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Wilson OWA, Wojcik KM, Kamil D, Gorzelitz J, Butera G, Matthews CE, Jayasekera J. The associations of muscle-strengthening exercise with recurrence and mortality among breast cancer survivors: a systematic review. Int J Behav Nutr Phys Act 2024; 21:100. [PMID: 39256770 PMCID: PMC11389293 DOI: 10.1186/s12966-024-01644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/14/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Our systematic review aimed to critically evaluate empirical literature describing the association of muscle-strengthening exercise (MSE) with recurrence and/or mortality among breast cancer survivors. METHODS We included English-language empirical research studies examining the association between MSE and recurrence and/or mortality among females diagnosed with breast cancer. Seven databases (MEDLINE, PsycINFO, Embase, Scopus, Web of Science, Cochrane CENTRAL, and CINAHL) were searched in September 2023. Quality was appraised using the Mixed Methods Appraisal Tool. Results are summarized descriptively. RESULTS Five sources were identified. MSE measurement differed in relation to the description of the MSE (i.e., muscle-strengthening vs. strength training), examples of activities (e.g., sit-ups or push-ups vs. calisthenics vs. circuit training), and exercise frequency (i.e., days vs. times/week). Findings offer provisional evidence that some MSE may lower the hazards of recurrence and mortality. This association may vary by race, weight status, and menopausal status. CONCLUSIONS In summary, limited available evidence suggests that MSE may lower the hazards of recurrence and mortality. More consistent measurement and analyses would help generate findings that are more readily comparable and applicable to inform clinical practice. Further research is needed to improve understanding of the strength and differences of these associations among underserved and underrepresented women.
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Affiliation(s)
- Oliver W A Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute of on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kaitlyn M Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute of on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute of on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Jessica Gorzelitz
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute of on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA.
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Soldato D, Michiels S, Havas J, Di Meglio A, Pagliuca M, Franzoi MA, Pistilli B, Iyengar NM, Cottu P, Lerebours F, Coutant C, Bertaut A, Tredan O, Vanlemmens L, Jouannaud C, Hrab I, Everhard S, Martin AL, André F, Vaz-Luis I, Jones LW. Dose/Exposure Relationship of Exercise and Distant Recurrence in Primary Breast Cancer. J Clin Oncol 2024; 42:3022-3032. [PMID: 38838281 PMCID: PMC11361355 DOI: 10.1200/jco.23.01959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE Postdiagnosis exercise is associated with lower breast cancer (BC) mortality but its link with risk of recurrence is less clear. We investigated the impact and dose-response relationship of exercise and recurrence in patients with primary BC. METHODS Multicenter prospective cohort analysis among 10,359 patients with primary BC from 26 centers in France between 2012 and 2018 enrolled in the CANcer TOxicities study, with follow-up through October 2021. Exercise exposure was assessed using the Global Physical Activity Questionnaire-16, quantified in standardized metabolic equivalent of task-hours per week (MET-h/wk). We examined the dose/exposure response of pretreatment exercise on distant recurrence-free interval (DRFI) for all patients and stratified by clinical subtype and menopausal status using inverse probability treatment weighted multivariable Cox models to estimate hazard ratios (HRs). RESULTS For the overall cohort, the relationship between exercise and DRFI was nonlinear: increasing exercise ≥ 5 MET-h/wk was associated with an inverse linear reduction in DRFI events up to approximately 25 MET-h/wk; increasing exercise over this threshold did not provide any additional DRFI benefit. Compared with <5 MET-h/wk, the adjusted HR for DRFI was 0.82 (95% CI, 0.61 to 1.00) for ≥ 5 MET-h/wk. Stratification by subtype revealed the hormone receptor-/human epidermal growth factor receptor 2- (HR-/HER2-; HR, 0.59 [95% CI, 0.38 to 0.92]) and HR-/HER2+ (HR, 0.37 [95% CI, 0.14 to 0.96]) subtypes were preferentially responsive to exercise. The benefit of exercise was observed especially in the premenopausal population. CONCLUSION Postdiagnosis/pretreatment exercise is associated with lower risk of DRFI events in a nonlinear fashion in primary BC; exercise has different impact on DRFI as a function of subtype and menopausal status.
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Affiliation(s)
- Davide Soldato
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- INSERM U1018 CESP, Service de Biostatistique et d’Epidemiologie, Institut Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | - Martina Pagliuca
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
- Division of Breast Medical Oncology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Maria Alice Franzoi
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
| | | | - Neil M. Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Iona Hrab
- Centre François Baclesse, Caen, France
| | | | | | - Fabrice André
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- INSERM U981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy, Villejuif, France
- Medical Oncology Department, Gustave Roussy, Villejuif, France
- Supportive Care and Pathways Department (DIOPP), Gustave Roussy, Villejuif, France
| | - Lee W. Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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3
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Xu J, Jiao X, Bayat R. Outcomes of physical exercises on initiation, progression, and treatment of breast cancer. Cell Commun Signal 2024; 22:260. [PMID: 38715015 PMCID: PMC11075339 DOI: 10.1186/s12964-024-01634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
The emergence of drug resistance is a substantial obstacle to the effective management of breast cancer, which is the primary cause of cancer-related deaths in women worldwide. To facilitate the development of targeted therapies that can effectively overcome drug resistance, it is crucial to possess a comprehensive comprehension of the molecular mechanisms that underpin resistance to breast cancer treatment. So far, considerable progress has been made in the field of exercise-oncology research and overcome drug resistance, specifically about breast cancer. Evidence has suggested that participation in physical activity is correlated with a decrease in reappearance and fatality rates of breast cancer patients. It has been reported that participation in physical activity can yield favorable outcomes in the prevention, treatment, and post-treatment of breast cancer. An increasing body of empirical evidence suggests that participation in physical activity can alter diverse biological mechanisms, potentially augmenting breast cancer treatments' efficacy. Comparing increased physical activity versus reduced physical activity in breast cancer patients who received chemotherapy, radiotherapy, and surgery supported the significance of exercise in comprehensive care strategies to enhance overall health and treatment efficacy. Furthermore, previous studies have reported that physical activity can enhance the efficacy of breast cancer treatments. This review provides the current literature regarding the influence of physical activity on the occurrence and progression of breast cancer.
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Affiliation(s)
- Junwei Xu
- Physical education institute, Henan University of Economics and Law, Zhengzhou, China.
| | - Xiance Jiao
- College of Continuing Education, Henan Quality Polytechnic, Pingdingshan, China
| | - Reyhaneh Bayat
- Department of General Surgery, Shahid Beheshti University of Medical Science and Health Services, Taleghani Hospital, Tehran, Iran.
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Marino P, Mininni M, Deiana G, Marino G, Divella R, Bochicchio I, Giuliano A, Lapadula S, Lettini AR, Sanseverino F. Healthy Lifestyle and Cancer Risk: Modifiable Risk Factors to Prevent Cancer. Nutrients 2024; 16:800. [PMID: 38542712 PMCID: PMC10974142 DOI: 10.3390/nu16060800] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 08/07/2024] Open
Abstract
Cancer has become a serious problem worldwide, as it represents the main cause of death, and its incidence has increased over the years. A potential strategy to counter the growing spread of various forms of cancer is the adoption of prevention strategies, in particular, the use of healthy lifestyles, such as maintaining a healthy weight, following a healthy diet; being physically active; avoiding smoking, alcohol consumption, and sun exposure; and vitamin D supplementation. These modifiable risk factors are associated with this disease, contributing to its development, progression, and severity. This review evaluates the relationship between potentially modifiable risk factors and overall cancer development, specifically breast, colorectal, and prostate cancer, and highlights updated recommendations on cancer prevention. The results of numerous clinical and epidemiological studies clearly show the influence of lifestyles on the development and prevention of cancer. An incorrect diet, composed mainly of saturated fats and processed products, resulting in increased body weight, combined with physical inactivity, alcohol consumption, and smoking, has induced an increase in the incidence of all three types of cancer under study. Given the importance of adopting correct and healthy lifestyles to prevent cancer, global institutions should develop strategies and environments that encourage individuals to adopt healthy and regular behaviors.
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Affiliation(s)
- Pasquale Marino
- Unit of Oncological Gynecology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (G.D.); (F.S.)
| | - Mariangela Mininni
- Department Direzione Generale per la Salute e le Politiche della Persona, Regione Basilicata, Via Vincenzo Verrastro, 4, 85100 Potenza, Italy;
| | - Giovanni Deiana
- Unit of Oncological Gynecology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (G.D.); (F.S.)
| | - Graziella Marino
- Unit of Breast Surgery, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Potenza, Italy;
| | - Rosa Divella
- Nutritionist’s Studio at the Gravina in Puglia, C.so Giuseppe Di Vittorio, 14, 70024 Bari, Italy;
| | - Ilaria Bochicchio
- Unit of Clinical Psychology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (I.B.); (A.G.); (S.L.); (A.R.L.)
| | - Alda Giuliano
- Unit of Clinical Psychology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (I.B.); (A.G.); (S.L.); (A.R.L.)
| | - Stefania Lapadula
- Unit of Clinical Psychology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (I.B.); (A.G.); (S.L.); (A.R.L.)
| | - Alessandro Rocco Lettini
- Unit of Clinical Psychology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (I.B.); (A.G.); (S.L.); (A.R.L.)
| | - Francesca Sanseverino
- Unit of Oncological Gynecology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio, 1, 85028 Potenza, Italy; (G.D.); (F.S.)
