-rank and uni-/multivariable Cox analyses applied to identify predictors of reclassification. RESULTS Eighty-five patients were included in the analysis, with a median age of 66 years (IQR: 59-70); 16% were active, 45% were former smokers, and 3 presented with metabolic syndrome (MetS). Prostate-specific antigen (PSA) density was 0.12 (IQR: 0.07-0.15); 34 men showed a PSA doubling time <10 years. The Median PASE score was 86 (IQR: 61.5-115.8): 24 patients were sedentary, 46 moderately active, and 15 active. At a median follow-up of 37 months (IQR: 14-53), 25% of patients experienced PCaR. These were less physically active (PASE score 69.3 vs 87.8; p = 0.056) and presented with significantly smaller prostates (46 ml vs 50.7 ml; p = 0.001) and a higher PSAD (0.14 vs 0.10; p = 0.019). At 2 years, the risk of reclassification was 25 ± 5%, while it was 38 ± 7% at both 5 and 10 years. The risk was significantly different in the three PA groups (Log Rank p = 0.033). PASE score was the only independent predictor of PCaR (HR: 0.987; 95%CI: 0.977-0.998; p = 0.016). CONCLUSIONS PA influences PCa evolution, as increasing levels are associated with a significantly reduced risk of tumor reclassification among patients undergoing active surveillance.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
| | | | - Giorgio Napodano
- Department of Urology, "Umberto I" Hospital, Nocera Inferiore, Italy
| | | | - Fabio Badenchini
- Department of Urology, Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Flavia Proietti
- Department of Urology, "Sapienza" University of Rome, Rome, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.,Department of Urology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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Gregg JR, Zhang X, Chapin B, Ward J, Kim J, Davis J, Daniel CR. Adherence to the Mediterranean diet and grade group progression in localized prostate cancer: An active surveillance cohort. Cancer 2021; 127:720-728. [PMID: 33411364 PMCID: PMC9810094 DOI: 10.1002/cncr.33182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/23/2020] [Accepted: 07/23/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The Mediterranean diet (MD) may be beneficial for men with localized prostate cancer (PCa) on active surveillance (AS) because of its anti-inflammatory, antilipidemic, and chemopreventive properties. This study prospectively investigated adherence to the MD with Gleason score progression and explored associations by diabetes status, statin use, and other factors. METHODS Men with newly diagnosed PCa on an AS protocol (n = 410) completed a baseline food frequency questionnaire, and the MD score was calculated across 9 energy-adjusted food groups. Cox proportional hazards models were fit to evaluate multivariable-adjusted associations of the MD score with progression-free survival; progression was defined as an increase in the Gleason grade group (GG) score over a biennial monitoring regimen. RESULTS In this cohort, 15% of the men were diabetic, 44% of the men used statins, and 76 men progressed (median follow-up, 36 months). After adjustments for clinical factors, higher adherence to the MD was associated with a lower risk of GG progression among all men (hazard ratio [HR] per 1-unit increase in MD score, 0.88; 95% confidence interval [CI], 0.77-1.01), non-White men (HR per 1-unit increase in MD score, 0.64; 95% CI, 0.45-0.92; P for interaction = .07), and men without diabetes (HR per 1-unit increase in MD score, 0.82; 95% CI, 0.71-0.96; P for interaction = .03). When joint effects of the MD score and statin use were examined, a similar risk reduction was observed among men with high MD scores who did not use statins in comparison with men with low/moderate MD scores with no statin use. CONCLUSIONS The MD is associated with a lower risk of GG progression in men on AS, and this is consistent with prior reports about the MD and reduced cancer morbidity and mortality.
