1
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Tagai EK, Mantia‐Smaldone GM, Belfiglio A, Chu CS, Lapitan E, Santos H, Hernandez E, Sarwer DB, Miller SM. Perceived importance of weight loss and exercise among endometrial cancer survivors with overweight or obesity: Implications for lifestyle modification interventions. Obes Sci Pract 2023; 9:661-669. [PMID: 38090692 PMCID: PMC10712408 DOI: 10.1002/osp4.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/23/2023] [Accepted: 07/17/2023] [Indexed: 02/01/2024] Open
Abstract
Objective Type 1 endometrial cancer (EC) survivors who are overweight or obese are at increased risk of comorbidities and reduced quality of life. Lifestyle modification interventions (e.g., healthy eating, exercise) may help these women reduce excess weight and improve their quality of life. However, existing interventions have shown limited success. Guided by Self-Determination Theory, the proposed study sought to identify factors associated with perceived importance of weight loss and exercise as well as interest in lifestyle modification interventions (components of extrinsic and intrinsic motivation) among EC survivors with overweight or obesity to inform future intervention development. Methods One hundred type 1 EC survivors [body mass index (BMI) ≥ 25 kg/m2] completed a cross-sectional survey assessing sociodemographics, medical factors, exercise, risk perceptions and provider communication, quality of life, barriers to dieting and exercise, perceived importance of healthy lifestyles, and desired intervention content. Results EC survivors who were aware obesity is a risk factor for EC were significantly more likely to perceive weight loss as important and were interested in weight loss programs and receiving information about exercise (ps < 0.05). Additionally, EC survivors who reported their provider discussed the importance of a healthy weight after their diagnosis were significantly more likely to perceive exercise as important and were interested in receiving dieting information. Conclusions EC survivors expressed interest in lifestyle modification interventions. Increasing awareness about the risk of obesity and provider discussions about healthy weight during routine appointments may motivate EC survivors to engage in lifestyle modification interventions.
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Affiliation(s)
- Erin K. Tagai
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Gina M. Mantia‐Smaldone
- Division of Gynecologic OncologyFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Andrew Belfiglio
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Christina S. Chu
- Division of Gynecologic OncologyFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Emmanuel Lapitan
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
| | - Heather Santos
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
- Department of Epidemiology and BiostatisticsDornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Enrique Hernandez
- Obstetrics, Gynecology, and Reproductive SciencesLewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - David B. Sarwer
- College of Public HealthCenter for Obesity Research and EducationTemple UniversityPhiladelphiaPAUSA
| | - Suzanne M. Miller
- Cancer Prevention and ControlFox Chase Cancer Center/Temple University Health SystemPhiladelphiaPennsylvaniaUSA
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2
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Spanoudaki M, Giaginis C, Karafyllaki D, Papadopoulos K, Solovos E, Antasouras G, Sfikas G, Papadopoulos AN, Papadopoulou SK. Exercise as a Promising Agent against Cancer: Evaluating Its Anti-Cancer Molecular Mechanisms. Cancers (Basel) 2023; 15:5135. [PMID: 37958310 PMCID: PMC10648074 DOI: 10.3390/cancers15215135] [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: 10/01/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cancer cases are continuously increasing, while the prevalence rates of physical inactivity are also continuously increasing. Physical inactivity is a causative factor in non-communicable diseases, including cancer. However, the potential beneficial effects of exercise on cancer treatment have not received much attention so far. The aim of this study was to highlight the relationship between cancer and exercise on a molecular basis. METHODS Comprehensive and in-depth research was conducted in the most accurate scientific databases by using relevant and effective keywords. RESULTS The mechanisms by which exercise may reduce cancer risk and/or progression may include the metabolic profile of hormones, systemic inflammation reduction, insulin sensitivity increase, antioxidant capacity augmentation, the boost to the immune system, and the direct effect on the tumor. There is currently substantial evidence that the effect of exercise may predict a stronger association with cancer and could supplementarily be embedded in cancer clinical practice to improve disease progression and prognosis. CONCLUSION The field of this study requires interconnecting the overall knowledge of exercise physiology with cancer biology and cancer clinical oncology to provide the basis for personalized targeting strategies that can be merged with training as a component of a holistic co-treatment approach to optimize cancer healthcare.
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Affiliation(s)
- Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (M.S.); (A.N.P.); (S.K.P.)
- 424 General Military Hospital of Thessaloniki, 54621 Thessaloniki, Greece; (K.P.); (G.S.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece;
| | - Dimitra Karafyllaki
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece;
| | | | - Evangelos Solovos
- 424 General Military Hospital of Thessaloniki, 54621 Thessaloniki, Greece; (K.P.); (G.S.)
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece;
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece;
| | - Georgios Sfikas
- 424 General Military Hospital of Thessaloniki, 54621 Thessaloniki, Greece; (K.P.); (G.S.)
| | - Athanasios N. Papadopoulos
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (M.S.); (A.N.P.); (S.K.P.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (M.S.); (A.N.P.); (S.K.P.)
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3
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Rose GL, Stewart EM, Clifford BK, Bailey TG, Rush AJ, Abbott CR, Hayes SC, Obermair A, McCarthy AL. Efficacy of exercise interventions for women during and after gynaecological cancer treatment - a systematic scoping review. Support Care Cancer 2023; 31:342. [PMID: 37195433 DOI: 10.1007/s00520-023-07790-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To systematically synthesise evidence of exercise intervention efficacy for physical/psychosocial outcomes that matter to women during/following treatment for gynaecological cancer. METHODS Five databases were searched (PubMed, EMBASE, CINAHL, PsychInfo, Scopus). Exercise-only intervention studies that included women during/ following treatment for any gynaecological cancer, with/ without control comparison, on any physical or psychosocial outcome(s), were included and qualitatively appraised using the Revised Cochrane Risk of Bias tool and a modified Newcastle-Ottawa Scale. RESULTS Seven randomised controlled trials (RCTs), three single-arm pre-post studies, and one prospective cohort study satisfied were included (11 studies). Most studies were completed following treatment (91%), included combined (aerobic and resistance; 36%) and aerobic (36%) training, were fully/mostly (63%) unsupervised, and had a moderate-to-high risk of bias. Overall, 33 outcomes (64% objectively-measured) were assessed. Improvements were observed in aerobic capacity (V̇O2 Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m), lower- (30-second sit-to-stand +2-4 repetitions) and upper-limb strength (30-second arm curl +5 repetitions; 1RM grip strength/chest press +2.4-3.1 kg), and agility (timed up-and-go -0.6 seconds). However, changes in quality of life, anthropometry/body composition, balance and flexibility were inconsistent. There was no evidence to support worsening of outcomes. CONCLUSION Preliminary research into the role of exercise post-gynaecological cancer suggests an improvement in exercise capacity, muscular strength, and agility which, in the absence of exercise, typically decline following gynaecological cancer. Future exercise trials involving larger and more diverse gynaecological cancer samples will improve understanding of the potential and magnitude of effect of guideline-recommended exercise on outcomes that matter to patients.
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Affiliation(s)
- Grace Laura Rose
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia.
| | - Elizabeth Mary Stewart
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Briana Kristine Clifford
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Alexandra Jane Rush
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Claudia Rose Abbott
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
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4
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Smits A, Galaal K, Winnan S, Lopes A, Bekkers RLM. Feasibility and Effectiveness of the Exercise Program in Endometrial Cancer; Feasibility and Acceptability Survivorship Trial (EPEC-FAST). Cancers (Basel) 2022; 14:cancers14225579. [PMID: 36428675 PMCID: PMC9688636 DOI: 10.3390/cancers14225579] [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: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
To evaluate the feasibility of an individualized exercise program in the standard care for endometrial cancer patients aimed to improve quality of life and other health outcomes. This was a single-arm prospective intervention trial to assess the feasibility of an individualized exercise intervention in endometrial cancer patients after treatment. The exercise intervention consisted of weekly individualized training sessions, for 10 weeks, at a local gym facility. The program started six weeks post-operatively. Primary outcomes were feasibility aspects including number of eligible patients, recruitment and adherence rates. Secondary outcomes included quality of life outcomes and anthropometric measures. A total of 54 women were eligible for participation, of which 22 (41%) consented to the study. Overall attendance was 86%, and there were no adverse events. There was a significant improvement in quality of life outcomes, including role (p = 0.02), emotional (p = 0.02) and cognitive functioning (p = 0.04). In addition, there was a significant improvement in visceral fat percentage (p = 0.039) and physical fitness (six-minute walk test p < 0.001). The maximum weight loss achieved was 6.0 kg after 3 months and 8.4 kg after 6 months. An individualized one-to-one exercise intervention in endometrial cancer patients is feasible in terms of recruitment, adherence and safety.