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Czenczek-Lewandowska E, Szeliga E, Leszczak J. The effect of aquatic and land exercise on the mental well-being of women following breast cancer surgery-comparative study. Breast Cancer Res Treat 2023; 202:585-593. [PMID: 37665473 PMCID: PMC10564663 DOI: 10.1007/s10549-023-07088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Women after surgical treatment of breast cancer are less likely to engage in physical activity and may exhibit depressive symptoms even for many years post-treatment. The aim of the study was to compare the impact of 6 months aquatic and land exercise on mental well-being of women after breast cancer surgery. METHODS The study was based on a survey which involved a total of 90 women ≥ 50 years of age (including 60 subjects after treatment of breast cancer ≥ 2 years after surgery and 30 healthy control). The study participants were divided into three groups, i.e. women attending general exercise sessions in a gym (A, n = 30), participating in aquatic exercise (B, n = 30), as well as healthy female peers reporting no regular physical exercise for the period of 6 months (C, n = 30). The present data were acquired using standardized questionnaires designed to assess physical activity (IPAQ-SF), mental well-being (WHO-5) and level of anxiety, i.e., Generalized Anxiety Disorder Questionnaire (GAD-7). RESULTS Both the aquatic and land exercise had positive effect on mental well-being of woman after breast cancer surgery and there were no significant differences between them. Analysis of the anxiety level (GAD-7) confirms that women after breast cancer treatment were more exposed to a feeling of generalised anxiety disorder, i.e. 8.67 vs. 6.73, 4.5 (p = 0.001). The results of WHO-5 index were significantly higher in the A and B groups comparing to healthy control, i.e. 13.27 vs. 14.18; 10.10 (p < 0.001), but the obtained results still indicate the low self-esteem of the study group. Women after breast cancer surgery who regularly participated in aquatic exercise were engaged in more vigorous physical activity compared to the other groups, i.e. 1049.33 vs. 521.33; 860.00 MET min/week (p = 0.001). CONCLUSION Regardless of the type of physical activity, 6 months aquatic and land exercise contributed to improved mental well-being and ensured adequate levels of moderate physical activity of woman after BC surgery. Regular physical activity is crucial in the rehabilitation after mastectomy and can be an effective treatment to achieve beneficial mental outcomes.
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Affiliation(s)
| | - Ewa Szeliga
- Institute of Health Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
| | - Justyna Leszczak
- Institute of Health Sciences, Medical College, University of Rzeszow, Rzeszow, Poland
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6
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Bantum EO, Yamada PM, Makolo T, Yu H, Pagano I, Subia N, Walsh C, Loo LWM. Hula as a physical activity and social support intervention for sustained activity in female breast and gynecologic cancer survivors. Front Psychol 2023; 14:1190532. [PMID: 37941759 PMCID: PMC10629222 DOI: 10.3389/fpsyg.2023.1190532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/07/2023] [Indexed: 11/10/2023] Open
Abstract
Background Physical activity improves health and psychosocial functioning for people who have been diagnosed with cancer. Native Hawaiians face disparities for some cancers, including breast cancer. Delivering culturally grounded interventions has the potential to improve enjoyment and adherence to the intervention. We sought to test the adherence and impact of a 6 month randomized wait-list controlled trial of hula. Methods In this randomized wait-list controlled design people who had been diagnosed with breast or gynecologic cancers were invited to participate with other cancer survivors in a group based setting. Participants were randomized to begin hula immediately or after six months. Attendance was collected and heart-rate measured three times per session. In addition, demographic data, self-report psychosocial data, and biological data (findings will be reported elsewhere) were collected at three time points: baseline, 6 months, and 12 months. The study included six months of hula, twice per week, 60 min each session. In addition, participants committed to practice 60 min per week at home. Results Participants in the study (n = 42) attended, on average, 72% of the sessions. Significant increase in moderate physical activity (d = 0.50, p = 0.03) was observed in the intervention versus control group. For the measures of intra-individual changes pre-and post-intervention, an increase in total physical activity were seen in the intervention group (d = 0.69, p = 0.003), daily caloric intake decreased (d = -0.62, p = 0.007), and a reduction in waist circumference (d = -0.89, p = 0.0002) that was sustained six months after completion of the intervention. Psychosocially, cognitive functioning significantly declined from baseline to 12 months (d = -0.50, p = 0.03), with role functioning improving (d = 0.55, p = 0.02), social constraints increasing (d = 0.49, p = 0.03), and financial difficulties improving (d = -0.55, p = 0.02). Conclusion Sustainable physical activity is crucial to improve both the survival and quality of life of cancer survivors. Culturally grounded interventions, such as hula have the potential to increase the maintenance of physical activity. In addition, they create a support group where the benefits of people who have all experienced cancer can gather and garner those benefits of social support, too. This study was registered as a clinical trial through the National Cancer Institute (NCT02351479). Clinical trial registration Clinicaltrails.gov, NCT02351479.
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Affiliation(s)
- Erin O. Bantum
- Cancer Prevention in the Pacific, Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Paulette M. Yamada
- Kinesiology and Rehabilitation Science, College of Education, University of Hawaii at Manoa, Honolulu, HI, United States
| | - TeMoana Makolo
- Cancer Prevention in the Pacific, Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Herbert Yu
- Cancer Epidemiology, Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Ian Pagano
- Cancer Prevention in the Pacific, Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Natalie Subia
- Cancer Epidemiology, Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Catherine Walsh
- Cancer Epidemiology, Population Sciences in the Pacific, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Lenora W. M. Loo
- Cancer Biology Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, United States
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7
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Puklin LS, Harrigan M, Cartmel B, Sanft T, Gottlieb L, Zhou B, Ferrucci LM, Li FY, Spiegelman D, Sharifi M, Irwin ML. Randomized Trial Evaluating a Self-Guided Lifestyle Intervention Delivered via Evidence-Based Materials versus a Waitlist Group on Changes in Body Weight, Diet Quality, Physical Activity, and Quality of Life among Breast Cancer Survivors. Cancers (Basel) 2023; 15:4719. [PMID: 37835412 PMCID: PMC10571774 DOI: 10.3390/cancers15194719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Lifestyle interventions for breast cancer survivors have proved effective at stimulating positive behavior change and promoting healthy weight loss, although integrating these programs into clinical practice is challenging. We evaluated the effect of a 6-month, unsupervised, self-guided, lifestyle intervention using printed materials and online videos vs. waitlist group on body weight for breast cancer survivors. Methods: The Lifestyle, Exercise and Nutrition (LEAN) Self-Guided trial randomized breast cancer survivors with a body mass index ≥25 kg/m2 to a 6-month lifestyle intervention (N = 102) or waitlist group (N = 103). Effects of the intervention on self-reported body weight, physical activity (PA), diet quality (via Health Eating Index-2010 (HEI-2010)), and quality of life were assessed using mixed model repeated measures analysis. Results: At 6 months, the intervention arm had significantly greater weight loss compared with the waitlist group (mean difference = -1.3 kg, 95% confidence interval [CI] = -2.5, -0.13). We observed suggestive improvements in PA (mean difference = 18.7 min/week, 95% CI = -24.2, 61.6), diet quality (mean difference in HEI = 3.2 points, 95% CI = -0.20, 6.5), and fatigue (mean difference in Functional Assessment of Chronic Illness Therapy-Fatigue scale = 1.4 points, 95% CI = -1.1, 3.9). Conclusions: The LEAN Self-Guided intervention led to favorable weight changes over 6 months. Low-resource-intensive programs have the potential to be delivered in diverse healthcare settings and may support breast cancer survivors in achieving a healthy body weight.
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Affiliation(s)
- Leah S. Puklin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Maura Harrigan
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT 06510, USA
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Linda Gottlieb
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
| | - Bin Zhou
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Leah M. Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Fang-Yong Li
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Donna Spiegelman
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
| | - Mona Sharifi
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Melinda L. Irwin
- Yale School of Public Health, Yale University, New Haven, CT 06510, USA; (L.S.P.); (L.M.F.); (F.-Y.L.)
- Yale Cancer Center, New Haven, CT 06510, USA
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Darmochwal S, Bischoff C, Thieme R, Gockel I, Tegtbur U, Hillemanns P, Schulze A, Voss J, Falz R, Busse M. Impact of home-based training and nutritional behavior on body composition and metabolic markers in cancer patients: data from the CRBP-TS study. Front Nutr 2023; 10:1152218. [PMID: 37794972 PMCID: PMC10546323 DOI: 10.3389/fnut.2023.1152218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Obesity and physical inactivity are known to affect cancer's development and prognosis. In this context, physical aerobic and resistance training as well as a Mediterranean nutrition have been proven to have many positive health effects. The aim of this study was therefore to investigate the effect of home-based training on body composition and certain metabolic laboratory parameters. Methods Patients with breast, colorectal and prostate cancer who underwent curative surgery at stages T1N0M0-T3N3M0 were eligible for this trial and randomized to an intervention and control group. In the intervention group the patients carried out online-based strength-endurance home training during the 6-month study period. Body composition was assessed via bioelectrical impedance analysis (baseline, 3 months and 6 months). Metabolic blood parameters were also analyzed and nutrition behavior determined using the Mediterranean Diet Adherence Screener (MEDAS). Results The intervention group's fat mass decreased while their lean body mass increased (time effect p = 0.001 and p = 0.001, respectively). We found no interaction effect in body weight (p = 0.19), fat mass [p = 0.06, 6-months estimates -0.9 (95% CI -1.8 to -0.1)] and lean body mass (p = 0.92). Blood samples also failed to show a statistically significant interaction effect between time × group for HbA1c% (p = 0.64), Insulin (p = 0.33), Adiponectin (p = 0.87), Leptin (p = 0.52) and Triglycerides (p = 0.43). Only Adiponectin revealed significance in the time effect (p < 0.001) and Leptin in the group effect (p = 0.03). Dietary behavior during the study period was similar in patients in the intervention and control groups (interaction p = 0.81; group p = 0.09 and time p = 0.03). Discussion Individualized online-based home training in postoperative cancer patients revealed only minor changes, with no group differences in body composition or metabolic laboratory parameters, which were predominantly in the reference range at baseline. More studies investigating effects of online-based home training on body composition and nutrition behavior are needed. Trial registration https://drks.de/search/en/trial/DRKS00020499, DRKS-ID: DRKS00020499.