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Affiliation(s)
- Justin R. Gregg
- University of Texas MD Anderson Cancer Center, Houston, TX,Joint Corresponding authors: Justin R. Gregg, MD, Mailing address: 1155 Pressler Street, Unit 1373, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, , Phone: 713-563-1432, Fax: 713-794-4824, Carrie R. Daniel, PhD, Mailing address: 1155 Pressler Street, Unit 1340, Room CPB4.3241, Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, , Phone: 713-563-5783, Fax: 713-563-1367
| | - Xiaotao Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian Chapin
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jeri Kim
- Merck & Co., Inc. Kenilworth, NJ
| | - John Davis
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carrie R. Daniel
- University of Texas MD Anderson Cancer Center, Houston, TX,Joint Corresponding authors: Justin R. Gregg, MD, Mailing address: 1155 Pressler Street, Unit 1373, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, , Phone: 713-563-1432, Fax: 713-794-4824, Carrie R. Daniel, PhD, Mailing address: 1155 Pressler Street, Unit 1340, Room CPB4.3241, Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, , Phone: 713-563-5783, Fax: 713-563-1367
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Rees K, Al-Khudairy L, Takeda A, Stranges S. Vegan dietary pattern for the primary and secondary prevention of cardiovascular diseases. Cochrane Database Syst Rev 2021; 2:CD013501. [PMID: 33629376 PMCID: PMC8092640 DOI: 10.1002/14651858.cd013501.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diet plays a major role in the aetiology of cardiovascular disease (CVD) and as a modifiable risk factor is the focus of many prevention strategies. Recently vegan diets have gained popularity and there is a need to synthesise existing clinical trial evidence for their potential in CVD prevention. OBJECTIVES To determine the effectiveness of following a vegan dietary pattern for the primary and secondary prevention of CVD. SEARCH METHODS We searched the following electronic databases on 4 February 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Web of Science Core Collection. We also searched ClinicalTrials.gov in January 2021. We applied no language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) in healthy adults and adults at high risk of CVD (primary prevention) and those with established CVD (secondary prevention). A vegan dietary pattern excludes meat, fish, eggs, dairy and honey; the intervention could be dietary advice, provision of relevant foods, or both. The comparison group received either no intervention, minimal intervention, or another dietary intervention. Outcomes included clinical events and CVD risk factors. We included only studies with follow-up periods of 12 weeks or more, defined as the intervention period plus post-intervention follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data and assessed risks of bias. We used GRADE to assess the certainty of the evidence. We conducted three main comparisons: 1. Vegan dietary intervention versus no intervention or minimal intervention for primary prevention; 2. Vegan dietary intervention versus another dietary intervention for primary prevention; 3. Vegan dietary intervention versus another dietary intervention for secondary prevention. MAIN RESULTS Thirteen RCTs (38 papers, 7 trial registrations) and eight ongoing trials met our inclusion criteria. Most trials contributed to primary prevention: comparisons 1 (four trials, 466 participants randomised) and comparison 2 (eight trials, 409 participants randomised). We included only one secondary prevention trial for comparison 3 (63 participants randomised). None of the trials reported on clinical endpoints. Other primary outcomes included lipid levels and blood pressure. For comparison 1 there was moderate-certainty evidence from four trials with 449 participants that a vegan diet probably led to a small reduction in total cholesterol (mean difference (MD) -0.24 mmol/L, 95% confidence interval (CI) -0.36 to -0.12) and low-density lipoprotein (LDL) cholesterol (MD -0.22 mmol/L, 95% CI -0.32 to -0.11), a very small decrease in high-density lipoprotein (HDL) levels (MD -0.08 mmol/L, 95% CI -0.11 to -0.04) and a very small increase in triglyceride levels (MD 0.11 mmol/L, 95% CI 0.01 to 0.21). The very small changes in HDL and triglyceride levels are in the opposite direction to that expected. There was a lack of evidence for an effect with the vegan dietary intervention on systolic blood pressure (MD 0.94 mmHg, 95% CI -1.18 to 3.06; 3 trials, 374 participants) and diastolic blood pressure (MD -0.27 mmHg, 95% CI -1.67 to 1.12; 3 trials, 372 participants) (low-certainty evidence). For comparison 2 there was a lack of evidence for an effect of the vegan dietary intervention on total cholesterol levels (MD -0.04 mmol/L, 95% CI -0.28 to 0.20; 4 trials, 163 participants; low-certainty evidence). There was probably little or no effect of the vegan dietary intervention on LDL (MD -0.05 mmol/L, 95% CI -0.21 to 0.11; 4 trials, 244 participants) or HDL cholesterol levels (MD -0.01 mmol/L, 95% CI -0.08 to 0.05; 5 trials, 256 participants) or triglycerides (MD 0.21 mmol/L, 95% CI -0.07 to 0.49; 5 trials, 256 participants) compared to other dietary interventions (moderate-certainty evidence). We are very uncertain about any effect of the vegan dietary intervention on systolic blood pressure (MD 0.02 mmHg, 95% CI -3.59 to 3.62) or diastolic blood pressure (MD 0.63 mmHg, 95% CI -1.54 to 2.80; 5 trials, 247 participants (very low-certainty evidence)). Only one trial (63 participants) contributed to comparison 3, where there was a lack of evidence for an effect of the vegan dietary intervention on lipid levels or blood pressure compared to other dietary interventions (low- or very low-certainty evidence). Four trials reported on adverse events, which were absent or minor. AUTHORS' CONCLUSIONS Studies were generally small with few participants contributing to each comparison group. None of the included studies report on CVD clinical events. There is currently insufficient information to draw conclusions about the effects of vegan dietary interventions on CVD risk factors. The eight ongoing studies identified will add to the evidence base, with all eight reporting on primary prevention. There is a paucity of evidence for secondary prevention.