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Affiliation(s)
- Anke Smits
- Gynecological Oncology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-309-79-58
| | - Khadra Galaal
- Gynecological Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Seeb 999046, Oman
| | - Steve Winnan
- Royal Cornwall Hospital Trust, Penryn TR10 9FE, UK
| | - Alberto Lopes
- Gynecological Oncology, Royal Cornwall Hospital Trust, Truro TR1 3HD, UK
| | - Ruud L. M. Bekkers
- Gynecological Oncology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Gynecological Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
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5
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McKenzie ND, Ahmad S. Impact of Lifestyle Interventions on Gynecologic Cancers: Beyond Diet and Exercise. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221123764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A Lifestyle Medicine approach to compliment cancer care is less commonly researched or implemented for women with gynecologic cancers as compared to better funded malignancies such as breast, prostate, and colorectal. Yet, several gynecologic malignancies are linked to obesity, estrogen/metabolic signaling pathways, and altered tumor microenvironment which could benefit greatly from a lifestyle medicine program. Lifestyle medicine, an evidenced-based branch of science, has expanded to the prevention and treatment of disorders caused by lifestyle factors (including cancer). Modifiable lifestyle factors such as obesity, lack of physical activity/nutrient density, microbial dysbiosis, sleep disturbance, and chronic stressors contribute greatly to cancer morbidity and mortality worldwide. This overarching area of research is evolving with some subtopics in their infancy requiring further investigation. Modern tools have allowed for better understanding of mechanisms by which adiposity and inactivity affect tumor promoting signaling pathways as well as the local tumor environment. Through the evolving use of these sophisticated techniques, novel prognostic biomarkers have emerged to explore efficacy of pharmacologic and lifestyle interventions in cancer. This state-of-the-art review article appraises recent evidence for a lifestyle medicine approach, beyond diet and exercise, to optimize survivorship and quality of life for patients with gynecologic cancers and introduces the 8-week web-based comprehensive HEAL-GYN program.
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Affiliation(s)
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
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6
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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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7
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Bates LC, Damare MI, Hanson ED, Moore JB, Bae-Jump V, Meyer ML, Stoner L. Sedentary Behavior Reduction: A Stepwise Approach to Increasing Physical Activity and Reducing Cardiovascular Disease Risk in Endometrial Cancer Survivors. Rev Cardiovasc Med 2022; 23:250. [PMID: 39076920 PMCID: PMC11266804 DOI: 10.31083/j.rcm2307250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 07/31/2024] Open
Abstract
Endometrial cancer survivors experience high rates of cardiovascular disease (e.g., heart disease, obesity, diabetes). The heightened cardiovascular disease risk may be attributed to cancer treatment coupled with sub-optimal lifestyle behaviors following treatment, including high amounts of sedentary behavior (SB). Public health agencies have graded the association of evidence between SB and cardiovascular disease as strong. However, while clinicians may wish to prescribe SB substitution strategies to reduce SB, guidelines do not currently exist. An additional challenge to behavior change pertains to the unique barriers that endometrial cancer survivors face, including treatment-associated fatigue and limited self-efficacy. Engaging in healthy movement behaviors, including minimizing SB and achieving recommended amounts of physical activity, are critical for health and well-being as well as cardiometabolic disease prevention. The purpose of this perspective paper is to propose an informed approach to physical activity promotion aimed to initiate movement and promote long-term behavior change by starting with an emphasis on reducing SB in endometrial cancer survivors. First, we address why endometrial cancer survivors should be targeted with SB reduction. Then, we suggest a stepwise approach to increasing physical activity by starting with SB reduction, including consideration to behavioral theories. Finally, we provide suggestions for future directions.
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Affiliation(s)
- Lauren C. Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Margaret I. Damare
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Erik D. Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
| | - Justin B. Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Victoria Bae-Jump
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
- Division of Gynecology Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Michelle L. Meyer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, NC 27599, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, NC 27599, USA
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8
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Dunston ER, Bai Y, Newton M, Podlog L, Walker D, Oza S, Zingg RW, Hansen PA, Coletta AM. Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program. Integr Cancer Ther 2022; 21:15347354221105482. [PMID: 35723412 PMCID: PMC9344112 DOI: 10.1177/15347354221105482] [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
Objective: Despite the numerous benefits of regular exercise participation for cancer
survivors, nearly 60% of survivors do not meet current guidelines.
Hospital-based exercise oncology programs may be one strategy to promote
exercise engagement as survivors have expressed a preference for exercise
programs associated with a cancer hospital. However, follow-up rates in
hospital-based exercise oncology programs can be low. Follow-up assessments
are a critical component of exercise oncology programs as they determine
survivor progress, allow for revision of exercise prescriptions, and
demonstrate the effectiveness of the exercise program. Therefore, the
purpose of this study was to identify clinical and demographic factors
associated with not attending a 12-week follow-up assessment in a
hospital-based exercise oncology program. Methods: We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman
Cancer Institute’s hospital-based exercise oncology program, the Personal
Optimism with Exercise Recovery (POWER) program. Cancer survivors completed
an assessment at the start of POWER and were encouraged to attend a 12-week
follow-up assessment. Factors associated with not attending a 12-week
follow-up assessment were identified using logistic regression. Results: Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09,
4.98) to not attend a 12-week follow-up assessment, whereas endometrial
cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater
travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI:
1.61, 3.49) were associated with not attending a 12-week follow-up
assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference
(OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR
1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were
associated with an increased likelihood of not attending a 12-week follow-up
assessment. Survivors with a higher baseline quality of life (OR 0.96; 95%
CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were
less likely not to attend a 12-week follow-up assessment. Conclusions: Both clinical and demographic factors were associated with not attending a
12-week follow-up assessment in a hospital-based exercise oncology program.
Understanding factors related to follow-up assessment attendance in exercise
oncology programs can inform the development of targeted interventions to
improve follow-up rate thus maximizing exercise support for cancer
survivors.
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Affiliation(s)
- Emily R Dunston
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA
| | - Yang Bai
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA
| | - Maria Newton
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA
| | - Leslie Podlog
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA
| | - Darren Walker
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Sonal Oza
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.,University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Rebecca W Zingg
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.,University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Pamela A Hansen
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.,University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Adriana M Coletta
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, USA.,Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
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9
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Dimauro I, Grazioli E, Antinozzi C, Duranti G, Arminio A, Mancini A, Greco EA, Caporossi D, Parisi A, Di Luigi L. Estrogen-Receptor-Positive Breast Cancer in Postmenopausal Women: The Role of Body Composition and Physical Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9834. [PMID: 34574758 PMCID: PMC8467802 DOI: 10.3390/ijerph18189834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/14/2022]
Abstract
Breast cancer (BC) is the most commonly diagnosed cancer among women worldwide and the most common cause of cancer-related death. To date, it is still a challenge to estimate the magnitude of the clinical impact of physical activity (PA) on those parameters producing significative changes in future BC risk and disease progression. However, studies conducted in recent years highlight the role of PA not only as a protective factor for the development of ER+ breast cancer but, more generally, as a useful tool in the management of BC treatment as an adjuvant to traditional therapies. In this review, we focused our attention on data obtained from human studies analyzing, at each level of disease prevention (i.e., primary, secondary, tertiary and quaternary), the positive impact of PA/exercise in ER+ BC, a subtype representing approximately 70% of all BC diagnoses. Moreover, given the importance of estrogen receptors and body composition (i.e., adipose tissue) in this subtype of BC, an overview of their role will also be made throughout this review.
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Affiliation(s)
- Ivan Dimauro
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy;
| | - Elisa Grazioli
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (E.G.); (A.P.)
| | - Cristina Antinozzi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
| | - Guglielmo Duranti
- Unit of Biocheminstry and Molecular Biology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy;
| | - Alessia Arminio
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
| | - Annamaria Mancini
- Dipartimento di Scienze Motorie e del Benessere (DISMeB), Università Degli Studi di Napoli “Parthenope”, Via F. Acton, 38, 80133 Naples, Italy;
- CEINGE-Biotecnologie Avanzate s.c.ar.l., Via Gaetano Salvatore 482, 80145 Naples, Italy
| | - Emanuela A. Greco
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
- Department of Health Science, University “Magna Graecia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Daniela Caporossi
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy;
| | - Attilio Parisi
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (E.G.); (A.P.)
| | - Luigi Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
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10
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Schwartz AR, Bartlett DB, Johnson JL, Broadwater G, Channell M, Nolte KC, Wilkes PA, Huffman KM, Secord AA. A Pilot Study of Home-Based Exercise and Personalized Nutrition Counseling Intervention in Endometrial Cancer Survivors. Front Oncol 2021; 11:669961. [PMID: 34178654 PMCID: PMC8232933 DOI: 10.3389/fonc.2021.669961] [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: 02/19/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction To assess the feasibility of a home-based aerobic exercise and nutrition counseling intervention and effect on cardiorespiratory fitness, cardiovascular disease risk profile, and immune response in obese endometrial cancer survivors. Methods A longitudinal pilot study assessed a 12-week home-based aerobic exercise and nutrition counseling intervention in obese endometrial cancer survivors. The primary outcome was feasibility defined as 80% adherence to weekly walking sessions calculated among individuals that completed the intervention. Secondary outcomes comprised pre- and post-intervention differences in cardiorespiratory fitness, cardiovascular risk factors, and T-cell function. Descriptive statistics summarized data. Wilcoxon sign tests identified differences between and pre and post-intervention variables. Results Nineteen women with stage 1 endometrial cancer consented; 9 withdrew and one was a screen failure. Median adherence to weekly walking sessions was 83.3%. Body composition was significantly altered with a reduction in median fat mass from 52.5 kg to 46.9 kg (p=0.04), and BMI from 37.5 kg/m2 to 36.2 kg/m2 (p = 0.004). There was no significant difference in cardiorespiratory fitness or cardiovascular parameters. The percentage of CD4+ and CD8+ T-cells producing IFNγ towards MAGE-A4 significantly increased from and 5.9% to 7.2% (p=0.043) and 13.9% to 14.8% (p=0.046), respectively. There were 3 related adverse events: hip pain, back sprain, and abdominal pain. Discussion Our home-based exercise and nutrition counseling program was feasible based on 80% adherence to walking sessions and favored altered body composition. However, the discontinuation rate was high and further research is needed to overcome barriers to implementation. Improvement in cardiovascular parameters will most likely require longer and more intensive programs.
