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Song J, Yang X, Wu J, Wu Z, Niu S, Zhuo L, Lyu W, Ye J, Fang Y, Zhan Z, Zhang H, Li X, Hong J, Su L. The association analysis between fatigue and body composition loss in patients with nasopharyngeal carcinoma during radiotherapy: An observational longitudinal study. Radiother Oncol 2024; 197:110340. [PMID: 38797492 DOI: 10.1016/j.radonc.2024.110340] [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: 10/06/2023] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study aimed to reveal the association of fatigue with weekly changes in the body composition in patients with nasopharyngeal carcinoma (NPC) and identified the independent strength. METHODS Four body composition indexes and fatigue were assessed before treatment (T0, baseline) and once a week throughout radiotherapy (T1-T7). Generalized additive mixed models (GAMMs) were used to explore the trajectories and longitudinal relationships of fatigue and weekly changes in body composition. The marginal structural model (MSM) was used to control the effect of depression and anxiety. RESULTS The trajectories of fatigue in 105 participants reached a peak in the fifth week, and changes in body composition started appearing from the second week. Four body composition indexes, weight, body mass index (BMI), body fat rate, and lean body weight loss weekly were positively associated with fatigue. High magnitude of effects was revealed when anxiety and depression were controlled as time-dependent confounders. The positive associations with fatigue were manifested in patients aged >53 years, those with senior high and above education, no drinking, >5000 Y/month of family inflow, ≥ stage III, or those receiving a dose of ≥70 Gy, ≥3 cycles of induced chemotherapy, and ≤1 cycle of concurrent chemotherapy. CONCLUSIONS Loss of weight, BMI, body fat rate, and lean body weight could be used to independently evaluate the development of fatigue in patients with NPC during radiotherapy. Positive associations between fatigue and weekly body composition loss were found in patients with certain characteristics.
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Affiliation(s)
- Jihong Song
- School of Nursing, Fujian Medical University, Fuzhou, China; School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xinru Yang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jieling Wu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Zilan Wu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Sitian Niu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Litao Zhuo
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Wenlong Lyu
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China
| | - Jinru Ye
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China
| | - Yan Fang
- Nursing Department, The First Affiliated Hospital of Fujian Medical University, China
| | - Zhiying Zhan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, China
| | - Hairong Zhang
- Fujian Center for Disease Control and Prevention, China
| | - Xiaomei Li
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China.
| | - Li Su
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China.
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Ross A, Brewer K, Hudgens S, Brown B, Fallick M, de Paauw-Holt S, Arondekar B, Clegg J, Hunsche E. Development of a Novel Patient-Reported Outcome Measure to Assess Symptoms and Impacts of Androgen Deprivation Therapy for Advanced Prostate Cancer. Adv Ther 2024:10.1007/s12325-024-02888-9. [PMID: 38861216 DOI: 10.1007/s12325-024-02888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION This qualitative research study was conducted to develop a novel, comprehensive, patient-reported outcome measure (PRO), the "Symptoms and Impacts of Androgen Deprivation Therapy (ADT) for Prostate Cancer" (SIADT-PC), assessing hormonal therapy-related symptoms and their impacts on men with advanced prostate cancer. METHODS Concept elicitation (CE) interviews were conducted among adult men with prostate cancer to evaluate their experiences with ADT. Based on key symptom and impact concepts mentioned, an initial PRO measure was developed. The draft measure was further assessed in cognitive debriefing (CD) interviews with men with prostate cancer, in which participants reviewed items, response options, and recall periods. Initial item-based psychometric analyses were conducted using interview data. The draft questionnaire was revised on the basis of participant feedback, quantitative psychometric results, and consultation with clinical experts. RESULTS A total of 21 participants were interviewed (CE concept elicitation, n = 12; CD cognitive debriefing, n = 17; n = 8 completed both). Mean participant age (SD) was 59.7 (8.7) years and 76.2% were white. The de novo SIADT-PC measure consists of 27 items: 11 symptoms (e.g., fatigue, hot flashes, and erectile dysfunction), 2 long-term symptoms (e.g., weight gain), 10 impacts (e.g., impacts on physical activities and relationships), and 4 related to mode of administration (i.e., injection-site reactions). Items were assessed with a 5-point verbal rating scale, with answer choices that capture frequency or severity. CONCLUSIONS Once fully validated, this de novo measure may be used in clinical studies and clinical practice to assess hormone therapy-related symptoms and impacts, enabling physicians to identify timely and appropriate interventions.