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Affiliation(s)
- Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrea Takeda
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Cho D, Basen-Engquist K, Acquati C, Ma H, Pettaway C, Li Y, Diep CS, McNeill LH. Study protocol: a lifestyle intervention for African American and Hispanic prostate cancer survivors on active surveillance and their partners. Pilot Feasibility Stud 2020; 6:111. [PMID: 32782817 PMCID: PMC7414583 DOI: 10.1186/s40814-020-00653-7] [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: 11/28/2018] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Prostate cancer is the most commonly diagnosed cancer in both African American and Hispanic men. Active surveillance is a treatment option for low- or very low-risk prostate cancer survivors, and lifestyle interventions have been found to reduce the disease progression and improve the quality of life for both survivors and their partners. To date, no lifestyle interventions that specifically target African American or Hispanic men and their partners exist. This protocol describes a study that tests the feasibility of a randomized controlled trial, a lifestyle intervention developed to enhance healthy lifestyle and quality of life among African American and Hispanic men on active surveillance and their partners. Methods A mixed-method study, including a two-arm randomized controlled trial (n = 30 dyads in the intervention arm and n = 10 dyads in the control arm) and in-depth interviews, will be conducted. Intervention arm participants will receive bi-weekly health coaching calls (a total of 12 calls based on Motivational Interviewing), as well as physical activity-specific (e.g., power point slides, print materials about physical activity, and activity trackers for self-monitoring) and nutrition-specific education (e.g., two nutrition counseling sessions from a registered dietitian, print materials about nutrition, and food intake recording for self-monitoring) over 6 months. All participants will be assessed at baseline, month 3, and month 6. Blood will be collected at baseline and month 6 from the prostate cancer survivors. Finally, in-depth interviews will be conducted with subsamples (up to n = 15 dyads in the intervention arm and up to n = 5 dyads in the control arm) at baseline and months 3 and 6 to conduct a process evaluation and further refine the intervention. Discussion If effective, the intervention may have a higher health impact compared with a typical lifestyle intervention targeting only survivors (or partners), as it improves both survivors’ (tertiary prevention) and partners’ health (primary prevention). Results from this study will provide important information regarding recruiting racial/ethnic minority cancer survivors and their partners. Lessons learned from this study will be used to apply for a large-scale grant to test the impact of the dyadic intervention in a fully powered sample. Trial registration ClinicalTrials.gov (NCT No. 03575832) registered on 3 July 2018.
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Affiliation(s)
- Dalnim Cho
- Department of Health Disparities Research, UT Texas MD Anderson Cancer Center, 1400 Pressler St, 9th floor, Houston, TX 77030 USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, UT Texas MD Anderson Cancer Center, Houston, TX USA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX USA
| | - Hilary Ma
- Department of General Oncology, UT Texas MD Anderson Cancer Center, Houston, TX USA
| | - Curtis Pettaway
- Department of Urology, UT Texas MD Anderson Cancer Center, Houston, TX USA
| | - Yisheng Li
- Department of Biostatistics, UT Texas MD Anderson Cancer Center, Houston, TX USA
| | | | - Lorna H McNeill
- Department of Health Disparities Research, UT Texas MD Anderson Cancer Center, 1400 Pressler St, 9th floor, Houston, TX 77030 USA
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Optimizing psychosocial support in prostate cancer patients during active surveillance. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Chemopreventive effects of nanoparticle curcumin in a mouse model of Pten-deficient prostate cancer. Hum Cell 2020; 33:730-736. [PMID: 32146706 DOI: 10.1007/s13577-020-00337-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/21/2020] [Indexed: 01/12/2023]
Abstract
The present study investigated the antitumor activity and chemopreventive effects of a nanoparticle formulation of curcumin in preclinical models of mouse Pten-deficient prostate cancer. The antitumor activity of the nanoparticle curcumin was evaluated in mouse castration-naïve (7113-D3) and castration-resistant prostate cancer (2945-E10) derived cell lines in vitro. Cell viability was reduced in both cell lines in a dose and time-dependent manner. The effects of long-term dietary supplementation with the nanoparticle curcumin formulation were evaluated in a conditional Pten-deficient mouse model. Prostate tissues from Pten-deficient prostate cancers were obtained after sixteen weeks of dietary supplementation of 76 mg/kg/day or 380 mg/kg/day nanoparticle curcumin. Daily supplementation of nanoparticle curcumin did not affect mouse bodyweights or spleen size but did result in enlargement of the liver. Dietary supplementation did not influence tumor burden, however, mice fed high-dose curcumin had lower cancer cell proliferation rates at 12 and 16 weeks of age. Together, these results show that daily supplementation of a nanoparticle formulation of curcumin is tolerable and suggest that curcumin could have chemopreventive activity in early-stage prostate cancer.