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Affiliation(s)
- Amanda R Schwartz
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC, United States
| | - David B Bartlett
- Department of Medicine, Division of Medical Oncology, Duke University Hospital, Durham, NC, United States
| | - Johanna L Johnson
- Duke Molecular Physiology Institute, Duke Center for Living, Duke University, Durham, NC, United States
| | - Gloria Broadwater
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Meghan Channell
- Department of Clinical Research, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kimberly C Nolte
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Health System, Durham, NC, United States
| | - Patricia A Wilkes
- Department of Nutrition Services, Duke University Hospital, Durham, NC, United States
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke Center for Living, Duke University, Durham, NC, United States.,Department of Medicine, Division of Rheumatology, Duke University Hospital, Durham, NC, United States
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Health System, Durham, NC, United States
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11
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Wilson EM, Zamorano AS, Liu J, Morris D, Leon A, Kuroki LM, Thaker PH, McCourt CK, Fuh KC, Powell MA, Mutch DG, Colditz GA, Hagemann AR. Obese endometrial cancer survivors' perceptions of weight loss strategies and characteristics that may influence participation in behavioral interventions. Gynecol Oncol Rep 2021; 36:100719. [PMID: 33665293 PMCID: PMC7907756 DOI: 10.1016/j.gore.2021.100719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/08/2023] Open
Abstract
Endometrial cancer (EC) survivors have attempted many methods to lose weight. EC survivors rarely choose bariatric surgery, physical therapy, or psychologic support services to lose weight. EC survivors without recurrence were more likely to enroll in a weight loss intervention trial than those with recurrence.
We aimed to evaluate obese endometrial cancer (EC) survivors' perceptions of weight loss barriers and previously attempted weight loss methods and to identify characteristics that predicted willingness to enroll in a behavioral intervention trial. We administered a 27-question baseline survey at an academic institution to EC survivors with body mass index ≥ 30 kg/m2. Survivors were asked about their lifestyles, previous weight loss attempts, perceived barriers, and were offered enrollment into an intervention trial. Data was analyzed using Fisher’s Exact, Kruskal-Wallis, and univariate and multivariate regressions. 155 of 358 (43%) eligible obese EC survivors were surveyed. Nearly all (n = 148, 96%) had considered losing weight, and 77% (n = 120) had tried two or more strategies. Few had undergone bariatric surgery (n = 5, 3%), psychologic counseling (n = 2, 1%), or met with physical therapists (n = 9, 6%). Lower income was associated with difficulty in accessing interventions. Survivors commented that negative self-perceptions and difficulties with follow-through were barriers to weight loss, and fear of complications and self-perceived lack of qualification were deterrents to bariatric surgery. 80 (52%) of those surveyed enrolled in the trial. In a multivariate model, adjusting for race and stage, survivors without recurrence were 4.3 times more likely to enroll than those with recurrence. Most obese EC survivors have tried multiple strategies to lose weight, but remain interested in weight loss interventions, especially women who have never experienced recurrence. Providers should encourage weight loss interventions early, at the time of initial diagnosis, and promote underutilized strategies such as psychological counseling, physical therapy, and bariatric surgery.
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Affiliation(s)
- Elise M Wilson
- Department of Obstetrics & Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Abigail S Zamorano
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - David Morris
- Siteman Cancer Center Psychology Service, Barnes-Jewish Hospital, St. Louis, MO, United States
| | - Andrea Leon
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Premal H Thaker
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Matthew A Powell
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - David G Mutch
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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12
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Rahimy E, Usoz M, von Eyben R, Fujimoto D, Watanabe D, Karam A, Jairam-Thodla A, Mills M, Dorigo O, Diver EJ, Teng N, English D, Kidd E. Phase II trial evaluating efficacy of a Fitbit program for improving the health of endometrial cancer survivors. Gynecol Oncol 2021; 161:275-281. [PMID: 33551199 DOI: 10.1016/j.ygyno.2021.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the favorable prognosis of early stage endometrial cancer, mortality from cardiovascular disease is high. We aimed to evaluate the efficacy of a Fitbit program to improve physical activity in endometrial cancer survivors. METHODS Eligible patients were diagnosed with stage IA-IIIA endometrial adenocarcinoma, ≥3 months out from treatment. Participants received a Fitbit Alta and were randomized to receive communication via telephone or electronic methods (email/text). Communication was every two weeks for two months, then once during months four and five. Average daily steps were assessed weekly for nine months. RESULTS The 46 analyzable patients demonstrated a baseline of 5641 median daily average steps. Average steps increased by 22% at 6 months but decreased to baseline by nine months. Baseline activity level (daily steps and walks per week) was the greatest predictor of activity level. Only the telephone intervention participants demonstrated increased activity level at several timepoints, although not maintained by nine months. BMI was unchanged. There was mild improvement in physical and social well-being in those with low baseline well-being (p = 0.009 and 0.014, respectively), regardless of intervention group. Emotional well-being correlated with step count (p = 0.005). CONCLUSIONS Activity level was low and mildly improved on the Fitbit program with the telephone intervention, but effects did not persist by study completion. The program had the greatest impact on a select group of telephone intervention patients with high baseline walking frequency and low baseline step count. Others may require more intense intervention to promote more robust/persistent lifestyle changes.
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Affiliation(s)
- Elham Rahimy
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
| | - Melissa Usoz
- Duke University School of Medicine, Durham, NC, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Dylann Fujimoto
- University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Darla Watanabe
- Department of Gynecologic Oncology, Stanford University, Stanford, CA, USA
| | - Amer Karam
- Department of Gynecologic Oncology, Stanford University, Stanford, CA, USA
| | | | - Margaret Mills
- Department of Gynecologic Oncology, Stanford University, Stanford, CA, USA
| | - Oliver Dorigo
- Department of Gynecologic Oncology, Stanford University, Stanford, CA, USA
| | | | - Nelson Teng
- Department of Gynecologic Oncology, Stanford University, Stanford, CA, USA
| | - Diana English
- Department of Gynecologic Oncology, University of South Florida, Tampa, FL, USA
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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13
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Buchanan A, Roddy M, Badr H. Patient-reported outcomes of non-pharmacological interventions for endometrial cancer survivors: a systematic review. J Cancer Surviv 2020; 15:526-535. [PMID: 33140266 DOI: 10.1007/s11764-020-00946-z] [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: 07/31/2020] [Accepted: 09/18/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE The objective of this review was to assess the efficacy of non-pharmacological interventions on endometrial cancer (EC) survivors' QOL, and their use of patient-reported outcome measures (PROMs). METHODS We conducted a systematic review of randomized controlled trials (RCTs) of non-pharmacological interventions that assessed the impact of intervention on EC survivors' general and domain-specific QOL (i.e., physical, psychological, and social well-being) using PROMs. RESULTS Of the 3178 studies identified, 28 full-text articles were reviewed, and 10 were included in the review. Nine RCTs assessed at least one PROM as a primary outcome and six assessed a PROM as a secondary outcome, but few studies used validated PROMs. Significant improvements in general QOL were found in two studies, domain-specific QOL in three studies, and both general and domain-specific QOL in three studies; however, effect sizes ranged from small to large and no significant effects were found for social well-being and few were found for psychological well-being. CONCLUSIONS Few non-pharmacological interventions for EC survivors targeted QOL, even though QOL was assessed as either a primary or secondary outcome of the RCT. Despite this, findings suggest that non-pharmacological interventions for EC survivors hold promise for improving general and domain-specific QOL. Use of validated PROMs would greatly enhance outcome reporting and facilitate comparisons across studies. More interventions are also needed that address social and psychological functioning in this population. IMPLICATIONS FOR CANCER SURVIVORS Our review highlights a need to (1) expand non-pharmacological RCTs for EC survivors, (2) increase the use of validated PROMs measuring QOL, and (3) address psychosocial domains of QOL when developing interventions for this population.