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Affiliation(s)
- Ashley Ross
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Simon de Paauw-Holt
- Sumitomo Pharma Switzerland GmbH, Aeschengraben 27, 4051, Basel, Switzerland
| | | | | | - Elke Hunsche
- Sumitomo Pharma Switzerland GmbH, Aeschengraben 27, 4051, Basel, Switzerland.
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Singh F, Newton RU, Taaffe DR, Lopez P, Thavaseelan J, Brown M, Ooi E, Nosaka K, Hayne D, Galvão DA. Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy. J Cancer Res Clin Oncol 2023; 149:16563-16573. [PMID: 37712960 PMCID: PMC10645629 DOI: 10.1007/s00432-023-05409-3] [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: 06/16/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE The study compared the efficacy of commencing supervised exercise in men with prostate cancer before and after prostatectomy on objective and patient-reported outcomes, hospital length of stay, and urinary incontinence. METHODS Forty-one men were randomised to a 6-week prehabilitation or rehabilitation exercise programme. Prehabilitation involved resistance and aerobic exercise thrice weekly pre-surgery, while rehabilitation comprised the same commencing 6-weeks post-surgery. Assessments included strength, function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition, fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with urinary incontinence (24-h pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken. RESULTS Of thirty-eight men (48-73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, prehabilitation improved muscle strength (leg press: 17.2 kg; chest press: 2.9 kg; p ≤ 0.001), 400-m, chair rise, 6-m fast and backward walk tests (p ≤ 0.001-0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehabilitation showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6 kg, p < 0.001; chest press: 6.8 kg, p < 0.001; 400-m walk: -12.0 s, p = 0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital length of stay or urinary incontinence. CONCLUSION Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery. TRIAL REGISTRATION ACTRN12617001115325 registered 31 July 2017.
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Affiliation(s)
- Favil Singh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Dennis R Taaffe
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Pedro Lopez
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | | | - Matthew Brown
- Perth Urology Clinic, Perth, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | | | - Kazunori Nosaka
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Dickon Hayne
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | - Daniel A Galvão
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
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Beebe-Dimmer JL, Finlay DG, Ruterbusch JJ, Baird T, Simon MS, Abrams J, Harper FW, Podgorski I, Heath EI. The impact of high intensity interval training in a diverse group of cancer survivors: CAPABLE, a pilot study. Prev Med Rep 2023; 35:102288. [PMID: 37449003 PMCID: PMC10336780 DOI: 10.1016/j.pmedr.2023.102288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/15/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Given the well-documented benefits of regular exercise to cancer survivors, current American Cancer Society guidelines recommend that patients engage in a minimum of 150 min per week of moderate-to-vigorous physical activity with a minimum of two days of strength training. However, few survivors meet this goal, particularly among minorities. Methods The CAPABLE study is a single-arm, pilot exercise intervention that introduced 48 cancer survivors to a high intensity interval and strength training program three days a week for 12 weeks. We evaluated the impact of this unique training method on bodyweight, % body fat, serum markers correlated with an adverse cardiometabolic profile and health-related quality of life (HRQoL). Measures were summarized at baseline and program exit. Paired t-tests were used to assess change in each of these measures over time. Results We observed losses in weight, body mass index, and % body fat, and glycosylated hemoglobin (HbA1c) levels over 12-weeks. There were also clinically meaningful improvements in reported overall HRQoL (FACTG total change +9.5 (95% CI, 4.6, 14.4)) and in each one of the individual domains (physical, social, emotional, and functional well-being). Conclusions We observed meaningful improvements in body composition, HbA1c and quality of life over 12 weeks among cancer survivors participating in a high-intensity interval training program. Future work will include a control arm for comparison and address barriers to participation and adherence which will be important in using this intervention and others like it to improve outcomes and reduce cancer health disparities.