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Parsons JK, Zahrieh D, Mohler JL, Paskett E, Hansel DE, Kibel AS, Liu H, Seisler DK, Natarajan L, White M, Hahn O, Taylor J, Hartman SJ, Stroup SP, Van Veldhuizen P, Hall L, Small EJ, Morris MJ, Pierce JP, Marshall J. Effect of a Behavioral Intervention to Increase Vegetable Consumption on Cancer Progression Among Men With Early-Stage Prostate Cancer: The MEAL Randomized Clinical Trial. JAMA 2020; 323:140-148. [PMID: 31935026 PMCID: PMC6990696 DOI: 10.1001/jama.2019.20207] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Guidelines endorsing vegetable-enriched diets to improve outcomes for prostate cancer survivors are based on expert opinion, preclinical studies, and observational data. OBJECTIVE To determine the effect of a behavioral intervention that increased vegetable intake on cancer progression in men with early-stage prostate cancer. DESIGN, SETTING, AND PARTICIPANTS The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) was a randomized clinical trial conducted at 91 US urology and medical oncology clinics that enrolled 478 men aged 50 to 80 years with biopsy-proven prostate adenocarcinoma (International Society of Urological Pathology grade group = 1 in those <70 years and ≤2 in those ≥70 years), stage cT2a or less, and serum prostate-specific antigen (PSA) level less than 10 ng/mL. Enrollment occurred from January 2011 to August 2015; 24-month follow-up occurred from January 2013 to August 2017. INTERVENTIONS Patients were randomized to a counseling behavioral intervention by telephone promoting consumption of 7 or more daily vegetable servings (MEAL intervention; n = 237) or a control group, which received written information about diet and prostate cancer (n = 241). MAIN OUTCOMES AND MEASURES The primary outcome was time to progression; progression was defined as PSA level of 10 ng/mL or greater, PSA doubling time of less than 3 years, or upgrading (defined as increase in tumor volume or grade) on follow-up prostate biopsy. RESULTS Among 478 patients randomized (mean [SD] age, 64 [7] years; mean [SD] PSA level, 4.9 [2.1] ng/mL), 443 eligible patients (93%) were included in the primary analysis. There were 245 progression events (intervention: 124; control: 121). There were no significant differences in time to progression (unadjusted hazards ratio, 0.96 [95% CI, 0.75 to 1.24]; adjusted hazard ratio, 0.97 [95% CI, 0.76 to 1.25]). The 24-month Kaplan-Meier progression-free percentages were 43.5% [95% CI, 36.5% to 50.6%] and 41.4% [95% CI, 34.3% to 48.7%] for the intervention and control groups, respectively (difference, 2.1% [95% CI, -8.1% to 12.2%]). CONCLUSIONS AND RELEVANCE Among men with early-stage prostate cancer managed with active surveillance, a behavioral intervention that increased vegetable consumption did not significantly reduce the risk of prostate cancer progression. The findings do not support use of this intervention to decrease prostate cancer progression in this population, although the study may have been underpowered to identify a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01238172.