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Affiliation(s)
- Ashley Buchanan
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - McKenzie Roddy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Hoda Badr
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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14
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Burse NR, Bhuiyan N, Mama SK, Schmitz KH. Physical activity barriers and resources among black women with a history of breast and endometrial cancer: a systematic review. J Cancer Surviv 2020; 14:556-577. [PMID: 32240461 PMCID: PMC8258672 DOI: 10.1007/s11764-020-00873-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/04/2020] [Indexed: 12/31/2022]
Abstract
Physical inactivity is a significant public health problem among black women. However, there is limited evidence regarding barriers to physical activity and the availability of opportunities to engage in physical activity, specifically for posttreatment black women with a history of cancer. PURPOSE The purpose of this paper was to systematically review, summarize, and synthesize findings on physical activity-related research including barriers, facilitators, and resources for physical activity among posttreatment black women with a history of breast and endometrial cancer. METHODS We developed a comprehensive search strategy and conducted searches in the following databases: PsycINFO, Web of Science, Cochrane, PubMed, and Sociological Abstracts. Summary measures were described qualitatively (e.g., themes) and quantitatively (e.g., frequencies). RESULTS This review identified 35 eligible articles describing 12 intervention and 23 observational studies. We described intervention preferences (e.g., resistance activities), beliefs about physical activity, and benefits of physical activity for quality of life (e.g., improvements in social wellbeing) in black cancer survivors. In addition, very few studies identified barriers to physical activity (n = 7) and focused on increasing physical activity (n = 12) among black women with a history of cancer. The most common reported barriers among the target population were fatigue, lack of social support, weather, illness/health issues, cost, time constraints, living too far away, and inability/unwillingness to obtain physician clearance, whereas the most common facilitators were faith, other health concerns, and social support. CONCLUSIONS/IMPLICATIONS Future studies should target barriers, facilitators, and culturally adapted strategies for physical activity at all levels of influence to develop multi-level interventions to engage and improve physical activity among black women with a history of breast and endometrial cancer. PROTOCOL REGISTRATION NUMBER CRD42018110008.
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Affiliation(s)
- Natasha R Burse
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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15
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Romero-Elías M, Beltrán-Carrillo VJ, González-Cutre D, Jiménez-Loaisa A. Barriers to physical activity participation in colorectal cancer patients during chemotherapy treatment: A qualitative study. Eur J Oncol Nurs 2020; 46:101769. [PMID: 32506009 DOI: 10.1016/j.ejon.2020.101769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To explore the barriers that colorectal cancer patients (stage II and III) perceive to participate in physical activity (PA) when involved in adjuvant chemotherapy. Views of relatives and physicians concerning this issue were also included. METHOD Qualitative data from ten patients, ten relatives, and ten health professionals were obtained through semi-structured interviews (n = 30). RESULTS Two main themes were identified after data analysis: (a) barriers to PA related to ostomy and adjuvant chemotherapy and (b) barriers related to perceived lack of support for PA. In regard to the first theme, participants reported difficulties associated with the ostomy, limitations of the intravenous chemotherapy device, fatigue and reduced physical fitness, and focusing on cancer and restructuring priorities. Concerning the perceived lack of support for PA, participants referred to their families' overprotection, the health professionals' lack of knowledge and time to prescribe PA, and the lack of PA services in health centres. CONCLUSIONS Further information from health professionals about the recommendations of PA and its benefits during adjuvant chemotherapy could palliate these PA barriers. The offer of specific PA programmes for these patients is also recommended.
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Affiliation(s)
- María Romero-Elías
- Department of Sport Sciences. Sport Research Centre. Miguel Hernández University of Elche, Spain.
| | | | - David González-Cutre
- Department of Sport Sciences. Sport Research Centre. Miguel Hernández University of Elche, Spain.
| | - Alejandro Jiménez-Loaisa
- Department of Sport Sciences. Sport Research Centre. Miguel Hernández University of Elche, Spain.
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16
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Liao Y, Song J, Robertson MC, Cox-Martin E, Basen-Engquist K. An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors. Ann Behav Med 2020; 54:320-334. [PMID: 31722394 DOI: 10.1093/abm/kaz050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects. PURPOSE To examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors. METHODS Ecological momentary assessment (EMA) surveys were delivered up to eight 5- to 7-day periods over 6 months. Participants (n = 100) rated their affective and physiological states before and after each exercise session (predictors) and recorded their self-efficacy and outcome expectancy each morning (mediators). Exercise (outcome) was based on self-reported EMA surveys and accelerometer measures. A 1-1-1 multilevel mediation model was used to disaggregate the within-subject (WS) and between-subject (BS) effects. RESULTS At the WS level, a more positive affective state after exercise was associated with higher self-efficacy and positive outcome expectation the next day, which in turn was associated with higher subsequent exercise levels (ps < .05). At the BS level, participants who typically had more positive affective and experienced less intense physiological sensation after exercise had higher average self-efficacy, which was associated with higher average exercise levels (ps < .05). CONCLUSIONS In endometrial cancer survivors, affective experience after exercise, daily self-efficacy and positive outcome expectation help explain the day-to-day differences in exercise levels within-person. Findings from this study highlight potentials for behavioral interventions that target affective experience after exercise and daily behavioral cognitions to promote physical activity in cancer survivors' everyday lives.
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Affiliation(s)
- Yue Liao
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael C Robertson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Emily Cox-Martin
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Yu CH, Wang TJ, Chang CL, Liang SY, Wu SF, Liu CY, Lu YY. Healthy life styles, sleep and fatigue in endometrial cancer survivors: A cross-sectional study. J Clin Nurs 2020; 29:1372-1380. [PMID: 31970842 DOI: 10.1111/jocn.15189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES The primary aim of this study is to explore the influence of obesity, healthy lifestyle and sleep quality of endometrial cancer survivors on their fatigue level. BACKGROUND As many as 30% of endometrial cancer survivors still suffer from fatigue 5 years after completing therapy. Fatigue may hinder cancer survivors from participating in daily activities or returning to their original roles and functions, thus affecting their health-related quality of life. DESIGN This study adopted a cross-sectional correlational research design. The STROBE checklist for cross-sectional studies was used as a reference for reporting the study. METHODS A consecutive sample of 134 endometrial cancer survivors was recruited from the outpatient clinics of a medical centre in Taipei, Taiwan. Data were collected using structured questionnaires. RESULTS Study subjects scored 44 points (SD = 7.09) on average for the fatigue levels. Results of linear regression showed that sleep quality (ß = -0.38), comorbidity index (ß = -0.024) and age (ß = 0.20) were important predictors of fatigue. However, differences in obesity, vegetable and fruit intake, physical activity did not lead to significant differences in fatigue level. CONCLUSIONS Survivors who had poorer sleep quality, higher comorbidity index and younger age reported higher fatigue. RELEVANCE TO CLINICAL PRACTICE The study findings are relevant for assessing and preventing fatigue in endometrial cancer survivors. Those with poorer sleep quality, higher comorbidity index and younger age are at a greater risk for fatigue and deserve further attention. Although the study results failed to support the link between obesity, vegetable and fruit intake, physical activity and fatigue, the ratio of survivors who comply with recommended healthy lifestyles was low. Hence, it is of urgent necessity that this population receives the help to maintain a healthy lifestyle.
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Affiliation(s)
- Chia-Hui Yu
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Chih-Long Chang
- Department of Medical Research, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Shu-Fang Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Science, Taipei, Taiwan, ROC
| | - Yu Ying Lu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
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Hayes SC, Newton RU, Spence RR, Galvão DA. The Exercise and Sports Science Australia position statement: Exercise medicine in cancer management. J Sci Med Sport 2019; 22:1175-1199. [DOI: 10.1016/j.jsams.2019.05.003] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/25/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022]
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19
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Torres D, Shafa A, Klennert S, Hokenstad A, Bird M, Weinhold M, Mundi MS, Langstraat C, Kumar A. Using quality improvement to increase the awareness of obesity among endometrial cancer patients. Int J Gynecol Cancer 2019; 29:1010-1015. [PMID: 31203202 DOI: 10.1136/ijgc-2019-000495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To increase discussion about obesity and endometrial cancer and referrals to weight loss clinic in patients with newly diagnosed low-risk endometrial cancer. METHODS A multidisciplinary team used a quality improvement methodology to increase patient awareness about obesity and endometrial cancer. Target population included patients <80 years old with a body mass index ≥30 kg/m2 who underwent surgery at our institution and had a final diagnosis of complex hyperplasia or stage I, grade 1-2 endometrioid endometrial cancer. A toolkit was developed for the intervention. Clinical characteristics, discussion about obesity, and referrals to a weight loss clinic were abstracted for a historic and intervention cohort. Data for the two cohorts were compared using chi-square, Fisher's exact test, and t-test. RESULTS 54 patients from the historic cohort and 53 from the intervention cohort met inclusion criteria. Clinical characteristics were balanced between the groups. Discussion about obesity increased from 11.1% (6/54) to 79.2% (42/53) after implementing the toolkit (p<0.001). Referrals to the weight loss clinic also increased from 3.7% (2/54) to 26.4% (14/53) after implementing the toolkit (p=0.001), but in both groups only 50% of those referred actually attended the weight loss clinic. No clinical characteristics were identified as associated with being more likely to have documented conversations or referrals. CONCLUSIONS A multidisciplinary quality-improvement project can be used to increase discussion about obesity and referral to a weight loss clinic in patients with low-risk endometrial cancer. Increasing patient awareness of the connection between obesity and endometrial cancer may have implications on the long-term health of endometrial cancer survivors.