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Affiliation(s)
- Sophia Darmochwal
- Institute of Sport Medicine and Prevention, University Leipzig, Leipzig, Germany
| | - Christian Bischoff
- Institute of Sport Medicine and Prevention, University Leipzig, Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Tegtbur
- Department of Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Antina Schulze
- Institute of Sport Medicine and Prevention, University Leipzig, Leipzig, Germany
| | - Johannes Voss
- Institute of Sport Medicine and Prevention, University Leipzig, Leipzig, Germany
| | - Roberto Falz
- Institute of Sport Medicine and Prevention, University Leipzig, Leipzig, Germany
| | - Martin Busse
- Institute of Sport Medicine and Prevention, University Leipzig, Leipzig, Germany
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Falz R, Bischoff C, Thieme R, Tegtbur U, Hillemanns P, Stolzenburg JU, Aktas B, Bork U, Weitz J, Lässing J, Leps C, Voß J, Lordick F, Schulze A, Gockel I, Busse M. Effect of home-based online training and activity feedback on oxygen uptake in patients after surgical cancer therapy: a randomized controlled trial. BMC Med 2023; 21:293. [PMID: 37553660 PMCID: PMC10408062 DOI: 10.1186/s12916-023-03010-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Exercise training is beneficial in enhancing physical function and quality of life in cancer patients. Its comprehensive implementation remains challenging, and underlying cardiopulmonary adaptations are poorly investigated. This randomized controlled trial examines the implementation and effects of home-based online training on cardiopulmonary variables and physical activity. METHODS Of screened post-surgical patients with breast, prostate, or colorectal cancer, 148 were randomly assigned (1:1) to an intervention (2 × 30 min/week of strength-endurance training using video presentations) and a control group. All patients received activity feedback during the 6-month intervention period. Primary endpoint was change in oxygen uptake after 6 months. Secondary endpoints included changes in cardiac output, rate pressure product, quality of life (EORTC QoL-C30), C-reactive protein, and activity behavior. RESULTS One hundred twenty-two patients (62 intervention and 60 control group) completed the study period. Change in oxygen uptake between intervention and control patients was 1.8 vs. 0.66 ml/kg/min (estimated difference after 6 months: 1.24; 95% CI 0.23 to 2.55; p = 0.017). Rate pressure product was reduced in IG (estimated difference after 6 months: - 1079; 95% CI - 2157 to - 1; p = 0.05). Physical activity per week was not different in IG and CG. There were no significant interaction effects in body composition, cardiac output, C-reactive protein, or quality of life. CONCLUSIONS Home-based online training among post-surgery cancer patients revealed an increase of oxygen uptake and a decrease of myocardial workload during exercise. The implementation of area-wide home-based training and activity feedback as an integral component in cancer care and studies investigating long-term effects are needed. TRIAL REGISTRATION DRKS-ID: DRKS00020499 ; Registered 17 March 2020.
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Affiliation(s)
- Roberto Falz
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 30, Leipzig, 04103, Germany.
| | - Christian Bischoff
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 30, Leipzig, 04103, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Tegtbur
- Institute of Sport Medicine, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | | | - Bahriye Aktas
- Department of Gynaecology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Bork
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
| | - Johannes Lässing
- Institute of Exercise Science & Sports Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Christian Leps
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 30, Leipzig, 04103, Germany
| | - Johannes Voß
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 30, Leipzig, 04103, Germany
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Antina Schulze
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 30, Leipzig, 04103, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Busse
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 30, Leipzig, 04103, Germany
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10
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Troeschel AN, Hartman TJ, McCullough LE, Ergas IJ, Collin LJ, Kwan ML, Ambrosone CB, Flanders WD, Bradshaw PT, Feliciano EMC, Roh JM, Wang Y, Valice E, Kushi LH. Associations of Post-Diagnosis Lifestyle with Prognosis in Women with Invasive Breast Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:963-975. [PMID: 37079336 PMCID: PMC10330263 DOI: 10.1158/1055-9965.epi-22-1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/03/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Lifestyle habits can impact breast cancer development, but its impact on breast cancer prognosis remains unclear. We investigated associations of post-diagnosis lifestyle with mortality and recurrence in 1,964 women with invasive breast cancer enrolled in the Kaiser Permanente Northern California Pathways Study shortly after diagnosis with lifestyle information at baseline (2005-2013) and the 2-year follow-up. METHODS We calculated a post-diagnosis lifestyle score (range, 0-18) based on 9 diet, physical activity, and body weight recommendations from the American Cancer Society/American Society of Clinical Oncology (ACS/ASCO) using follow-up data (body weight also included baseline data); higher scores indicate greater guideline concordance. Similarly, we calculated a pre-diagnosis lifestyle score using baseline data to investigate pre- to post-diagnosis changes. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazard models, with follow-up through December 2018 (observing 290 deaths and 176 recurrences). RESULTS The 2-year post-diagnosis lifestyle score was inversely associated with all-cause mortality (ACM; HR per 2-point increase = 0.90; 95% CI, 0.82-0.98), and breast cancer-related mortality (HR, 0.79; 95% CI, 0.67-0.95), but not recurrence. Relative to women who maintained low concordance with recommendations at both time points, women who maintained high concordance had a lower risk of ACM (HR, 0.61, 95% CI, 0.37-1.03). Improved concordance with some specific recommendations (particularly PA) may be associated with a lower hazard of ACM (HRPA, 0.52; 95% CI, 0.35-0.78). CONCLUSIONS Results suggest that women with breast cancer may benefit from a post-diagnosis lifestyle aligned with ACS/ASCO guidelines. IMPACT This information may potentially guide lifestyle recommendations for breast cancer survivors to reduce mortality risk.
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Affiliation(s)
- Alyssa N. Troeschel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Terryl J. Hartman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Isaac J. Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lindsay J. Collin
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Patrick T. Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | | | - Janise M. Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Ying Wang
- Department of Population Science, American Cancer Society, Atlanta, GA
| | - Emily Valice
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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11
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Petrigna L, Zanghì M, Maugeri G, D'Agata V, Musumeci G. Methodological consideration for a physical activity intervention in breast cancer population: An umbrella review. Heliyon 2023; 9:e17470. [PMID: 37455988 PMCID: PMC10338308 DOI: 10.1016/j.heliyon.2023.e17470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Breast cancer patients and survivors are increasing in the last years such as their mean age. A feasible and useful complementary intervention to improve physical and psychological health, and decrease some disease symptoms seems to be physical activity. Consequently, this umbrella review wanted to analyze the protocols of different physical activity interventions and to eventually propose a standard operating procedure for possible exercise training in breast cancer patients.Design, Data sources, Eligibility criteria. The electronic databases PubMed, Scopus, and Web of Science were searched till 25 March 2022 to detect all systematic review and meta-analysis of randomized controlled trials on this topic. The studies were analyzed narratively and evaluated with a scale to assess their quality. Results The studies presented heterogeneity in their population included in terms of disease stage and treatments, intervention protocols and outcomes evaluated. This made difficult to synthesize the findings. Conclusion It was not possible to propose a standard operating procedure but some indications were proposed to provide feedback for future studies. Ideally, an intervention should be composed of combined training (aerobic and resistance training) with a component of a mindfulness intervention, with an intensity from moderate to high, and 3 times a week. The intervention should be supervised in the first period and then it could be home-based. Exercise training should be personalized to the patients treated.
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Affiliation(s)
- Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Marta Zanghì
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Velia D'Agata
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
- Department of Biology, College of Science and Technology, Sbarro Health Research Organization, Temple University, Philadelphia, PA, 19122, USA
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12
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Soldato D, Arecco L, Agostinetto E, Franzoi MA, Mariamidze E, Begijanashvili S, Brunetti N, Spinaci S, Solinas C, Vaz-Luis I, Di Meglio A, Lambertini M. The Future of Breast Cancer Research in the Survivorship Field. Oncol Ther 2023; 11:199-229. [PMID: 37005952 PMCID: PMC10260743 DOI: 10.1007/s40487-023-00225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.
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Affiliation(s)
- D Soldato
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - E Agostinetto
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M A Franzoi
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital Tbilisi, Tbilisi, Georgia
| | - N Brunetti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - S Spinaci
- Division of Breast Surgery, Villa Scassi Hospital, Genoa, Italy
| | - C Solinas
- Medical Oncology, AOU Cagliari, Policlinico Duilio Casula, Monserrato, Italy
| | - I Vaz-Luis
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, Institut National de la Sante et de la Recherche Medicale Unit 981, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy.