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Affiliation(s)
- J. Kellogg Parsons
- Department of Urology, UC San Diego Moores Comprehensive Cancer Center and VA San Diego Healthcare System, La Jolla, California
| | - David Zahrieh
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - James L. Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Electra Paskett
- Comprehensive Cancer Center, Department of Medicine, The Ohio State University College of Medicine, Columbus
| | - Donna E. Hansel
- Department of Pathology, University of California, San Diego, La Jolla
| | - Adam S. Kibel
- Division of Urology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Drew K. Seisler
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Loki Natarajan
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health and UC San Diego Moores Comprehensive Cancer Center, La Jolla, California
| | - Martha White
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health and UC San Diego Moores Comprehensive Cancer Center, La Jolla, California
| | - Olwen Hahn
- Alliance Central Protocol Operations, University of Chicago, Chicago, Illinois
| | - John Taylor
- Alliance Central Protocol Operations, University of Chicago, Chicago, Illinois
| | - Sheri J. Hartman
- Moores Cancer Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Sean P. Stroup
- Department of Urology, Naval Medical Center San Diego, San Diego, California
| | | | - Lannis Hall
- Siteman Cancer Center, Department of Radiation Oncology, Washington University, St Peters, Missouri
| | - Eric J. Small
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | - John P. Pierce
- Moores Cancer Center, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - James Marshall
- Department of Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Patel A, Schofield G, Keogh J. Influences on health-care practitioners' promotion of physical activity to their patients with prostate cancer: a qualitative study. J Prim Health Care 2019; 10:31-38. [PMID: 30068449 DOI: 10.1071/hc17036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Physical activity is beneficial for the physical and psychological health of patients with prostate cancer (PCa). Health-care practitioners are ideally positioned to promote physical activity to their patients. AIM To identify factors that influenced health care practitioners to either promote or not promote physical activity to their patients with PCa. METHODS Individual interviews were conducted with 16 Auckland-based health-care practitioners, including specialists (oncologists and urologists), physiotherapists and complementary and alternative (acupuncturists) health-care practitioners. Data were analysed using an inductive thematic approach. RESULTS Treatment-related factors (ie counteracting side-effects of hormone suppression treatment), longer life expectancy and risk factors for other conditions appeared to influence the promotion of physical activity to patients. Time constraints of consultations and complex medical issues were barriers to the promotion of physical activity. CONCLUSIONS This study found that a variety of health-care practitioners are providing some degree of physical activity advice to their patients with PCa. Collaborative practice among health-care practitioners to verbally reinforce the benefits of physical activity, coupled with referral to experts in physical activity promotion/rehabilitation (such as physiotherapists), should be encouraged for best practice care.
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Affiliation(s)
- Asmita Patel
- School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Grant Schofield
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Justin Keogh
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Cuthbert CA, Farragher JF, Hemmelgarn BR, Ding Q, McKinnon GP, Cheung WY. Self‐management interventions for cancer survivors: A systematic review and evaluation of intervention content and theories. Psychooncology 2019; 28:2119-2140. [DOI: 10.1002/pon.5215] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/18/2019] [Accepted: 08/21/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Colleen A. Cuthbert
- Department of Oncology, Cumming School of MedicineUniversity of Calgary Calgary Alberta Canada
| | - Janine F. Farragher
- Department of Community Health SciencesUniversity of Calgary Calgary Alberta Canada
| | - Brenda R. Hemmelgarn
- Department of Community Health SciencesUniversity of Calgary Calgary Alberta Canada
- Department of MedicineUniversity of Calgary Calgary Alberta Canada
| | - Qirui Ding
- Department of Molecular Genetics, Faculty of MedicineUniversity of Toronto Toronto Ontario Canada
| | - Geoffrey P. McKinnon
- Department of Oncology, Cumming School of MedicineUniversity of Calgary Calgary Alberta Canada
| | - Winson Y. Cheung
- Department of Oncology, Cumming School of MedicineUniversity of Calgary Calgary Alberta Canada
- Alberta Health Services Cancer ControlTom Baker Cancer Center Calgary Alberta Canada
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Jagielska A, Ruszczyńska A, Wagner B, Bulska E, Skrajnowska D, Bobrowska-Korczak B. ICP-MS analysis of diet supplementation influence on the elemental content of rat prostate gland. MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-02473-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kang DW, Fairey AS, Boulé NG, Field CJ, Courneya KS. Exercise duRing Active Surveillance for prostatE cancer-the ERASE trial: a study protocol of a phase II randomised controlled trial. BMJ Open 2019; 9:e026438. [PMID: 31278095 PMCID: PMC6615898 DOI: 10.1136/bmjopen-2018-026438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) is the preferred primary treatment strategy for men with low-risk clinically localised prostate cancer (PCa); however, the majority of these men still receive radical treatment within 10 years due to disease progression and/or fear of cancer progression. Interventions designed to suppress tumour growth, mitigate fear of cancer progression and precondition men for impending radical treatments are an unmet clinical need. Exercise has been shown to delay the progression of prostate tumours in animal models, improve physical and functional health and manage psychological outcomes in cancer patients; however, these outcomes have not been demonstrated in PCa patients undergoing AS. METHODS AND ANALYSIS This phase II randomised controlled trial will randomise 66 men undergoing AS to either an exercise group or a usual care group. The exercise group will perform a 12-week, supervised, high-intensity interval training programme, consisting of 3 sessions/week for 28-40 min/session. The primary outcome will be cardiorespiratory fitness. Secondary outcomes will include immunosurveillance and cancer-related biomarkers, psychosocial outcomes including fear of cancer progression and quality of life and physical function. Exploratory outcomes will include clinical indicators of disease progression. The trial has 80% power to detect a significant between-group difference in VO2peak of 3.5 mL/kg/min with a two-tailed alpha level <0.05 and a 10% dropout rate. ETHICS AND DISSEMINATION The study has received full ethical approval from the Health Research Ethics Board of Alberta - Cancer Committee (Protocol Number: HREBA.CC-17-0248). The findings of the study will be disseminated through public and scientific channels. TRIAL REGISTRATION NUMBER NCT03203460; Pre-results.