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Affiliation(s)
- Diogo Torres
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anousheh Shafa
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara Klennert
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexis Hokenstad
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan Bird
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan Weinhold
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Amanika Kumar
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Robertson MC, Lyons EJ, Song J, Cox-Martin M, Li Y, Green CE, Pinto BM, Carmack CL, Harrison C, Baum G, Basen-Engquist KM. Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention. Health Qual Life Outcomes 2019; 17:91. [PMID: 31133040 PMCID: PMC6537149 DOI: 10.1186/s12955-019-1154-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Endometrial cancer survivors are at an increased risk of poor quality of life outcomes. Physical activity is positively associated with general quality of life in this population, however, little is known about how changes in physical activity may be associated with changes in specific aspects of quality of life. The aim of this secondary data analysis was to explore the relationships between change in physical activity and change in physical, mental, social, and other aspects of quality of life in endometrial cancer survivors receiving a physical activity intervention. METHODS Endometrial cancer survivors (N = 100) participated in a telephone-based physical activity intervention for six months. At baseline and post-intervention we measured physical activity via accelerometry and ecological momentary assessment, and quality of life via the Short Form Health Survey (SF-36), the Quality of Life of Adult Cancer Survivors instrument, the Brief Symptom Inventory, the Pittsburgh Sleep Quality Index, and the Perceived Stress Scale. We conducted structural equation modeling path analyses to investigate how physical activity post-intervention was associated with the quality of life measures' subscales post-intervention, adjusting for baseline levels and potentially confounding covariates. RESULTS Increasing physical activity was positively associated with improvements in general health (p = .044), role limitation due to physical health (p = .005), pain (p = .041), and somatic distress (p = .023). There was no evidence to indicate that change in physical activity was associated with change in other aspects of quality of life. CONCLUSIONS Endometrial cancer survivors are at higher risk for suffering from challenges to physical quality of life, and findings from this study suggest that increasing physical activity may alleviate some of these problems. Further research is needed to determine whether other aspects of quality of life are linked to change in physical activity. TRIAL REGISTRATION Trial registration number: NCT00501761 Name of registry: clinicaltrials.gov Date of registration: July 16, 2007. Date of enrollment: June 16, 2005.
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Affiliation(s)
- Michael C. Robertson
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030 USA
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030 USA
| | - Elizabeth J. Lyons
- Department of Nutrition and Metabolism, School of Health Professions, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-1124 USA
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030 USA
| | - Matthew Cox-Martin
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado at Denver-Anschutz Medical Campus, Aurora, CO USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030 USA
| | - Charles E. Green
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin St, Houston, TX 77030 USA
| | - Bernardine M. Pinto
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 302B, Columbia, SC 29208-4001 USA
| | - Cindy L. Carmack
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030 USA
| | - Carol Harrison
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030 USA
| | - George Baum
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030 USA
| | - Karen M. Basen-Engquist
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030 USA
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Obesity counseling in obstetrics and gynecology: provider perceptions and barriers. Gynecol Oncol Rep 2018; 27:31-34. [PMID: 30582746 PMCID: PMC6299124 DOI: 10.1016/j.gore.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/27/2018] [Accepted: 12/01/2018] [Indexed: 12/19/2022] Open
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Advancing Uterine Cancer Survivorship Among African American Women. J Natl Med Assoc 2018; 110:391-395. [PMID: 30126566 DOI: 10.1016/j.jnma.2017.08.002] [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: 09/23/2016] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have examined health behavior interventions for African American women who are uterine cancer survivors. Black-white differences in uterine cancer survival suggest that there are unmet needs among these survivors. METHODS This article identifies opportunities to address disparities in uterine corpus cancer survival and quality of life, and thereby to increase uterine cancer survivorship among African American women. RESULTS For cancer survivors, common side effects, lasting for long periods after cancer treatment, include fatigue, loss of strength, lymphedema, and difficulty sleeping. A variety of interventions have been evaluated to address physical and mental health concerns, including exercise and dietary interventions. Considerable information exists about the effectiveness of such interventions for alleviating distress and improving quality of life among cancer survivors, but few studies have focused specifically on African American women with a uterine corpus cancer diagnosis. Research-tested culturally tailored lifestyle interventions are lacking. CONCLUSIONS There is a need for a better understanding of uterine cancer survivorship among African American women. Additional evaluations of interventions for improving the quality of life and survival of African American uterine cancer survivors are needed.
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Armbruster SD, Song J, Gatus L, Lu KH, Basen-Engquist KM. Endometrial cancer survivors' sleep patterns before and after a physical activity intervention: A retrospective cohort analysis. Gynecol Oncol 2018; 149:133-139. [PMID: 29395314 PMCID: PMC5915323 DOI: 10.1016/j.ygyno.2018.01.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the baseline sleep patterns of endometrial cancer survivors and examine the impact of a physical activity intervention on their sleep quality via retrospective secondary analysis. METHODS Early-stage endometrial cancer survivors participated in a 6-month single-arm exercise intervention using printed materials, telephone-based counseling, and pedometers to encourage adherence to exercise guidelines. Participants completed questionnaires evaluating their sleep (PSQI), physical activity (CHAMPS), quality of life (SF-36), and stress (PSS) at baseline and study completion. RESULTS Ninety-five survivors had PSQI data at both time points. Mean age was 57.1 years (range, 25-76). Mean body mass index was 34.3 kg/m2. The majority were non-Hispanic white (75%) and had stage I disease (80%). At baseline, most survivors (61%) had poor sleep quality (PSQI > 5), with 24% reporting fairly or very bad sleep. The majority (63%) slept <7 h/night. At least once during the preceding month, 83% had an episode of daytime dysfunction. A pairwise comparison showed that obese survivors had more sleep disturbances than normal weight survivors (p = 0.029). No other clinicodemographic factors were associated with sleep. In unadjusted analyses, sleep quality significantly improved in women who increased weekly total or moderate/vigorous physical activity (p = 0.004 and p < 0.050, respectively). This association persisted after adjusting for the potential covariates of age, time since diagnosis, obesity status, disease stage, and treatment (p = 0.026). CONCLUSIONS Our data demonstrated that poor sleep is common and detrimental to endometrial cancer survivors. Increasing exercise may improve this dysfunction and should be investigated as part of a prospective study.
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Affiliation(s)
- Shannon D Armbruster
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Leticia Gatus
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Yeganeh L, Harrison C, Vincent AJ, Teede H, Boyle JA. Effects of lifestyle modification on cancer recurrence, overall survival and quality of life in gynaecological cancer survivors: A systematic review and meta-analysis. Maturitas 2018; 111:82-89. [PMID: 29673836 DOI: 10.1016/j.maturitas.2018.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 01/24/2023]
Abstract
The benefits of lifestyle interventions for women who have survived gynaecological cancer (GC) remain unclear. This systematic review aimed to determine the effect of lifestyle interventions on cancer recurrence, overall survival and quality of life (QoL) in women with GC. We searched Medline, Embase, PsycINFO and EBM Reviews from June to July 2016 to identify relevant literature. We included randomized controlled trials in which a lifestyle intervention (diet, weight loss, physical activity and/or behavioural interventions) were compared with a control condition (usual care, placebo or other lifestyle interventions) in women who had survived endometrial or ovarian cancer. Primary outcomes included cancer recurrence and overall survival and the secondary outcome was QoL. Data extraction and risk-of-bias assessment were performed by two independent reviewers. A random-effects meta-analysis model was used to calculate mean differences (md) and 95% confidence intervals (CI). The literature search yielded 928 citations and three trials met the inclusion criteria. No randomized controlled trial assessed the effect of lifestyle interventions on cancer recurrence or survival. Meta-analysis of two randomized controlled trials on the effect of lifestyle interventions on total QoL at 3 or 6 months post-intervention showed no significant difference between intervention and control groups [(md; 1.60; 95% CI, -1.65 to 4.85) and (md; 2.07; 95% CI, -1.80 to 5.94), respectively]. That is, lifestyle intervention had no effect on overall QoL or individual QoL domains (physical, emotional, social wellbeing and fatigue) in GC survivors. Systematic review registration: PROSPERO CRD42016043719.
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Affiliation(s)
- Ladan Yeganeh
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Menopause Unit, Monash Health, Melbourne, Victoria, Australia.
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia; Monash Partners Academic Health Sciences Centre, Melbourne, Victoria, Australia.
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Menopause Unit, Monash Health, Melbourne, Victoria, Australia.