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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13
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Cannioto RA, Attwood KM, Davis EW, Mendicino LA, Hutson A, Zirpoli GR, Tang L, Nair NM, Barlow W, Hershman DL, Unger JM, Moore HCF, Isaacs C, Hobday TJ, Hortobagyi GN, Gralow JR, Albain KS, Budd GT, Ambrosone CB. Adherence to Cancer Prevention Lifestyle Recommendations Before, During, and 2 Years After Treatment for High-risk Breast Cancer. JAMA Netw Open 2023; 6:e2311673. [PMID: 37140922 PMCID: PMC10160875 DOI: 10.1001/jamanetworkopen.2023.11673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Importance The American Institute for Cancer Research and American Cancer Society regularly publish modifiable lifestyle recommendations for cancer prevention. Whether these recommendations have an impact on high-risk breast cancer survival remains unknown. Objective To investigate whether adherence to cancer prevention recommendations before, during, and 1 and 2 years after breast cancer treatment was associated with disease recurrence or mortality. Design, Setting, and Participants The Diet, Exercise, Lifestyles, and Cancer Prognosis Study (DELCaP) was a prospective, observational cohort study designed to assess lifestyles before diagnosis, during treatment, and at 1 and 2 years after treatment completion, implemented ancillary to the Southwest Oncology Group (SWOG) S0221 trial, a multicenter trial that compared chemotherapy regimens in breast cancer. Participants were chemotherapy-naive patients with pathologic stage I to III high-risk breast cancer, defined as node-positive disease with hormone receptor-negative tumors larger than 1 cm or any tumor larger than 2 cm. Patients with poor performance status and comorbidities were excluded from S0221. The study was conducted from January 1, 2005, to December 31, 2010; mean (SD) follow-up time for those not experiencing an event was 7.7 (2.1) years through December 31, 2018. The analyses reported herein were performed from March 2022 to January 2023. Exposure An aggregated lifestyle index score comprising data from 4 time points and 7 lifestyles, including (1) physical activity, (2) body mass index, (3) fruit and vegetable consumption, (4) red and processed meat intake, (5) sugar-sweetened beverage consumption, (6) alcohol consumption, and (7) smoking. Higher scores indicated healthier lifestyle. Main Outcomes and Measures Disease recurrence and all-cause mortality. Results A total of 1340 women (mean [SD] age, 51.3 [9.9] years) completed the baseline questionnaire. Most patients were diagnosed with hormone-receptor positive breast cancer (873 [65.3%]) and completed some education beyond high school (954 [71.2%]). In time-dependent multivariable analyses, patients with highest vs lowest lifestyle index scores experienced a 37.0% reduction in disease recurrence (hazard ratio, 0.63; 95% CI, 0.48-0.82) and a 58.0% reduction in mortality (hazard ratio, 0.42; 95% CI, 0.30-0.59). Conclusions and Relevance In this observational study of patients with high-risk breast cancer, strongest collective adherence to cancer prevention lifestyle recommendations was associated with significant reductions in disease recurrence and mortality. Education and implementation strategies to help patients adhere to cancer prevention recommendations throughout the cancer care continuum may be warranted in breast cancer.
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Affiliation(s)
- Rikki A. Cannioto
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kristopher M. Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Evan W. Davis
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lucas A. Mendicino
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alan Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gary R. Zirpoli
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Li Tang
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Nisha M. Nair
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - William Barlow
- Southwest Oncology Group Statistics and Data Management Center, Fred Hutchinson Cancer Center, University of Washington, Seattle
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
| | - Joseph M. Unger
- Southwest Oncology Group Statistics and Data Management Center, Fred Hutchinson Cancer Center, University of Washington, Seattle
| | - Halle C. F. Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Timothy J. Hobday
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Gabriel N. Hortobagyi
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Julie R. Gralow
- Fred Hutchinson Cancer Center and the Seattle Cancer Care Alliance, University of Washington, Seattle-
| | - Kathy S. Albain
- Division of Hematology/Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - G. Thomas Budd
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Christine B. Ambrosone
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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14
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Min J, Yeon S, Ryu J, Kim JY, Yang EJ, Kim SI, Park S, Jeon JY. Shoulder function and health outcomes in newly diagnosed breast cancer patients receiving surgery: a prospective study. Clin Breast Cancer 2023; 23:e247-e258. [PMID: 36990840 DOI: 10.1016/j.clbc.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Breast cancer surgery is associated with upper-body morbidities that may last several years postsurgery. Research has not determined if the type of surgery leads to differential effects on shoulder function, activity levels, and QoL during the early rehabilitation period. The main objective of this study is to examine changes in shoulder function, health, and fitness outcomes from the day before to surgery to 6 months postsurgery. PATIENTS AND METHODS We recruited breast cancer patients (N = 70) scheduled to receive breast cancer surgery at Severance Hospital in Seoul to participate in this prospective study. Shoulder range of motion (ROM) and upper body strength, the disabilities of Arm, Shoulder, and Hand (quick-DASH), body composition, physical activity levels, and QoL were measured at baseline (presurgery) and then weekly for 4 weeks, and at 3 months and 6 months postsurgery. RESULTS During 6 months after surgery, shoulder ROM was reduced only affected arm while shoulder strength was significantly declined in both affected and unaffected arms. Within 4 weeks postsurgery, patients who underwent total mastectomy were significantly less recovered than patients with partial mastectomy in ROM of flexion (P < .05) and abduction (P < .05). However, shoulder strength of both arms observed no interaction between surgical type and time. We observed significant changes in body composition, quick-DASH score, physical activity levels, and QoL from presurgery to 6-months postsurgery. CONCLUSIONS Shoulder function, activity levels, and QoL improved significantly from surgery to 6-months postsurgery. Surgery type influenced changes in shoulder ROM.
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15
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Cariolou M, Abar L, Aune D, Balducci K, Becerra‐Tomás N, Greenwood DC, Markozannes G, Nanu N, Vieira R, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK, Chan DSM. Postdiagnosis recreational physical activity and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:600-615. [PMID: 36279903 PMCID: PMC10091720 DOI: 10.1002/ijc.34324] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
It is important to clarify the associations between modifiable lifestyle factors such as physical activity and breast cancer prognosis to enable the development of evidence-based survivorship recommendations. We performed a systematic review and meta-analyses to summarise the evidence on the relationship between postbreast cancer diagnosis physical activity and mortality, recurrence and second primary cancers. We searched PubMed and Embase through 31st October 2021 and included 20 observational studies and three follow-up observational analyses of patients enrolled in clinical trials. In linear dose-response meta-analysis of the observational studies, each 10-unit increase in metabolic equivalent of task (MET)-h/week higher recreational physical activity was associated with 15% and 14% lower risk of all-cause (95% confidence interval [CI]: 8%-22%, studies = 12, deaths = 3670) and breast cancer-specific mortality (95% CI: 4%-23%, studies = 11, deaths = 1632), respectively. Recreational physical activity was not associated with breast cancer recurrence (HR = 0.97, 95% CI: 0.91-1.05, studies = 6, deaths = 1705). Nonlinear dose-response meta-analyses indicated 48% lower all-cause and 38% lower breast cancer-specific mortality with increasing recreational physical activity up to 20 MET-h/week, but little further reduction in risk at higher levels. Predefined subgroup analyses across strata of body mass index, hormone receptors, adjustment for confounders, number of deaths, menopause and physical activity intensities were consistent in direction and magnitude to the main analyses. Considering the methodological limitations of the included studies, the independent Expert Panel concluded 'limited-suggestive' likelihood of causality for an association between recreational physical activity and lower risk of all-cause and breast cancer-specific mortality.
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Affiliation(s)
- Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism SectionInternational Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Doris S. M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
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Evidence-Based Guidance for Breast Cancer Survivorship. Hematol Oncol Clin North Am 2023; 37:225-243. [PMID: 36435612 DOI: 10.1016/j.hoc.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Breast cancer survivorship care includes management of lingering physical symptoms, supports to address the emotional toll exacted by a cancer diagnosis and cancer therapies, monitoring and optimization of cardiac and bone health, general wellness promotion, reproductive health care, surveillance for cancer recurrence, care coordination, and efforts to mitigate health disparities.
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17
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Doré I, Plante A, Bedrossian N, Montminy S, St-Onge K, St-Cyr J, Pomey MP, Charpentier D, Pettigrew L, Brisson I, Saad F, Tournoux F, Raynault MF, Mes-Masson AM, Gauvin L. Developing practice guidelines to integrate physical activity promotion as part of routine cancer care: A knowledge-to-action protocol. PLoS One 2022; 17:e0273145. [PMID: 35969619 PMCID: PMC9377590 DOI: 10.1371/journal.pone.0273145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cancer is a leading cause of disease burden worldwide and the first cause of mortality in Canada with 30.2% of deaths attributable to cancer. Given aging of the population and the improvement of prevention and treatment protocols, the number of cancer survivors is steadily increasing. These individuals have unique physical and mental health needs some of which can be addressed by integrating physical activity promotion into ongoing and long-term care. Despite the benefits of being active, delivery of PA programs for cancer patients in both clinical and community settings remains challenging. This knowledge-to-action protocol–called Kiné-Onco–aims to develop a practice guideline for the delivery, implementation, and scaling-up of cancer-specific physical activity promotion programs and services in clinical and community settings located in Québec, Canada. Method The Kiné-Onco project involves knowledge synthesis of scientific and grey literature to establish the benefits and added value of physical activity for cancer patients and survivors, describes current practices in delivering physical activity programs, analyses quantitative data from electronic health records (EHR) of patients participating in a novel hospital-based physical activity program, collects and analyses qualitative data from patients and healthcare providers interviews about lived experience, facilitators, and barriers to physical activity promotion, outlines deliberative workshops among multidisciplinary team members to develop implementation guidelines for physical activity promotion, and summarizes a variety of knowledge transfer and exchange activities to disseminate the practice guidelines. Discussion This paper describes the protocol for a knowledge-to-action project aimed at producing and sharing actionable evidence. Our aim is that physical activity promotion programs and services be scaled up in such a way as to successfully integrate physical activity promotion throughout cancer treatment and survivorship in order to improve the physical and mental health of the growing population of individuals having received a cancer diagnosis.