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Affiliation(s)
- Dong-Woo Kang
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Adrian S Fairey
- Division of Urology, Department of Surgery, Facultyof Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
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Diet quality and Gleason grade progression among localised prostate cancer patients on active surveillance. Br J Cancer 2019; 120:466-471. [PMID: 30679782 PMCID: PMC6462004 DOI: 10.1038/s41416-019-0380-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/20/2018] [Accepted: 01/03/2019] [Indexed: 01/11/2023] Open
Abstract
Background High diet quality may support a metabolic and anti-inflammatory state less conducive to tumour progression. We prospectively investigated diet quality in relation to Gleason grade progression among localised prostate cancer patients on active surveillance, a clinical management strategy of disease monitoring and delayed intervention. Methods Men with newly diagnosed Gleason score 6 or 7 prostate cancer enroled on a biennial monitoring regimen. Patients completed a food frequency questionnaire (FFQ) at baseline (n = 411) and first 6-month follow-up (n = 263). Cox proportional hazards models were fitted to evaluate multivariable-adjusted associations of diet quality [defined via the Healthy Eating Index (HEI)-2015] with Gleason grade progression. Results After a median follow-up of 36 months, 76 men progressed. Following adjustment for clinicopathologic factors, we observed a suggestive inverse association between baseline diet quality and Gleason grade progression [hazard ratio (HR) and 95% confidence interval (CI) for the highest vs. the lowest HEI-2015 tertile: 0.59 (0.32–1.08); Ptrend = 0.06]. We observed no associations with diet quality at 6-month follow-up, nor change in diet quality from baseline. Conclusions In localised prostate cancer patients on surveillance, higher diet quality or conformance with United States dietary guidelines at enrolment may lower risk of Gleason grade progression, though additional confirmatory research is needed.
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Abstract
OBJECTIVES The mostly indolent natural history and long overall survival associated with a diagnosis of prostate cancer provides a unique opportunity for men to explore diet and lifestyle interventions to alter the trajectory of their disease. As many patients may be appropriate for postponing conventional therapy, the effects of various integrative interventions can be investigated. In addition, treatment of prostate cancer with surgery, radiation, or androgen deprivation therapy, all may produce physical or psychological side effects that could be amenable to complementary therapies. This article serves to review salient information in the published literature. DESIGN A review of published research was conducted. RESULTS A plant-based antioxidant-rich diet with an emphasis on cruciferous vegetables, tomatoes, soy, pomegranate, and marine omega 3 fatty acids while avoiding saturated fats, including dairy products is the best option. Supplementation with vitamin D3, omega 3, and some nutraceutical-based preparations may be advised. It is likely prudent to avoid vitamin E and selenium supplements. Physical activity has been shown to have multiple benefits in men diagnosed with all stages of prostate cancer from strengthening bones, improving body habitus, and enhancing overall wellbeing. Yoga, combining physical activity with a mind-body component, has been shown to have a salutogenic effect in both prostate cancer patients and their caregivers. Traditional Chinese Medicine may be particularly useful in managing side effects of conventional treatments, especially the hot flashes associated with androgen deprivation therapy. Although the long natural history, availability of a useful blood marker of disease progression and prolonged survival are overall positive features, they also combine to allow men to live for a long time with diagnosed cancer, fear of progression, or recurrence and fixation on changes in their prostate-specific antigen level. The resultant stress can be deleterious to general health as well as possibly the natural history of their disease. Mind-body interventions to reduce stress, including mindfulness-based stress reduction and support groups may be useful adjunctive therapies. CONCLUSION Men with prostate cancer may benefit from lifestyle and complementary interventions integrated with their conventional care.