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Affiliation(s)
- Jennifer L. Beebe-Dimmer
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - David G. Finlay
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Julie J. Ruterbusch
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Tara Baird
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Michael S. Simon
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Judith Abrams
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Felicity W.K. Harper
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Izabela Podgorski
- Wayne State University, School of Medicine Departments of Pathology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
| | - Elisabeth I. Heath
- Wayne State University, School of Medicine Departments of Oncology, Detroit, MI 48201, United States
- Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, United States
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Animaw L, Woldegiorgis Abate T, Endeshaw D, Tsegaye D. Fatigue and associated factors among adult cancer patients receiving cancer treatment at oncology unit in Amhara region, Ethiopia. PLoS One 2023; 18:e0279628. [PMID: 36607977 PMCID: PMC9821493 DOI: 10.1371/journal.pone.0279628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Fatigue is one of the most commonly and frequently reported symptoms by cancer patients. The cause of fatigue is multifactorial in origin, and its impact varies in range from affecting patients' daily social life, and physical, mental, economic, and social well-being to becoming a threat to their quality of life. Therefore every cancer patient needs to be screened for fatigue and considered as one of the vital signs. OBJECTIVE To assess the prevalence of fatigue and associated factors among adult cancer patients, receiving cancer treatment at the oncology unit in Amhara region, Ethiopia, 2022. METHOD Institutional-based, cross-sectional study was conducted among adult cancer patients receiving cancer treatment from May 9th-June 8th, 2022. A stratified random sampling technique was used to select study participants. Data were entered into Epi data version 4.6 and then exported to the SPSS statistical package version 23 for further analysis. Both bivariable and multivariable logistic regression analyses were carried out. P-values <0.05 in multivariable logistic regression were considered statistically significant. RESULTS The prevalence of cancer-related fatigue was 77.3% at 95% CI (73.1-81.1) with nonresponse rate of 1.97% (9). Poor social support (AOR = 3.62; 95% CI: 1.53-8.60), anxiety (AOR = 3.13; 95% CI: 1.54-6.36), physical inactivity (AOR = 3.67; 95% CI: 1.74-7.54), underweight (AOR = 2.03; 95% CI: 1.05-3.90), anemia (AOR = 2.01; 95% CI: 1.04-3.90), surgery as a treatment modality (AOR = 0.21; 95% CI: 0.06-0.78), combination therapy (AOR = 3.56; 95% CI: 1.68-7.54), treatment less than 3 cycle (AOR = 4.43; 95% CI: 1.53-12.80), and treatment 3-5 cycle (AOR = 3.55; 95% CI: 1.38-9.09) were significantly associated factors with cancer related fatigue. CONCLUSION Psychosocial assessment and intervention, nutritional support, early intervention of anemia, and promoting exercise are the key elements to minimizing fatigue among cancer patients.
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Affiliation(s)
- Lingerew Animaw
- Adult Health Nursing at Feres Bet primary hospital, Amhara, Ethiopia
| | - Teshager Woldegiorgis Abate
- Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dejen Tsegaye
- Department of Nursing, Debre Markos University, College of Health Sciences, Debre Markos, Ethiopia
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The Impact of Exercise on Improving Body Composition and PSA in High-Risk Prostate Cancer Patients on Androgen-Deprivation Therapy. Nutrients 2022; 14:nu14235088. [PMID: 36501118 PMCID: PMC9738737 DOI: 10.3390/nu14235088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
This prospective study investigated how exercise impacted chronological changes in anthropometrics, body composition, prostate-specific antigen (PSA) level and prognostic nutrition index (PNI) in high-risk prostate cancer (PCa) patients on androgen deprivation therapy (ADT). The patients were divided into either the usual care or exercise group. All patients received measurements a week before ADT initiation, six- and twelve months after treatment. The exercise group received both aerobic and resistance training. The analysis was conducted using appropriate statistical methods. There were 45 males enrolled (age 67.4 ± 8 years and BMI 25.5 ± 3.6 kg/m2). Profound changes were observed at six months follow-up. The exercise group showed a significant increase in the trunk and leg lean mass, and a lesser loss of total and arm lean mass. A significant decrease in PSA was also observed among the exercise group. PNI and PSA were significantly associated with regional lean mass. Exercise can prevent loss or even increase lean mass in high-risk PCa, especially in the early stage of ADT treatment. Moreover, a strong bond between lean mass and PNI and PSA further underscores the importance of early and continuous exercise interventions.