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Effect of Physical Activity on Quality of Life as Perceived by Endometrial Cancer Survivors: A Systematic Review. Int J Gynecol Cancer 2018; 26:1727-1740. [PMID: 27654260 DOI: 10.1097/igc.0000000000000821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE A combination of the relatively high prevalence among gynecologic cancers, high survival, and the myriads of factors that negatively impact the quality of life (QoL) among endometrial cancer (EC) survivors underscores the potential benefits of meeting guideline physical activity (PA) guidelines of 150 minutes per week among EC survivors. The objective of the present systematic review was to collate and critically evaluate the currently available literature on the effects of PA on QoL among EC survivors. METHODS Medline and Web of Science databases were searched for articles on EC, QoL, and PA. We also inspected bibliographies of relevant publications to identify related articles. Our search criteria yielded 70 studies, 7 of which met the inclusion criteria. RESULTS Of the 7 studies examined, 2 of them were intervention studies, whereas 5 were cross-sectional studies. Meeting guideline PA was significantly associated with better QoL score in 4 of the 5 cross-sectional studies. CONCLUSIONS Results from the cross-sectional studies suggest that EC survivors' inactivity is significantly correlated with poorer QoL. This correlation was worse among obese survivors compared with normal weight survivors. Endometrial cancer survivors may benefit from interventions that incorporate PA. More randomized intervention studies among EC survivors are needed to add to this body of evidence.
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Marker RJ, Cox-Martin E, Jankowski CM, Purcell WT, Peters JC. Evaluation of the effects of a clinically implemented exercise program on physical fitness, fatigue, and depression in cancer survivors. Support Care Cancer 2017; 26:1861-1869. [PMID: 29270829 DOI: 10.1007/s00520-017-4019-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 12/10/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite national recommendations, exercise programs are still not clinically implemented as standard of care for cancer survivors. This investigation examined the effects of a clinically implemented and personalized exercise program on physical fitness, fatigue, and depression in a diverse population of cancer survivors. The association of various participant characteristics on program performance was also examined. METHODS Data were collected from 170 cancer survivors who had participated in a clinical exercise program. Any cancer type was included and survivors were either undergoing medical treatment or had completed treatment (< 6 months prior to program initiation). Baseline and post program measures of estimated VO2peak, grip strength, fatigue, and depression were compared in survivors who completed the program follow-up. Multiple regressions were performed to investigate the association of age, gender, body mass index (BMI), and medical treatment status on baseline and change scores in outcome measures, as well as program adherence. RESULTS All measures improved in participants who completed the program (p < 0.01). Age, gender, and BMI were associated with baseline measures of estimated VO2peak and grip strength (p < 0.01), and age was inversely associated with baseline fatigue (p = 0.02). Only BMI was inversely associated with change in estimated VO2peak (p < 0.01). No participant characteristics or baseline measures were predictive of program adherence (p > 0.05). CONCLUSION This investigation provides evidence that a personalized, clinical exercise program can be effective at improving physical fitness, fatigue, and depression in a diverse population of cancer survivors.
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Affiliation(s)
- Ryan J Marker
- Department of Physical Therapy, School of Health Sciences and Human Performance, Ithaca College, Ithaca, NY, USA.
| | - Emily Cox-Martin
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - W Thomas Purcell
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John C Peters
- Anschutz Health and Wellness Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Stewart JL, Besenyi GB, Williams LB, Burt V, Anglin JC, Ghamande SA, Coughlin SS. Healthy lifestyle intervention for African American uterine cancer survivors: Study protocol. Contemp Clin Trials Commun 2017; 8:11-17. [PMID: 29075673 PMCID: PMC5653315 DOI: 10.1016/j.conctc.2017.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/03/2017] [Accepted: 08/15/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cancer of the uterine corpus is the most common gynecologic malignancy and the fourth most common cancer in U.S. women. There is a racial disparity in the survival from endometrial cancer and this may be addressed by culturally-tailored lifestyle interventions to help African American (AA) endometrial cancer survivors lose weight or maintain a healthy weight. OBJECTIVE The overall purpose of this pilot study is to develop and evaluate a culturally-tailored lifestyle intervention to help AA uterine cancer survivors reduce their risk of cancer recurrence and improve their quality of life through healthy eating, physical activity, and weight management. While many interventions have been evaluated to assist cancer survivors through diet and physical activity, few have focused on AA women with a uterine cancer diagnosis. METHODS Community-engaged research principles are being followed. This study was developed with input from the Augusta University (AU) College of Nursing Community Advisory Board (CAB) and the Division of Gynecologic Oncology at the Georgia Cancer Center at AU. Weekly sessions throughout a 12-week intervention will include physical activity and lectures on improving nutritional status. The pre/post-test design includes baseline and 6-month follow-up, where participants will complete a questionnaire that assesses knowledge and attitudes about physical activity, nutrition, uterine cancer, social support, and quality of life. CONCLUSIONS From this pilot study, we will learn more about the feasibility and integration of healthy lifestyle interventions in this patient population, and the results can provide an opportunity for a larger-scale, multi-center study with a randomized controlled design.
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Affiliation(s)
- Jessica Lynn Stewart
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Gina B. Besenyi
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Lovoria B. Williams
- College of Nursing, Biobehavioral Nursing Department, Augusta University, Augusta, GA, United States
| | - Victoria Burt
- College of Nursing Community Advisory Board, Augusta University, Augusta, GA, United States
| | - Judith C. Anglin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Sharad A. Ghamande
- Division of Gynecologic Oncology, Georgia Cancer Center, Augusta University, GA, United States
| | - Steven Scott Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
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Lucas AR, Focht BC, Cohn DE, Buckworth J, Klatt MD. A Mindfulness-Based Lifestyle Intervention for Obese, Inactive Endometrial Cancer Survivors: A Feasibility Study. Integr Cancer Ther 2017; 16:263-275. [PMID: 27627985 PMCID: PMC5532075 DOI: 10.1177/1534735416668257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/19/2016] [Accepted: 07/24/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) to address self-regulation and lifestyle behaviors (diet, physical activity) may benefit endometrial cancer survivors (ECS), who are at increased risk for morbidity and mortality associated with obesity. However, the acceptability of mindfulness training and whether it can augment behavior change in ECS is unknown. We aimed to examine; 1) the feasibility of the Mindfulness in Motion + Diet (MIM+D) intervention and 2) the preliminary efficacy of MIM+D for improving mindfulness, diet, PA and health-related quality of life (HRQL). METHODS ECS (Mage=62.4, ±5yrs from diagnosis) completed assessments at baseline, 8 and 14 weeks. Feasibility was determined by intervention completion surveys, attendance and adherence data. We used repeated measures ANOVA's (SPSS 22.0) and effect size estimates (Cohen's d) to examine changes in mindfulness, diet, PA, and HRQL over time. RESULTS Thirteen ECS (76%) completed the MIM+D program and attendance (≥6/8 sessions) was 90%. Women reported favorably on the overall quality (mean of 4.75/5) and benefits of the MIM+D program; however, would have preferred receiving MIM+D closer to diagnosis. Intention to treat analyses found MIM+D did not significantly improve any outcomes. However, an intervention completers analysis showed significant change in mindfulness (p=.0039) and small to moderate estimates for change in fruits and vegetable intake (d=.23), MVPA (d=.45), RAND SF-36: MCS (d=.46), and sleep quality (d=.68). CONCLUSIONS Integrating mindfulness training into behavioral interventions is feasible and ECS that adhere to these lifestyle programs may benefit. However, to future research should examine the-long term effects of mindfulness-based behavioral lifestyle interventions.
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Affiliation(s)
| | | | - David E. Cohn
- The Ohio State University College of Medicine, Columbus, OH, USA
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Song J, Karlsten M, Yamal JM, Basen-Engquist K. Health-related quality of life factors associated with completion of a study delivering lifestyle exercise intervention for endometrial cancer survivors. Qual Life Res 2017; 26:1263-1271. [PMID: 27796772 PMCID: PMC8409014 DOI: 10.1007/s11136-016-1441-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to examine associations between participants' quality of life and study completion. This is a secondary analysis of an exercise intervention study for endometrial cancer survivors. METHODS We considered data for one-hundred post-treatment endometrial cancer survivors from a single-arm, six-month longitudinal exercise study. Participants received a home-based intervention consisting of exercise recommendations and telephone counseling sessions to encourage adherence. In addition to monitoring adherence to physical exercise recommendations, participants completed multiple psychological assessments, including health-related quality of life. Associations between study completion and health-related quality of life factors were analyzed using generalized additive models, to allow for possibly nonlinear associations. RESULTS Measures of bodily pain contributed to the odds of study completion in a nonlinear way (p = 0.025), suggesting that improvements in these factors were associated with study completion, especially for individuals reporting very high levels of pain. In addition, association between participants' levels of anxiety and study completion showed an inverse U-shaped relation: Whereas increase in anxiety was associated with higher odds of completion for individuals with low anxiety score (0-4), increase in anxiety contributed to lower odds of study completion for individuals with anxiety scores of approximately 5-10 (p = 0.035). CONCLUSIONS Results from this study indicate that baseline health-related quality of life factors may be associated with study completion in exercise intervention studies. In order to increase study completion rates, individually tailored study strategies may be prepared based on the baseline quality of life responses.
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Affiliation(s)
- Jaejoon Song
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St., Floor 4, FCT4.5009, Houston, TX, 77030, USA.