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Affiliation(s)
- Donald I Abrams
- Division of Oncology, Department of Medicine, Zuckerberg San Francisco General Hospital and UCSF Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA
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Sweetnam C, Mocellin S, Krauthammer M, Knopf N, Baertsch R, Shrager J. Prototyping a precision oncology 3.0 rapid learning platform. BMC Bioinformatics 2018; 19:341. [PMID: 30257653 PMCID: PMC6158802 DOI: 10.1186/s12859-018-2374-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/17/2018] [Indexed: 11/21/2022] Open
Abstract
Background We describe a prototype implementation of a platform that could underlie a Precision Oncology Rapid Learning system. Results We describe the prototype platform, and examine some important issues and details. In the Appendix we provide a complete walk-through of the prototype platform. Conclusions The design choices made in this implementation rest upon ten constitutive hypotheses, which, taken together, define a particular view of how a rapid learning medical platform might be defined, organized, and implemented.
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Affiliation(s)
| | - Simone Mocellin
- Istituto Oncologico Veneto, IOV-IRCSS; and Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Michael Krauthammer
- Program for Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Nathaniel Knopf
- Cancer Commons, Los Altos, CA, USA.,EECS Department, MIT, Cambridge, MA, USA
| | | | - Jeff Shrager
- Cancer Commons, Los Altos, CA, USA. .,Symbolic Systems Program, Stanford University (Adjunct), Stanford, CA, USA.
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Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJC, Rosario DJ, Thaha MA, Bourke L. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2018; 9:CD010192. [PMID: 30229557 PMCID: PMC6513653 DOI: 10.1002/14651858.cd010192.pub3] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in the Cochrane Library 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. OBJECTIVES To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? SEARCH METHODS We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. MAIN RESULTS We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week).Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). AUTHORS' CONCLUSIONS Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population.
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Affiliation(s)
- Rebecca R Turner
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Liz Steed
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public HealthBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Helen Quirk
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Rosa U Greasley
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - John M Saxton
- Northumbria UniversityDepartment of Sport, Exercise, and RehabilitationNewcastle‐upon‐TyneUKNE1 8ST
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
| | - Derek J Rosario
- University of SheffieldDepartment of OncologyBeech Hill RoadRoyal Hallamshire HospitalSheffieldUKS010 2RX
| | - Mohamed A Thaha
- Barts & The London School of Medicine & Dentistry, Queen Mary University LondonAcademic Surgical Unit, National Centre for Bowel Research & Surgical Innovation, Centre for Digestive Diseases, Blizard Institute1st Floor, Abernethy Building, 2 Newark StreetThe Royal London Hospital, WhitechapelLondonEnglandUKE1 2AT
| | - Liam Bourke
- Sheffield Hallam UniversityHealth and Wellbeing Research InstituteSheffieldUKS10 2BP
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Golubić M, Schneeberger D, Kirkpatrick K, Bar J, Bernstein A, Weems F, Ehrman J, Perko J, Doyle J, Roizen M. Comprehensive Lifestyle Modification Intervention to Improve Chronic Disease Risk Factors and Quality of Life in Cancer Survivors. J Altern Complement Med 2018; 24:1085-1091. [PMID: 30067063 DOI: 10.1089/acm.2018.0193] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Healthy lifestyle modifications, including weight management, regular physical activity, prudent diet, and stress relief, have been identified as key components of tertiary cancer prevention. In this study, we evaluate the effectiveness of a comprehensive, lifestyle medicine intervention, Lifestyle 180®, on chronic disease risk factors and quality of life in cancer survivors. DESIGN Retrospective subgroup analysis of a clinical program. SETTINGS/LOCATION An outpatient medical facility. SUBJECTS Lifestyle 180 participants with a diagnosis of past cancer. INTERVENTION Sixty-four hours of intensive nutrition, culinary medicine, physical activity, and stress relief practices over a 6-month period, with 9- and 12-month follow-up. OUTCOME MEASURES Pre-postanalysis (baseline vs. 12 months) included biometrics: weight, body mass index (BMI), waist circumference, and blood pressure; standard laboratory tests: lipids, C-reactive protein, fasting insulin/glucose, and insulin resistance; and empirically validated questionnaires: perceived stress, depression, and quality of life. RESULTS Fifty-eight cancer survivors participated in Lifestyle 180. Average age was 63 years, roughly 75% of participants were female, and the greatest majority had a diagnosis of breast, prostate, or skin cancer. Diagnosis of hyperlipidemia, hypertension, diabetes, and prediabetes presented in 47%, 57%, 22%, and 50% of patients, respectively. Forty-five percent of patients were obese, 24% were overweight, and 16% were depressed. At 12 months, participants lost an average of 14 pounds (-6.6%, p < 0.001) and 2.6 inches off their waist (-5.9%, p < 0.001). BMI decreased significantly by an average of 2.4 kg/m2 (-6.8%, p < 0.001). Significant decreases from well-managed baseline levels also occurred in most measured biomarkers (average change: high-density lipoprotein +3.3 mg/dL, p < 0.05; triglycerides -23.0 mg/dL, p < 0.01; C-reactive protein -1.3 mg/L, p < 0.01; fasting insulin -4.2 μU/mL, p < 0.05; and homeostasis model assessment-insulin resistance -1.5, p < 0.01; n = 40). Changes in psychosocial variables included significant improvements in perceived stress (-20%, p < 0.01) and quality of life (+54%, p < 0.001). We were unable to detect a difference in depressive symptoms. CONCLUSIONS Cancer survivors participating in a comprehensive intervention could employ the prescribed lifestyle modifications to produce clinically relevant health and quality-of-life benefits. These data support the American Cancer Society (ACS) and American Society of Clinical Oncology (ASCO) recommendations to incorporate healthy lifestyle modifications into long-term cancer survivorship care.