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Edmunds K, Scuffham P, Newton RU, Galvão DA, Tuffaha H. Exercise in preventing falls for men with prostate cancer: a modelled cost-utility analysis. Support Care Cancer 2022; 30:5037-5046. [PMID: 35201385 PMCID: PMC9046330 DOI: 10.1007/s00520-022-06900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia. METHODS A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA). RESULTS At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective. CONCLUSION This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.
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Affiliation(s)
- Kim Edmunds
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, 4072, Australia
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Wilson RL, Taaffe DR, Newton RU, Hart NH, Lyons-Wall P, Galvão DA. Obesity and prostate cancer: A narrative review. Crit Rev Oncol Hematol 2021; 169:103543. [PMID: 34808374 DOI: 10.1016/j.critrevonc.2021.103543] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022] Open
Abstract
Overweight and obese men with prostate cancer are at an increased risk of disease recurrence, exacerbated treatment-related adverse effects, development of obesity-related comorbidities, earlier progression and development of metastatic disease, and higher all-cause and prostate cancer-specific mortality. The physiological mechanisms associating obesity with poor prostate cancer outcomes remain largely unknown; however, an increased inflammatory environment and metabolic irregularities associated with excess fat mass are commonly postulated. Although research is limited, fat loss strategies using exercise and nutrition programmes may slow down prostate cancer progression and improve a patient's prognosis. This review is an overview of: 1) the association between obesity and poor prostate cancer prognosis; 2) potential physiological mechanisms linking obesity and prostate cancer progression; 3) the effect of obesity on treatments for prostate cancer; and 4) the potential for weight loss strategies to improve outcomes in patients with prostate cancer.
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Affiliation(s)
- Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, United States; Department of Medicine, Harvard Medical School, Boston, MA, 02215, United States.
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6027, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6027, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6027, Australia; Institute for Health Research, University of Notre Dame Australia, Perth, WA, 6160, Australia; College of Nursing and Health Science, Flinders University, Adelaide, SA, 5042, Australia
| | - Philippa Lyons-Wall
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6027, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 6027, Australia
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Preoperative Aerobic Exercise Therapy Prior to Abdominal Surgery: What Is the Evidence? What Dose? CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00488-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions. Nutrients 2021; 13:nu13103421. [PMID: 34684421 PMCID: PMC8537603 DOI: 10.3390/nu13103421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Nutrition and exercise interventions are strongly recommended for most cancer patients; however, much debate exists about the best prescription. Combining fasting with exercise is relatively untouched within the oncology setting. Separately, fasting has demonstrated reductions in chemotherapy-related side effects and improved treatment tolerability and effectiveness. Emerging evidence suggests fasting may have a protective effect on healthy cells allowing chemotherapy to exclusively target cancer cells. Exercise is commonly recommended and attenuates treatment- and cancer-related adverse changes to body composition, quality of life, and physical function. Given their independent benefits, in combination, fasting and exercise may induce synergistic effects and further improve cancer-related outcomes. In this narrative review, we provide a critical appraisal of the current evidence of fasting and exercise as independent interventions in the cancer population and discuss the potential benefits and mechanisms of combined fasting and exercise on cardiometabolic, body composition, patient-reported outcomes, and cancer-related outcomes. Our findings suggest that within the non-cancer population combined fasting and exercise is a viable strategy to improve health-related outcomes, however, its safety and efficacy in the oncology setting remain unknown. Therefore, we also provide a discussion on potential safety issues and considerations for future research in the growing cancer population.
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Li CC, Chou YJ, Shun SC. The Relationship Between Muscle Strength and Body Composition Measures and Cancer-Related Fatigue: A Systematic Review and Meta-Analysis. Oncol Nurs Forum 2021; 48:558-576. [PMID: 34411084 DOI: 10.1188/21.onf.558-576] [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: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Cancer-related fatigue (CRF) substantially affects daily living and quality of life, but objective CRF measures remain limited. This review aimed to identify the correlation between muscle strength and body composition measures and CRF, as well as potential objective indicators for assessing CRF. LITERATURE SEARCH PubMed®, MEDLINE®, CINAHL®/PsycINFO®, and Embase® were searched for studies published from January 2000 to January 2021. DATA EVALUATION Study selection and quality assessment were conducted using the Critical Appraisals Skills Programme checklist and the Strengthening the Reporting of Observational Studies in Epidemiology statement. Comprehensive Meta-Analysis software was used to perform meta-analysis. SYNTHESIS 25 studies were selected, and 19 measures were analyzed. CRF negatively correlated with hand grip strength, knee extensor strength, and the sit-to-stand test. No significant correlation was found between body composition measures and CRF. IMPLICATIONS FOR NURSING The evidence suggests that muscle strength measures may be potential indicators for CRF assessment. Combining objective and subjective CRF assessments could assist clinicians in evaluating the effectiveness of CRF interventions more accurately.