- Department of Biostatistics, School of Public Health, University of Texas Health Science Center, Houston, TX, USA.
| | - Melissa Karlsten
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - José-Miguel Yamal
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St., Floor 4, FCT4.5009, Houston, TX, 77030, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lin KY, Frawley H, Denehy L, Feil D, Granger C. Exercise interventions for patients with gynaecological cancer: a systematic review and meta-analysis. Physiotherapy 2016; 102:309-319. [DOI: 10.1016/j.physio.2016.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 02/16/2016] [Indexed: 02/09/2023]
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Armbruster SD, Song J, Bradford A, Carmack CL, Lu KH, Basen-Engquist KM. Sexual health of endometrial cancer survivors before and after a physical activity intervention: A retrospective cohort analysis. Gynecol Oncol 2016; 143:589-595. [PMID: 27678296 PMCID: PMC5116408 DOI: 10.1016/j.ygyno.2016.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Sexual dysfunction is common in endometrial cancer survivors (ECS). Our group previously tested a six-month exercise intervention in ECS. We performed a secondary analysis to determine intervention's impact on sexual health. METHODS We studied 100 post-treatment Stage I-IIIa sedentary ECS who participated in a non-controlled, single-arm, home-based exercise intervention utilizing telephone counseling, printed material, and pedometers. Quality-of-life and physical activity measures were collected at baseline and six months. Sexual function (SF) and sexual interest (SI) scores were extracted from the QLACS questionnaire. RESULTS Baseline SF and SI were lower in survivors with less than a four-year college degree (P<0.001). Baseline SI was higher in survivors who were married or living with a significant other (P=0.012). No significant differences in SF or SI were observed based on obesity status, race, time since diagnosis, or treatment type. Post-intervention, mean SF score improved (P=0.002), 51% of participants had improved SI, and 43% had improved SF. When controlled for age and time since diagnosis, a one-hour increase in weekly physical activity was associated with a 6.5% increased likelihood of improved SI (P=0.04). Increased physical activity was not associated with improved SF. CONCLUSIONS Although causation cannot be determined in this study, the correlation between receipt of an exercise intervention and improved sexual health for ECS is a novel finding. This finding suggests a role for physical activity as a strategy to improve the sexual health of ECS, which our group is examining in a larger prospective study.
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Affiliation(s)
- Shannon D Armbruster
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
| | - Jaejoon Song
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Andrea Bradford
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Cindy L Carmack
- Departments of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Karen H Lu
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Karen M Basen-Engquist
- Departments of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Laskey RA, McCarroll ML, von Gruenigen VE. Obesity-related endometrial cancer: an update on survivorship approaches to reducing cardiovascular death. BJOG 2016; 123:293-8. [PMID: 26841334 DOI: 10.1111/1471-0528.13684] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/28/2022]
Abstract
As the rate of obesity increases worldwide, so will the number of women diagnosed with obesity-related malignancy. The strongest correlation between obesity and cancer is endometrial cancer (EC). Obesity is the most significant modifiable risk factor for development of EC and also contributes to the most common cause of death in EC survivors-cardiovascular disease (CVD). Most cancer survivors after diagnosis do not implement lifestyle changes aimed at weight-loss and CVD risk reduction. This selective review highlights recent novel and unique approaches for managing CVD co-morbidities in EC survivorship.
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Affiliation(s)
| | - M L McCarroll
- Summa Health System, Akron, OH, USA.,Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - V E von Gruenigen
- Summa Health System, Akron, OH, USA.,Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
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Rossi A, Garber CE, Ortiz M, Shankar V, Goldberg GL, Nevadunsky NS. Feasibility of a physical activity intervention for obese, socioculturally diverse endometrial cancer survivors. Gynecol Oncol 2016; 142:304-10. [PMID: 27246303 DOI: 10.1016/j.ygyno.2016.05.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/20/2016] [Accepted: 05/27/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Determine the feasibility of a 12-week physical activity intervention for obese, socioculturally diverse endometrial cancer survivors and to evaluate whether the intervention improves physical activity behavior, physical function, waist circumference, and quality of life. METHODS Obese endometrial cancer survivors from Bronx, NY were assigned to either a 12-week physical activity intervention of behavioral counseling, physical activity and home-based walking (n=25), or wait-list control group (n=15). Mixed-design ANOVA (2 groups×2 time points) were analyzed to determine differences between the intervention and the control for the Yale Physical Activity Survey, six-minute walk test, 30-second chair stand test, waist circumference, and Functional Assessment of Cancer Therapy-Endometrial questionnaire. Data are presented as mean±standard deviation. RESULTS The sample was diverse (38% non-Hispanic black, 38% Hispanic, 19% non-Hispanic white). Mean Body Mass Index was 37.3±6.5kg·m(-2). Although recruitment rate was low (20% of 140 contacted), 15 of 25 participants in the intervention group attended 75-100% of scheduled sessions. Participants reported walking 118±79min/week at home. There were large effect sizes for the improvements in the six-minute walk test (22±17m vs. 1±22m, d=1.10), waist circumference (-5.3±5.3cm vs. 2.6±6.7cm, d=-1.32), quality of life (10±12 vs. -1±11, d=0.86) and walking self-efficacy (24±30% vs. 1±55%, d=0.87) compared to the control group. CONCLUSIONS The intervention appeared feasible in this population. The results show promising effects on several outcomes that should be confirmed in a larger randomized control trial, with more robust recruitment strategies.
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Affiliation(s)
- Amerigo Rossi
- Division of Athletic Training, Health and Exercise Science, Long Island University Brooklyn, 1 University Plaza, HS 311a, Brooklyn, NY 11238, USA; Department of Biobehavioral Sciences, Teachers College Columbia University, 525 West 120(th) Street, Box 93, New York, NY 10027, USA.
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College Columbia University, 525 West 120(th) Street, Box 93, New York, NY 10027, USA.
| | - Monica Ortiz
- Department of Health & Nutrition Sciences, Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY 11210, USA.
| | - Viswanathan Shankar
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue Bronx, NY 10461, USA.
| | - Gary L Goldberg
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Bronx, NY 10461, USA.
| | - Nicole S Nevadunsky
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Bronx, NY 10461, USA.
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Puszkiewicz P, Roberts AL, Smith L, Wardle J, Fisher A. Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application. JMIR Cancer 2016; 2:e7. [PMID: 28410168 PMCID: PMC5369632 DOI: 10.2196/cancer.5380] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/24/2016] [Accepted: 04/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population.
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Affiliation(s)
- Patrycja Puszkiewicz
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Anna L Roberts
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Lee Smith
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom.,The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
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Beavis AL, Smith AJB, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. Int J Womens Health 2016; 8:151-67. [PMID: 27284267 PMCID: PMC4883806 DOI: 10.2147/ijwh.s88367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Modifiable lifestyle factors, such as obesity, lack of physical activity, and smoking, contribute greatly to cancer and chronic disease morbidity and mortality worldwide. This review appraises recent evidence on modifiable lifestyle factors in the prevention of endometrial cancer (EC) and ovarian cancer (OC) as well as new evidence for lifestyle management of EC and OC survivors. For EC, obesity continues to be the strongest risk factor, while new evidence suggests that physical activity, oral contraceptive pills, and bariatric surgery may be protective against EC. Other medications, such as metformin and nonsteroidal anti-inflammatory drugs, may be protective, and interventional research is ongoing. For OC, we find increasing evidence to support the hypothesis that obesity and hormone replacement therapy increase the risk of developing OC. Oral contraceptive pills are protective against OC but are underutilized. Dietary factors such as the Mediterranean diet and alcohol consumption do not seem to affect the risk of either OC or EC. For EC and OC survivors, physical activity and weight loss are associated with improved quality of life. Small interventional trials show promise in increasing physical activity and weight maintenance for EC and OC survivors, although the impact on long-term health, including cancer recurrence and overall mortality, is unknown. Women's health providers should integrate counseling about these modifiable lifestyle factors into both the discussion of prevention for all women and the management of survivors of gynecologic cancers.
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Affiliation(s)
- Anna L Beavis
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
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Walker AJ, Benrubi ID, Ward KK. Care of survivors of gynecologic cancers. World J Obstet Gynecol 2016; 5:140-149. [DOI: 10.5317/wjog.v5.i2.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/16/2015] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.