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Affiliation(s)
- Mladen Golubić
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
| | | | - Kristin Kirkpatrick
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
| | - Judi Bar
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
| | | | | | - Jane Ehrman
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
| | - Jim Perko
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
| | - Jonathan Doyle
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
| | - Michael Roizen
- 1 Center for Integrative and Lifestyle Medicine, Wellness Institute, Cleveland Clinic , Lyndhurst, OH
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Abstract
PURPOSE OF REVIEW To review current evidence for prostate cancer prevention with nutrition, physical activity, and lifestyle interventions and identify future research directions. RECENT FINDINGS Multiple preclinical and observational studies have observed that diet, exercise, and lifestyle interventions may play a role in mitigating disease progression, mortality, and overall disease burden for high-grade and fatal prostate cancer. Increased vegetable and fruit intakes, decreased red meat and saturated fat intakes, and increased exercise are potentially associated with decreased risk of incident disease and increased progression-free, prostate cancer-specific, and overall survival. Randomized controlled trials (RCTs) have demonstrated that selenium and vitamin C supplements are ineffective in preventing incident prostate cancer and that vitamin E supplements potentially increase incident prostate cancer risk. A large RCT of a high vegetable diet intervention among prostate cancer patients on active surveillance, the Men's Eating and Living study, will soon complete analysis. An RCT for an exercise intervention among men with metastatic castrate-resistant prostate cancer is currently accruing. SUMMARY Although preclinical and observational studies have identified potential benefits for high vegetable, low fat, low meat diets, and increased exercise, Level I evidence is limited. To inform clinical care, future research should focus on RCTs evaluating clinical effectiveness.
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Galvão DA, Hayne D, Frydenberg M, Chambers SK, Taaffe DR, Spry N, Scuffham PA, Ware RS, Hart NH, Newton RU. Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial. BMJ Open 2018; 8:e022331. [PMID: 29678994 PMCID: PMC5914709 DOI: 10.1136/bmjopen-2018-022331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Active surveillance is a strategy for managing low-risk, localised prostate cancer, where men are observed with serial prostate-specific antigen assessments to identify signs of disease progression. Currently, there are no strategies to support active surveillance compliance nor are there interventions that can prevent or slow disease progression, ultimately delaying transition to active treatment before it is clinically required. Recently, we proposed that exercise may have a therapeutic potential in delaying the need for active treatment in men on active surveillance. METHODS AND ANALYSIS A single-blinded, two arm, multicentre randomised controlled trial will be undertaken with 168 patients randomly allocated in a ratio of 1:1 to exercise or usual care. Exercise will consist of supervised resistance and aerobic exercise performed three times per week for the first 6 months in an exercise clinical setting, and during months 7-12, a progressive stepped down approach will be used with men transitioning to once a week supervised training. Thereafter, for months 13 to 36, the men will self-manage their exercise programme. The primary endpoint will be the time until the patients begin active therapy. Secondary endpoints include disease progression (prostate specific antigen), body composition and muscle density, quality of life, distress and anxiety and an economic analysis will be performed. Measurements will be undertaken at 6 and 12 months (postintervention) and at 24 and 36 months follow-up. The primary outcome (time to initiation of curative therapy) will be analysed using Cox proportional hazards regression. Outcomes measured repeatedly will be analysed using mixed effects models to examine between-group differences. Data will be analysed using an intention-to-treat approach. ETHICS AND DISSEMINATION Outcomes from the study will be published in peer-reviewed academic journals and presented in scientific, consumer and clinical meetings.
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Affiliation(s)
- Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dickon Hayne
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Genesis CancerCare, Joondalup, Western Australia, Australia
- Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
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