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Affiliation(s)
- Isabelle Doré
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, Canada
- School of Public Health, Université de Montréal, Montréal, Canada
- * E-mail:
| | - Audrey Plante
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- School of Public Health, Université de Montréal, Montréal, Canada
| | - Nathalie Bedrossian
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- School of Public Health, Université de Montréal, Montréal, Canada
| | - Sarah Montminy
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Kadia St-Onge
- Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Jany St-Cyr
- Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- School of Public Health, Université de Montréal, Montréal, Canada
| | | | - Lise Pettigrew
- Fondation Virage, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Isabelle Brisson
- Fondation Virage, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Fred Saad
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - François Tournoux
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Marie-France Raynault
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Centre de recherche Léa-Roback, Montréal, Canada
| | - Anne-Marie Mes-Masson
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Lise Gauvin
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- School of Public Health, Université de Montréal, Montréal, Canada
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18
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Floris M, Pira G, Castiglia P, Idda M, Steri M, De Miglio M, Piana A, Cossu A, Azara A, Arru C, Deiana G, Putzu C, Sanna V, Carru C, Serra A, Bisail M, Muroni M. Impact on breast cancer susceptibility and clinicopathological traits of common genetic polymorphisms in TP53, MDM2 and ATM genes in Sardinian women. Oncol Lett 2022; 24:331. [PMID: 36039053 PMCID: PMC9404703 DOI: 10.3892/ol.2022.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/22/2022] [Indexed: 11/06/2022] Open
Abstract
Common variants of genes involved in DNA damage correction [tumor protein p53 (TP53), murine double 2 homolog oncoprotein (MDM2) and ataxia-telengiectasia mutated (ATM)] may serve a role in cancer predisposition. The purpose of the present study was to investigate the association of five variants in these genes with breast cancer risk and clinicopathological traits in a cohort of 261 women from northern Sardinia. Polymorphic variants in TP53 (rs17878362, rs1042522 and rs1625895), MDM2 (rs2279744) and ATM (rs1799757) were determined by PCR and TaqMan single nucleotide polymorphism assay in patients with breast cancer (n=136) and healthy controls (n=125). Association with clinicopathological (e.g., age at diagnosis, lymph node involvement, clinical stage) and lifestyle factors (e.g., smoking status, alcohol intake, contraceptive use) was also evaluated. TP53 rs17878362 and rs1625895 polymorphisms were associated with decreased risk of BC diagnosis in patients older than 50 years (codominant and recessive models) and post-menopause (recessive model). Furthermore, there was a significant association between lymph node status (positive vs. negative) and ATM rs1799757-delT in dominant and additive models and between MDM2 rs2279744-allele and use of oral contraceptives. This analysis suggested that TP53 rs17878362 and rs1625895 may affect age of onset of breast cancer and ATM rs1799757 and MDM2 rs2279744 may be associated with lymph node status and prolonged use of oral contraceptives, respectively.
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Affiliation(s)
- Matteo Floris
- Department of Biomedical Sciences, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Paolo Castiglia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Maria Idda
- Institute for Genetic and Biomedical Research, National Research Council, Monserrato, Cagliari, I-09121 Sardinia, Italy
| | - Maristella Steri
- Institute for Genetic and Biomedical Research, National Research Council, Monserrato, Cagliari, I-09121 Sardinia, Italy
| | - Maria De Miglio
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Andrea Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Andrea Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Antonio Azara
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Caterina Arru
- Department of Biomedical Sciences, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Giovanna Deiana
- Department of Biomedical Sciences, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Carlo Putzu
- Division of Medical Oncology, Azienda Ospedaliera Universitaria, Sassari, I-07100 Sardinia, Italy
| | - Valeria Sanna
- Division of Medical Oncology, Azienda Ospedaliera Universitaria, Sassari, I-07100 Sardinia, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, Surgery and Pharmacy, University of Sassari, Sassari, I-07100 Sardinia, Italy
| | - Antonello Serra
- Unit of Occupational Medicine, Azienda Ospedaliera Universitaria, Sassari, I-07100 Sardinia, Italy
| | - Marco Bisail
- Lega Italiana per la Lotta contro i Tumori, Sassari, I-07100 Sardinia, Italy
| | - Maria Muroni
- Institute for Genetic and Biomedical Research, National Research Council, Monserrato, Cagliari, I-09121 Sardinia, Italy
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19
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Rock CL, Thomson CA, Sullivan KR, Howe CL, Kushi LH, Caan BJ, Neuhouser ML, Bandera EV, Wang Y, Robien K, Basen-Engquist KM, Brown JC, Courneya KS, Crane TE, Garcia DO, Grant BL, Hamilton KK, Hartman SJ, Kenfield SA, Martinez ME, Meyerhardt JA, Nekhlyudov L, Overholser L, Patel AV, Pinto BM, Platek ME, Rees-Punia E, Spees CK, Gapstur SM, McCullough ML. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin 2022; 72:230-262. [PMID: 35294043 DOI: 10.3322/caac.21719] [Citation(s) in RCA: 250] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022] Open
Abstract
The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.
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Affiliation(s)
- Cheryl L Rock
- Department of Family Medicine, School of Medicine, University of California at San Diego, La Jolla, California
| | - Cynthia A Thomson
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kristen R Sullivan
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Carol L Howe
- Department of Medicine, University of Arizona Health Sciences Library, Tucson, Arizona
- Department of Family and Community Medicine, University of Arizona Health Sciences Library, Tucson, Arizona
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Marian L Neuhouser
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ying Wang
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Kimberly Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Karen M Basen-Engquist
- Division of Cancer Prevention and Population Sciences, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Justin C Brown
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Kerry S Courneya
- Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy E Crane
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - David O Garcia
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Barbara L Grant
- Cancer Care Center, St Alphonsus Regional Medical Center, Boise, Idaho
| | - Kathryn K Hamilton
- Carol G. Simon Cancer Center, Morristown Medical Center, Morristown, New Jersey
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California
| | - Stacey A Kenfield
- Department of Urology, University of California at San Francisco, San Francisco, California
| | - Maria Elena Martinez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California
- Moores Cancer Center, University of California at San Diego, La Jolla, California
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alpa V Patel
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Mary E Platek
- School of Health Professions, D'Youville College, Buffalo, New York
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Erika Rees-Punia
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Colleen K Spees
- College of Medicine, The Ohio State University, Columbus, Ohio
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20
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Salam A, Woodman A, Chu A, Al-Jamea LH, Islam M, Sagher M, Sager M, Akhtar M. Effect of post-diagnosis exercise on depression symptoms, physical functioning and mortality in breast cancer survivors: A systematic review and meta-analysis of randomized control trials. Cancer Epidemiol 2022; 77:102111. [DOI: 10.1016/j.canep.2022.102111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/14/2022]
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21
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Physical Activity and Sedentary Behavior in Relation to Cancer Survival: A Narrative Review. Cancers (Basel) 2022; 14:cancers14071720. [PMID: 35406492 PMCID: PMC8997144 DOI: 10.3390/cancers14071720] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Globally, cancer is a major issue and an increasing number of people live with cancer. Lifestyle-associated factors play a major role in cancer prevention. Being physically active and limiting the amount of time spent sitting reduce the risk of developing several types of cancer. Furthermore, physical activity before, during, and after cancer diagnosis has been found to improve cancer outcomes. In addition, reduced levels of time spent sedentary may lead to improved outcomes in cancer survivors as well. This narrative review summarizes the existing evidence on the relationship of physical activity and sedentary behavior to cancer survival and other health outcomes in cancer survivors. The review provides an overview on the barriers, facilitators, and other factors that determine the levels of physical activity and sedentary behavior in cancer survivors as well as on the current recommendations on physical activity and sedentary behavior for cancer survivors. Abstract From a public health perspective, cancer is a major issue, and it contributes to a high economic and societal burden. Lifestyle-associated risk factors play a crucial role in cancer prevention. The present narrative review aims to summarize the existing evidence on the relationship of physical activity and sedentary behavior to cancer survival, including the evidence on mortality and other health-related outcomes. There is strong evidence that physical activity before, during, and after cancer diagnosis improves outcomes for breast and colorectal cancers. In addition, there is emerging evidence that reduced levels of sedentary behavior in cancer survivors are associated with improved outcomes. Future studies are needed to strengthen the evidence and to provide details on additional cancer sites. In the meantime, existing recommendations for physical activity and sedentary behavior in cancer survivors should be followed to improve the health status of cancer survivors.