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Dean LT, Zhang X, Latif N, Giuntoli R, Lin L, Haggerty A, Kim S, Shalowitz D, Stashwick C, Simpkins F, Burger R, Morgan M, Ko E, Schmitz K. Race-based disparities in loss of functional independence after hysterectomy for uterine cancer. Support Care Cancer 2016; 24:3573-80. [PMID: 27025595 DOI: 10.1007/s00520-016-3185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/21/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Racial disparities in uterine cancer-related outcomes have been reported. The goal of this study was to determine if race, pre-operative body mass index (BMI), and medical comorbidities are predictors of loss of functional independence after hysterectomy for uterine cancer. METHODS Loss of independence was defined as a change from pre-operative functional independence, to a post-operative requirement of discharge to a post-care facility, or death within the first 30 days following uterine cancer surgery. Demographic factors, comorbidities, BMI, intra-operative and post-operative outcomes, and discharge status were abstracted from the 2011 and 2012 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Statistical analyses included multivariable logistic regression and Wald tests for interaction. RESULTS A total of 4005 patients had uterine cancer and were functionally independent pre-operatively. After adjusting for clinical features and comorbidities, Black women were not significantly more likely to lose functional independence than non-Black women. However, a significant interaction (OR = 1.17, p < 0.001) was found between race and BMI for loss of functional independence. Interaction plots revealed worsening functional outcomes for Black women with BMI >40 but not in non-Blacks. CONCLUSIONS The interaction suggests a 17 % increased odds of losing independence for each unit of BMI difference for Black uterine cancer patients, or 170 % increased odds of losing independence for a 10-point increase in BMI, given a linear association. To reduce the likelihood of losing post-operative functional independence, Black, high-BMI patients with or at risk for uterine cancer may especially benefit from weight loss or interventions to optimize physical function.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Xiaochen Zhang
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nawar Latif
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Giuntoli
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lilie Lin
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Kim
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Shalowitz
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin Stashwick
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Fiona Simpkins
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Burger
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Morgan
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Ko
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn Schmitz
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA, USA
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Smits A, Lopes A, Das N, Bekkers R, Massuger L, Galaal K. Exercise Programme in Endometrial Cancer; Protocol of the Feasibility and Acceptability Survivorship Trial (EPEC-FAST). BMJ Open 2015; 5:e009291. [PMID: 26674498 PMCID: PMC4691724 DOI: 10.1136/bmjopen-2015-009291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Obesity has been associated with impaired quality of life and poorer outcomes in endometrial cancer survivors. Lifestyle interventions promoting exercise and weight reduction have been proposed for survivorship care. However, studies evaluating exercise programmes for endometrial cancer survivors are lacking. PURPOSE The objective of this study is to evaluate the feasibility of an individualised exercise intervention for endometrial cancer survivors to improve quality of life. METHODS AND ANALYSIS This is a feasibility study in which women will undergo a 10-week exercise programme with a personal trainer. The study population comprises women with confirmed diagnosis of endometrial cancer, who have completed surgical treatment with curative intent, and are aged 18 years or older. The study will take place at the Royal Cornwall Hospital Trust, UK. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes are quality of life, psychological distress, fatigue, pain and complication rates. In addition, the acceptability of the programme will be assessed. ETHICS AND DISSEMINATION Ethical approval was obtained through the Exeter NRES Committee. The study results will be used to optimise the intervention content, and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses, relevant clinical groups and presented on the Trust's website. TRIAL REGISTRATION NUMBER NCT02367950; pre-results.
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Affiliation(s)
- Anke Smits
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Alberto Lopes
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Nagindra Das
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Ruud Bekkers
- Department of Gynaecology, Radboud UMC, Nijmegen, The Netherlands
| | - Leon Massuger
- Department of Gynaecology, Radboud UMC, Nijmegen, The Netherlands
| | - Khadra Galaal
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
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The effect of lifestyle interventions on the quality of life of gynaecological cancer survivors: A systematic review and meta-analysis. Gynecol Oncol 2015; 139:546-52. [PMID: 26441008 DOI: 10.1016/j.ygyno.2015.10.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/02/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE We aimed to evaluate the effectiveness of lifestyle interventions in improving the quality of life (QoL) of endometrial and ovarian cancer survivors. METHODS The review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the Cochrane Handbook for Systematic Reviews of Interventions. We performed a search of MEDLINE (1946-2015), EMBASE (1980-2015), CINAHL (1981-2015), PsycINFO (1806-2015) and the Cochrane Trial Register to identify studies evaluating the effect of lifestyle interventions on the QoL of endometrial and ovarian cancer survivors. RESULTS Eight studies fulfilled the inclusion criteria and comprised a total of 413 patients. Three studies were randomised controlled trials (RCTs), which showed that lifestyle interventions may improve physical functioning and significantly reduce fatigue in endometrial cancer survivors. In addition, lifestyle interventions in endometrial cancer survivors resulted in significant weight loss and improved physical activity levels, but did not show improvements in global QoL in the meta-analysis (P=0.75, P=0.49). Non-randomised trials in ovarian cancer survivors support the feasibility of lifestyle interventions and suggest they may result in QoL improvements. CONCLUSIONS Lifestyle interventions have the potential to improve the QoL of endometrial cancer and ovarian cancer survivors, and may significantly reduce fatigue. However, the current evidence is limited and there is a need for future studies to further evaluate lifestyle interventions and their effect on QoL outcomes.
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Smits A, Smits E, Lopes A, Das N, Hughes G, Talaat A, Pollard A, Bouwman F, Massuger L, Bekkers R, Galaal K. Body mass index, physical activity and quality of life of ovarian cancer survivors: Time to get moving? Gynecol Oncol 2015; 139:148-54. [DOI: 10.1016/j.ygyno.2015.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 02/06/2023]
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Kurnit KC, Ward KK, McHale MT, Saenz CC, Plaxe SC. Increased prevalence of comorbid conditions in women with uterine cancer. Gynecol Oncol 2015; 138:731-4. [DOI: 10.1016/j.ygyno.2015.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 12/30/2022]
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Cardiorespiratory fitness in survivors of cervical, endometrial, and ovarian cancers: The Cooper Center Longitudinal Study. Gynecol Oncol 2015; 138:394-7. [PMID: 26026734 DOI: 10.1016/j.ygyno.2015.05.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/20/2015] [Accepted: 05/24/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF), a strong predictor of mortality, is impaired among cancer patients. There is limited data, however, regarding CRF levels in women diagnosed with gynecologic cancers. METHODS We compared CRF among ovarian, endometrial, and cervical cancer cases (n=89) to age-matched controls (n=89) in the Cooper Center Longitudinal Study (CCLS). CRF was evaluated by a maximal treadmill exercise tolerance test using a modified-Balke protocol. Conditional logistic regression was used to test for case-control differences in cardiorespiratory fitness, after controlling for age and body mass index, and adhering to the matched pairs design. RESULTS The mean ages of cancer cases and controls were 50.9 years and 51.1 years, respectively (p=0.81). Peak METs (1 MET=3.5 mL kg(-1)min(-1)) were 9.2 ± 2.0 in cancer cases compared to 10.0 ± 2.2 in controls (p=0.03). When stratifying by type of cancer, peak METs were 8.9 ± 2.2, 8.4 ± 1.9, 9.5 ± 2.0 for patients with ovarian, endometrial, and cervical cancer, respectively. A gynecological cancer diagnosis was associated with greater odds of having 1-MET lower CRF compared to controls (OR 1.31, 95% CI: 1.05-1.64, p=0.018), after controlling for age and BMI. CONCLUSION Gynecologic cancer survivors were more likely to have a 1-MET lower CRF than controls. Given a 1-MET change in CRF is associated with a significant, we advocate for more robust research regarding CRF in gynecologic cancer patients.
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Benedetto C, Salvagno F, Canuto EM, Gennarelli G. Obesity and female malignancies. Best Pract Res Clin Obstet Gynaecol 2015; 29:528-40. [DOI: 10.1016/j.bpobgyn.2015.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 12/26/2022]
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Stabile C, Gunn A, Sonoda Y, Carter J. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer. Transl Androl Urol 2015; 4:169-85. [PMID: 26816823 PMCID: PMC4708131 DOI: 10.3978/j.issn.2223-4683.2015.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention.
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Abstract
UNLABELLED There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management. METHODS This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors. RESULTS The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort. CONCLUSIONS Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.
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Affiliation(s)
- David O Garcia
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
| | - Cynthia A Thomson
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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Subgroup effects in a randomised trial of different types and doses of exercise during breast cancer chemotherapy. Br J Cancer 2014; 111:1718-25. [PMID: 25144625 PMCID: PMC4453726 DOI: 10.1038/bjc.2014.466] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/21/2014] [Accepted: 07/26/2014] [Indexed: 12/31/2022] Open
Abstract
Background: The Combined Aerobic and Resistance Exercise Trial tested different types and doses of exercise in breast cancer patients receiving chemotherapy. Here, we explore potential moderators of the exercise training responses. Methods: Breast cancer patients initiating chemotherapy (N=301) were randomly assigned to three times a week, supervised exercise of a standard dose of 25–30 min of aerobic exercise, a higher dose of 50–60 min of aerobic exercise, or a higher dose of 50–60 min of combined aerobic and resistance exercise. Outcomes were patient-reported symptoms and health-related fitness. Moderators were baseline demographic, exercise/fitness, and cancer variables. Results: Body mass index moderated the effects of the exercise interventions on bodily pain (P for interaction=0.038), endocrine symptoms (P for interaction=0.029), taxane/neuropathy symptoms (P for interaction=0.013), aerobic fitness (P for interaction=0.041), muscular strength (P for interaction=0.007), and fat mass (P for interaction=0.005). In general, healthy weight patients responded better to the higher-dose exercise interventions than overweight/obese patients. Menopausal status, age, and baseline fitness moderated the effects on patient-reported symptoms. Premenopausal, younger, and fitter patients achieved greater benefits from the higher-dose exercise interventions. Conclusions: Healthy weight, fitter, and premenopausal/younger breast cancer patients receiving chemotherapy are more likely to benefit from higher-dose exercise interventions.
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