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22
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Metastatic Breast Cancer Recurrence after Bone Fractures. Cancers (Basel) 2022; 14:cancers14030601. [PMID: 35158869 PMCID: PMC8833729 DOI: 10.3390/cancers14030601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Bone fractures bear potential risk to promote metastatic relapse in breast cancer. We conducted a population-based cohort study of 84,300 breast cancer patients diagnosed between January 2015 and November 2019. Bone fracture after breast cancer diagnosis was associated with an increased metastasis risk. Fractures may pose an increased risk to developing metastasis. Potential clinical implications for cancer patients are in support of fall prevention programs. Abstract Experimental studies suggest that bone fractures result in the release of cytokines and cells that might promote metastasis. Obtaining observational data on bone fractures after breast cancer diagnoses related to distant breast cancer recurrence could help to provide first epidemiological evidence for a metastasis-promoting effect of bone fractures. We used data from the largest German statutory health insurance fund (Techniker Krankenkasse, Hamburg, Germany) in a population-based cohort study of breast cancer patients with ICD-10 C50 codes documented between January 2015 and November 2019. The risk of metastasis overall, regional, distant non-bone or bone metastasis related to a fracture was modeled by an adjusted discrete time-to-event analysis with time-dependent exposure. Of 154,000 breast cancer patients, 84,300 fulfilled the inclusion criteria and had a follow-up time of more than half a year. During follow-up, fractures were diagnosed in 13,579 (16.1%) patients. Metastases occurred in 7047 (8.4%) patients; thereof 1544 had affected regional lymph nodes only and 5503 distant metastases. Fractures demonstrated a statistically significant association with subsequent metastasis overall (adjusted HR 1.12, 95% CI 1.04, 1.20). The highest risk for metastasis was observed in patients with subsequent bone metastasis (adjusted HR 1.18, 95% CI 1.05, 1.34), followed by distant non-bone metastasis (adjusted HR 1.16, 95% CI 1.07, 1.26) and lymph node metastasis (adjusted HR 1.08, 95% CI 0.97, 1.21).
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23
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Mazzoni AS, Brooke HL, Berntsen S, Nordin K, Demmelmaier I. Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial. Integr Cancer Ther 2021; 19:1534735420946834. [PMID: 32909467 PMCID: PMC7493247 DOI: 10.1177/1534735420946834] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Adherence to exercise interventions in patients with cancer is often poorly described. Further, it is unclear if self-regulatory behavior change techniques (BCTs) can improve exercise adherence in cancer populations. We aimed to (1) describe exercise adherence in terms of frequency, intensity, time, type (FITT-principles) and dropouts, and (2) determine the effect of specific self-regulatory BCTs on exercise adherence in patients participating in an exercise intervention during curative cancer treatment. METHODS This study was a secondary analysis using data from a Swedish multicentre RCT. In a 2×2 factorial design, 577 participants recently diagnosed with curable breast, colorectal or prostate cancer were randomized to 6 months of high (HI) or low-to-moderate intensity (LMI) exercise, with or without self-regulatory BCTs (e.g., goal-setting and self-monitoring). The exercise program included supervised group-based resistance training and home-based endurance training. Exercise adherence (performed training/prescribed training) was assessed using attendance records, training logs and heart rate monitors, and is presented descriptively. Linear regression and logistic regression were used to assess the effect of self-regulatory BCTs on each FITT-principle and dropout rates, according to intention-to-treat. RESULTS For resistance training (groups with vs without self-regulatory BCTs), participants attended on average 52% vs 53% of prescribed sessions, performed 79% vs 76% of prescribed intensity, and 80% vs 77% of prescribed time. They adhered to exercise type in 71% vs 68% of attended sessions. For endurance training (groups with vs without self-regulatory BCTs), participants performed on average 47% vs 51% of prescribed sessions, 57% vs 62% of prescribed intensity, and 71% vs 72% of prescribed time. They adhered to exercise type in 79% vs 78% of performed sessions. Dropout rates (groups with vs without self-regulatory BCTs) were 29% vs 28%. The regression analysis revealed no effect of the self-regulatory BCTs on exercise adherence. CONCLUSION An exercise adherence rate ≥50% for each FITT-principle and dropout rates at ~30% can be expected among patients taking part in long-term exercise interventions, combining resistance and endurance training during curative cancer treatment. Our results indicate that self-regulatory BCTs do not improve exercise adherence in interventions that provide evidence-based support to all participants (e.g., supervised group sessions). TRIAL REGISTRATION NCT02473003.
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Affiliation(s)
- Anne-Sophie Mazzoni
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hannah L Brooke
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sveinung Berntsen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Sport Science and Physical Education, University of Agder, Norway
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Sport Science and Physical Education, University of Agder, Norway
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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24
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van de Wiel HJ, Stuiver MM, May AM, van Grinsven S, Aaronson NK, Oldenburg HSA, van der Poel HG, Koole SN, Retèl VP, van Harten WH, Groen WG. Effects of and Lessons Learned from an Internet-Based Physical Activity Support Program (with and without Physiotherapist Telephone Counselling) on Physical Activity Levels of Breast and Prostate Cancer Survivors: The PABLO Randomized Controlled Trial. Cancers (Basel) 2021; 13:cancers13153665. [PMID: 34359567 PMCID: PMC8345041 DOI: 10.3390/cancers13153665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We developed an Internet-based physical activity (PA) support program (IPAS), which is embedded in a patient portal. We evaluated the effectiveness and costs of IPAS alone (online only) or IPAS combined with physiotherapist telephone counselling (blended care), compared to a control group. METHODS Breast or prostate cancer survivors, 3-36 months after completing primary treatment, were randomized to 6-months access to online only, blended care, or a control group. At baseline and 6-month post-baseline, minutes of moderate-to-vigorous PA (MVPA) were measured by accelerometers. Secondary outcomes were self-reported PA, fatigue, mood, health-related quality of life, attitude toward PA, and costs. (Generalized) linear models were used to compare the outcomes between groups. RESULTS We recruited 137 survivors (participation rate 11%). We did not observe any significant between-group differences in MVPA or secondary outcomes. Adherence was rather low and satisfaction scores were low to moderate, with better scores for blended care. Costs for both interventions were low. CONCLUSIONS Recruitment to the study was challenging and the interventions were less efficacious than anticipated, which led to lessons learned for future trials. Suggestions for future research are as follows: improved accessibility of the support program, increased frequency of support, and use of activity trackers.
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Affiliation(s)
- H. J. van de Wiel
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
| | - M. M. Stuiver
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
- Center for Quality of Life, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
| | - A. M. May
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands;
| | - S. van Grinsven
- Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands;
| | - N. K. Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
| | - H. S. A. Oldenburg
- Division of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - H. G. van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - S. N. Koole
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
| | - V. P. Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
- Department of Health Technology and Services research, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - W. H. van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
- Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands;
- Department of Health Technology and Services research, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Correspondence:
| | - W. G. Groen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (H.J.v.d.W.); (M.M.S.); (N.K.A.); (S.N.K.); (V.P.R.); (W.G.G.)
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Cannioto RA, Hutson A, Dighe S, McCann W, McCann SE, Zirpoli GR, Barlow W, Kelly KM, DeNysschen CA, Hershman DL, Unger JM, Moore HCF, Stewart JA, Isaacs C, Hobday TJ, Salim M, Hortobagyi GN, Gralow JR, Albain KS, Budd GT, Ambrosone CB. Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival. J Natl Cancer Inst 2021; 113:54-63. [PMID: 32239145 DOI: 10.1093/jnci/djaa046] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although physical activity has been consistently associated with reduced breast cancer mortality, evidence is largely based on data collected at one occasion. We examined how pre- and postdiagnosis physical activity was associated with survival outcomes in high-risk breast cancer patients. METHODS Included were 1340 patients enrolled in the Diet, Exercise, Lifestyle and Cancer Prognosis (DELCaP) Study, a prospective study of lifestyle and prognosis ancillary to a SWOG clinical trial (S0221). Activity before diagnosis, during treatment, and at 1- and 2-year intervals after enrollment was collected. Patients were categorized according to the Physical Activity Guidelines for Americans as meeting the minimum guidelines (yes/no) and incrementally as inactive, low active, moderately active (meeting the guidelines), or high active. RESULTS In joint-exposure analyses, patients meeting the guidelines before and 1 year after diagnosis experienced statistically significant reductions in hazards of recurrence (hazard ratio [HR] = 0.59, 95% confidence interval [CI] = 0.42 to 0.82) and mortality (HR = 0.51, 95% CI = 0.34-0.77); associations were stronger at 2-year follow-up for recurrence (HR = 0.45, 95% CI = 0.31 to 0.65) and mortality (HR = 0.32, 95% CI = 0.19 to 0.52). In time-dependent analyses, factoring in activity from all time points, we observed striking associations with mortality for low- (HR = 0.41, 95% CI = 0.24 to 0.68), moderate- (HR = 0.42, 95% CI = 0.23 to 0.76), and high-active patients (HR = 0.31, 95% CI = 0.18 to 0.53). CONCLUSIONS Meeting the minimum guidelines for physical activity both before diagnosis and after treatment appears to be associated with statistically significantly reduced hazards of recurrence and mortality among breast cancer patients. When considering activity from all time points, including during treatment, lower volumes of regular activity were associated with similar overall survival advantages as meeting and exceeding the guidelines.
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Affiliation(s)
- Rikki A Cannioto
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Alan Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Shruti Dighe
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - William McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gary R Zirpoli
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - William Barlow
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Carol A DeNysschen
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Health, Nutrition, and Dietetics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University, New York, NY, USA
| | - Joseph M Unger
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Halle C F Moore
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James A Stewart
- Department of Hematology and Oncology, Baystate Medical Center, Springfield, MA, USA
| | - Claudine Isaacs
- Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Timothy J Hobday
- Department of Medical Oncology, Cancer Center, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Salim
- Medical Oncology, Allan Blair Cancer Centre, Regina, SK, Canada
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, Division of Cancer Medicine - Clinical, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julie R Gralow
- Breast Medical Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Kathy S Albain
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - G Thomas Budd
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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26
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Ortega MA, Fraile-Martínez O, García-Montero C, Pekarek L, Guijarro LG, Castellanos AJ, Sanchez-Trujillo L, García-Honduvilla N, Álvarez-Mon M, Buján J, Zapico Á, Lahera G, Álvarez-Mon MA. Physical Activity as an Imperative Support in Breast Cancer Management. Cancers (Basel) 2020; 13:E55. [PMID: 33379177 PMCID: PMC7796347 DOI: 10.3390/cancers13010055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 02/06/2023] Open
Abstract
Breast cancer (BC) is the most common malignancy and the second cause of cancer-related death among women. It is estimated that 9 in 10 cases of BC are due to non-genetic factors, and approximately 25% to 30% of total breast cancer cases should be preventable only by lifestyle interventions. In this context, physical activity represents an excellent and accessible approach not only for the prevention, but also for being a potential support in the management of breast cancer. The present review will collect the current knowledge of physical activity in the background of breast cancer, exploring its systemic and molecular effects, considering important variables in the training of these women and the evidence regarding the benefits of exercise on breast cancer survival and prognosis. We will also summarize the various effects of physical activity as a co-adjuvant therapy in women receiving different treatments to deal with its adverse effects. Finally, we will reveal the impact of physical activity in the enhancement of quality of life of these patients, to conclude the central role that exercise must occupy in breast cancer management, in an adequate context of a healthy lifestyle.
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Affiliation(s)
- Miguel A. Ortega
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
| | - Oscar Fraile-Martínez
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
| | - Cielo García-Montero
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
| | - Leonel Pekarek
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
| | - Luis G. Guijarro
- Unit of Biochemistry and Molecular Biology (CIBEREHD), Department of System Biology, University of Alcalá, 28801 Alcalá de Henares, Spain;
| | - Alejandro J. Castellanos
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
| | - Lara Sanchez-Trujillo
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
| | - Natalio García-Honduvilla
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
| | - Melchor Álvarez-Mon
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain
| | - Julia Buján
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
| | - Álvaro Zapico
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain;
- Obstetrics and Gynecology Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
| | - Guillermo Lahera
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
| | - Miguel A. Álvarez-Mon
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (O.F.-M.); (C.G.-M.); (L.P.); (A.J.C.); (L.S.-T.); (N.G.-H.); (M.Á.-M.); (J.B.); (G.L.); (M.A.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Psychiatry and Medical Psychology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
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Miricescu D, Totan A, Stanescu-Spinu II, Badoiu SC, Stefani C, Greabu M. PI3K/AKT/mTOR Signaling Pathway in Breast Cancer: From Molecular Landscape to Clinical Aspects. Int J Mol Sci 2020; 22:E173. [PMID: 33375317 PMCID: PMC7796017 DOI: 10.3390/ijms22010173] [Citation(s) in RCA: 344] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Breast cancer is a serious health problem worldwide, representing the second cause of death through malignancies among women in developed countries. Population, endogenous and exogenous hormones, and physiological, genetic and breast-related factors are involved in breast cancer pathogenesis. The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) is a signaling pathway involved in cell proliferation, survival, invasion, migration, apoptosis, glucose metabolism and DNA repair. In breast tumors, PIK3CA somatic mutations have been reported, located in exon 9 and exon 20. Up to 40% of PIK3CA mutations are estrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) -negative in primary and metastatic breast cancer. HER2 is overexpressed in 20-30% of breast cancers. HER1, HER2, HER3 and HER4 are membrane receptor tyrosine kinases involved in HER signaling to which various ligands can be attached, leading to PI3K/AKT activation. Currently, clinical studies evaluate inhibitors of the PI3K/AKT/mTOR axis. The main purpose of this review is to present general aspects of breast cancer, the components of the AKT signaling pathway, the factors that activate this protein kinase B, PI3K/AKT-breast cancer mutations, PI3K/AKT/mTOR-inhibitors, and the relationship between everolimus, temsirolimus and endocrine therapy.
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Affiliation(s)
- Daniela Miricescu
- Department of Biochemistry, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania; (D.M.); (A.T.); (M.G.)
| | - Alexandra Totan
- Department of Biochemistry, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania; (D.M.); (A.T.); (M.G.)
| | - Iulia-Ioana Stanescu-Spinu
- Department of Biochemistry, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania; (D.M.); (A.T.); (M.G.)
| | - Silviu Constantin Badoiu
- Department of Anatomy and Embryology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania
| | - Constantin Stefani
- Department of Family Medicine and Clinical Base, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei, 010825 Bucharest, Romania;
| | - Maria Greabu
- Department of Biochemistry, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania; (D.M.); (A.T.); (M.G.)
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28
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Lee J. Associations between Physical Activity and Liver Cancer Risks and Mortality: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238943. [PMID: 33271947 PMCID: PMC7730643 DOI: 10.3390/ijerph17238943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023]
Abstract
(1) Background: The purpose of this meta-analysis was to investigate associations between physical activity (PA) and risks and mortality of liver cancer (LC) to suggest a minimum physical activity threshold to reduce LC risks and morality. (2) Methods: A database search was performed to identify relevant studies on the associations between PA and risks and mortality of LC before August 2020. The PA amounts were divided into three groups (high: ≥3 h/week, moderate: 2–3 h/week, and low: <2 h/week). The pooled relative risks of LC were calculated. (3) Results: A total of 10 prospective cohort studies were included. LC risks and mortality were 26% and 25% lower with high amounts of PA and 23% and 19% lower in moderate amounts of PA, respectively, compared to low amounts of PA. At the vigorous intensity PA level, high and moderate amounts of PA reduced the LC risk by 54% and 45%, respectively. (4) Conclusions: PA helps to reduce LC risks and mortality in a dose-dependent manner. At a minimum, two hours/week PA are mandatory to reduce LC mortality.
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Affiliation(s)
- Junga Lee
- Sports Medicine and Science, Kyung Hee University, Gwangju-si 17104, Korea
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29
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Maumy L, Salakos E, Rocher G, Al Mamari T, Bonneau C, Elies A, Neuzillet C, Rouzier R. [Physical activity after breast cancer diagnosis and survival: A systematic review]. Bull Cancer 2020; 107:1042-1055. [PMID: 32977937 DOI: 10.1016/j.bulcan.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The benefits of physical activity (PA) in breast cancer are currently recognized in primary prevention. The World Cancer Research Fund (WCRF) and then the National Cancer Institute (INCa) have reported conflicting results regarding the impact of post-diagnosis PA on breast cancer outcomes. The aim of this systematic review is to assess the association between PA after breast cancer diagnosis and overall mortality, specific mortality and risk of breast cancer recurrence in the literature. METHODS Randomized trials, prospective cohorts and meta-analyses studying post-diagnosis PA and overall mortality, breast cancer mortality or risk of recurrence after breast cancer published between January 1, 2014 and October 1, 2019 were included. The articles selected by the INCa report prior to 2014 were included in the literature review. RESULTS Eighteen articles have been selected. Studies unanimously concluded that overall mortality was reduced by post-diagnosis PA practice. For specific mortality, 5 meta-analyses showed a significant decrease in breast cancer mortality and 2 found a decrease in the risk of recurrence. CONCLUSION Post-diagnosis PA reduces overall mortality and appears to impact specific breast cancer mortality and risk of recurrence. However, these results need to be confirmed by larger randomized trials.
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Affiliation(s)
- Louise Maumy
- Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | | | | | | | - Claire Bonneau
- Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Antoine Elies
- Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Cindy Neuzillet
- Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France; Université de Versailles SQY, université Paris Saclay, UFR des sciences de la santé Simone-Veil, Paris, France
| | - Roman Rouzier
- Institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France; Université de Versailles SQY, université Paris Saclay, UFR des sciences de la santé Simone-Veil, Paris, France; Institut Curie, Inserm U900, Saint-Cloud, France.
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Bovbjerg ML. Current Resources for Evidence-Based Practice, September 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:487-499. [PMID: 32805207 PMCID: PMC7428455 DOI: 10.1016/j.jogn.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of “spin” in scientific reporting and its effect on summaries and syntheses of the literature and commentaries on reviews about early versus late amniotomy as part of labor induction protocols and the economic burden associated with maternal morbidity.
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31
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Gavala-González J, Gálvez-Fernández I, Mercadé-Melé P, Fernández-García JC. Rowing Training in Breast Cancer Survivors: A Longitudinal Study of Physical Fitness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144938. [PMID: 32659900 PMCID: PMC7400517 DOI: 10.3390/ijerph17144938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022]
Abstract
The aim of this study was to determine whether a rowing training program leads to improvements in physical fitness and body composition in women who have survived breast cancer (53.70 ± 7.88 years). The participants (n = 30) completed a twelve-week training program consisting of three sessions per week, with each session lasting from sixty to ninety minutes. An anthropometric and general physical fitness assessment was performed before and after the program. The results showed statistically significant improvements in all the physical fitness tests performed: sit and reach (2.82 cm); back scratch, dominant (3.29 cm); back scratch, non-dominant (4.59 cm); counter movement jump (1.91 cm); hand grip, dominant (2.54 kgf); hand grip, non-dominant (2.53 kgf); chair stand (2.56 rep); and six-minute walk (51.56 m). In addition, a significant improvement was observed in the efficiency of the cardiovascular system measured by heart rate, in beats per minute (bpm), both before (−12.63 bpm) and after the six-minute walk test (−11.46 bpm). The evaluated body composition parameters also improved, specifically total lean mass (2.18 kg) and the percentage of total body fat (−2.63%). We can therefore conclude that rowing training programs can be a strategy to be considered for improving physical fitness in this population given the improvement obtained in both anthropometric and physical fitness variables, thus leading to better health and quality of life.
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Affiliation(s)
- Juan Gavala-González
- Department of Physical Education and Sports, University of Seville, 41013 Seville, Spain;
| | - Ismael Gálvez-Fernández
- Department of Didactics of Languages, Arts and Sport, University of Malaga, Andalucia-Tech, IBIMA, 29071 Malaga, Spain;
- Correspondence:
| | - Pere Mercadé-Melé
- Department of Statistics and Econometrics, University of Malaga, Andalucia-Tech, 29071 Malaga, Spain;
| | - José Carlos Fernández-García
- Department of Didactics of Languages, Arts and Sport, University of Malaga, Andalucia-Tech, IBIMA, 29071 Malaga, Spain;
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Hojan K, Procyk D, Horyńska-Kęstowicz D, Leporowska E, Litwiniuk M. The Preventive role of Regular Physical Training in Ventricular Remodeling, Serum Cardiac Markers, and Exercise Performance Changes in Breast Cancer in Women Undergoing Trastuzumab Therapy-An REH-HER Study. J Clin Med 2020; 9:jcm9051379. [PMID: 32392882 PMCID: PMC7291322 DOI: 10.3390/jcm9051379] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiotoxicity is known as a severe clinical problem in oncological practice that reduces the options for cancer therapy. Physical exercise is recognized as a well-established protective measure for many heart and cancer diseases. In our study, we hypothesized that supervised and moderate-intensity exercise training would prevent heart failure and its consequences induced by trastuzumab therapy. The aim of this study was to examine the effect of physical training on ventricular remodeling, serum cardiac markers, and exercise performance in women with human epidermal growth receptor 2 (HER2+) breast cancer (BC) undergoing trastuzumab therapy. This was a prospective, randomized, clinical controlled trial. Forty-six BC women were randomized into either an intervention group (IG) or a control group (CG). An exercise program (IG) was performed after 3–6 months of trastuzumab therapy at 5 d/week (to 80% maximum heart rate (HRmax)) for 9 weeks. We then evaluated their cardiac function using echocardiography, a 6-Minute Walk Test (6MWT), and plasma parameters (C-reactive protein (CRP), myoglobin (MYO), interleukin-6 (IL-6), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK)). After the physical training program, we did not observe any significant changes in the left ventricular (LV) ejection fraction (LVEF) and 6MWT (p > 0.05) in the IG compared to the CG (decrease p < 0.05). The differences in the blood parameters were not significant (p < 0.05). To conclude, moderate-intensity exercise training prevented a decrease in the LVEF and physical capacity during trastuzumab therapy in HER2+ BC. Further research is needed to validate our results.
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Affiliation(s)
- Katarzyna Hojan
- Department of Rehabilitation, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
- Correspondence: ; Tel.: +48-601-509-967
| | - Danuta Procyk
- Central Labolatory, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (D.P.); (E.L.)
| | | | - Ewa Leporowska
- Central Labolatory, Greater Poland Cancer Centre, 61-866 Poznan, Poland; (D.P.); (E.L.)
| | - Maria Litwiniuk
- Department of Chemotherapy, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
- Department of Oncologic Pathology and Prophylaxis, Poznan University of Medical Sciences, 61-866 Poznan, Poland
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Mazzoni AS, Carlsson M, Berntsen S, Nordin K, Demmelmaier I. "Finding my own motivation" - A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment. Int J Behav Med 2019; 26:499-511. [PMID: 31441015 PMCID: PMC6785591 DOI: 10.1007/s12529-019-09809-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Exercising during oncological treatment is beneficial but challenging for persons with cancer and may require strategies to increase motivation. Behaviour change support, including specific behaviour change techniques (BCTs), have been used to facilitate exercise in persons undergoing oncological treatment, but more detailed knowledge from an individual perspective is needed to inform clinical practice. The aims were to explore the motivational experiences of exercise combined with behaviour change support, and to describe how specific BCTs were valued among persons exercising during oncological treatment. METHODS A mixed-methods study was conducted using semi-structured interviews (n = 18) and a questionnaire (n = 229). Participants with breast, colorectal or prostate cancer who completed or dropped out of a six-month exercise programme during oncological treatment were included. The interviews were analysed with thematic analysis and the questionnaire with descriptive statistics (median and interquartile range). RESULTS The participants underwent a motivational process through the exercise programme. By experiencing 'Health gains and mastery', 'Learning', 'Affinity', 'Commitment', and 'Managing challenges', they found incentives that fostered feelings of autonomy, competence and relatedness, leading to an increased motivation to exercise. Social support from coaches, structuring the physical environment with scheduled sessions, self-monitoring with resistance training log, and feedback based on heart rate monitor and fitness tests were the most valued BCTs. CONCLUSIONS The results indicate the importance of finding incentives and creating an environment that fosters autonomy, competence and relatedness to motivate persons to exercise during oncological treatment. Some BCTs appear particularly useful and may be used by health professionals to increase patients' motivation to exercise.
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Affiliation(s)
- Anne-Sophie Mazzoni
- Department of Public Health and Caring Sciences, Section of Lifestyle and Rehabilitation in Long-term Illness, Uppsala University, Uppsala, Sweden.
| | - Maria Carlsson
- Department of Public Health and Caring Sciences, Section of Lifestyle and Rehabilitation in Long-term Illness, Uppsala University, Uppsala, Sweden
| | - Sveinung Berntsen
- Department of Public Health and Caring Sciences, Section of Lifestyle and Rehabilitation in Long-term Illness, Uppsala University, Uppsala, Sweden.,Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Section of Lifestyle and Rehabilitation in Long-term Illness, Uppsala University, Uppsala, Sweden.,Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Section of Lifestyle and Rehabilitation in Long-term Illness, Uppsala University, Uppsala, Sweden
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Friedenreich CM, Stone CR, Cheung WY, Hayes SC. Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2019; 4:pkz080. [PMID: 32337494 PMCID: PMC7050161 DOI: 10.1093/jncics/pkz080] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Background Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival. Methods PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses. Results Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58–0.63) compared with prediagnosis PA (HR = 0.80–0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10–15 metabolic equivalent hours per week. Conclusion Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.
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Affiliation(s)
- Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsea R Stone
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Division of Medical Oncology, Tom Baker Cancer Centre, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Tough D, Robinson J, Gowling S, Raby P, Dixon J, Harrison SL. The feasibility, acceptability and outcomes of exergaming among individuals with cancer: a systematic review. BMC Cancer 2018; 18:1151. [PMID: 30463615 PMCID: PMC6249900 DOI: 10.1186/s12885-018-5068-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background Individuals with cancer have reduced quality of life, functionality, range of motion, strength, and an increase in pain and fatigue. Exergaming appears to be an effective rehabilitation tool for Parkinson’s disease, multiple sclerosis and post-stroke patients to improve functionality, balance and quality of life; however, the usefulness of exergaming in individuals with cancer is unknown. The aim of this systematic review is to describe exergaming interventions delivered to adults with a current or previous cancer diagnosis and to report the feasibility, acceptability and outcomes of such interventions. Methods Studies reporting on exergaming interventions delivered to individuals with a current or previous cancer diagnosis were included. 12 electronic databases were searched. Eight articles (seven interventions) were identified. Data were extracted and assessed for quality by two reviewers. Results Three interventions were delivered at hospital, two at home, one at a clinical laboratory, and one did not report. Two interventions were delivered by a physiotherapist, two by an occupational therapist, and one by a nurse, research staff and an exercise physiologist. The Nintendo Wii was used in four of seven studies, whilst the remaining three used the IREX system, BrightArm Duo Rehabilitation System or a custom made exergame. Studies showed that most participants enjoyed the exergaming intervention, and would recommend their use, with some preferring exergaming over standard care interventions. Adherence rates and enjoyment appear greater during exergaming than standard care. Exergaming interventions appear to support improvements balance, function, physical activity levels, strength, fatigue, emotions, cognition and pain. Conclusion Exergaming interventions delivered to individuals with cancer show great heterogeneity; differing in duration, frequency and gaming platform. The disease stage and severity of those included, and the outcome measures assessed also vary widely making it difficult to conclude its effectiveness at this time. However, adherence rates and enjoyment appear greater during exergaming compared to standard care, supporting the feasibility and acceptability of this type of intervention delivery for adults with cancer.
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Affiliation(s)
- Daniel Tough
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK.
| | - Jonathan Robinson
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Steven Gowling
- Department of Sport and Exercise Sciences, University of Sunderland, Sunderland, SR1 3SD, UK
| | - Peter Raby
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
| | - John Dixon
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Samantha L Harrison
- School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX, UK
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