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Crosby BJ, Lopez P, Galvão DA, Newton RU, Taaffe DR, Meniawy TM, Warburton L, Khattak MA, Gray ES, Singh F. Associations of Physical Activity and Exercise with Health-related Outcomes in Patients with Melanoma During and After Treatment: A Systematic Review. Integr Cancer Ther 2021; 20:15347354211040757. [PMID: 34412527 PMCID: PMC8381455 DOI: 10.1177/15347354211040757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Although exercise medicine is recommended to counter treatment-related
side-effects and improve health-related outcomes of patients affected by
different cancers, no specific recommendations exist for patients with
melanoma. As a result, we systematically examined the current evidence
regarding the effects of physical activity and exercise on
objectively-measured and patient-reported outcomes among patients with
melanoma. Methods: Searches were conducted in PubMed, CINAHL,
EMBASE, SPORTDiscus, and Web
of Science databases. This review included published data
involving physical activity or exercise and objectively-measured or
patient-reported outcomes of patients with cutaneous melanoma. The quality
of included studies was assessed using the McMaster University Critical
Appraisal Tool for Quantitative Studies. Results: Six studies including 882 patients with melanoma were included. Studies
presented heterogeneity of design with 2 cross-sectional surveys, 2
retrospective analyses, and 2 non-randomized intervention trials. No
statistically significant change in quality of life, fatigue, physical
function, cardiorespiratory fitness, body composition, psychological
distress, cognitive function, or treatment-related side-effects were
attributable to physical activity or exercise. Importantly, physical
activity or exercise during melanoma treatment or into survivorship did not
adversely impact patients/survivors. Conclusion: In summary, physical activity or exercise did not adversely impact quality of
life, objectively-measured or patient-reported outcomes in patients with
melanoma. In addition, there is a paucity of quality studies examining the
effects of physical activity or exercise on patients with melanoma
throughout the cancer care continuum.
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Affiliation(s)
| | - Pedro Lopez
- Edith Cowan University, Perth, WA, Australia
| | | | - Robert U Newton
- Edith Cowan University, Perth, WA, Australia.,University of Queensland, QLD, Australia
| | | | - Tarek M Meniawy
- Edith Cowan University, Perth, WA, Australia.,Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Lydia Warburton
- Edith Cowan University, Perth, WA, Australia.,Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Muhammad A Khattak
- Edith Cowan University, Perth, WA, Australia.,Fiona Stanley Hospital, Murdoch, WA, Australia.,University of Western Australia, Crawley, WA, Australia
| | - Elin S Gray
- Edith Cowan University, Perth, WA, Australia
| | - Favil Singh
- Edith Cowan University, Perth, WA, Australia
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13
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Dickinson K, Lim A, Kupzyk KA. Demographic, Symptom, and Lifestyle Factors Associated With Cancer-Related Fatigue in Men With Prostate Cancer. Oncol Nurs Forum 2021; 48:423-430. [PMID: 34142995 DOI: 10.1188/21.onf.423-430] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify potential demographic, symptom, and lifestyle factors associated with cancer-related fatigue (CRF) in men with prostate cancer. SAMPLE & SETTING Data were retrieved from men with prostate cancer across the disease trajectory who were enrolled in the Genitourinary Cancer Collaborative Registry-Prostate Cancer. METHODS & VARIABLES Self-reported data on demographic characteristics, lifestyle habits (smoking history, alcohol consumption, physical activity/exercise, dietary habits, and vitamins/supplements), and symptom experiences (measured using the Brief Fatigue Inventory, European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Prostate Cancer and -Bone Metastasis, and Pittsburgh Sleep Quality Index) were included in the registry. RESULTS Demographic (younger age) and symptom (sleep quality, urinary, bowel, hormone-related, and sexual activity) correlates of CRF were identified. Higher levels of moderate to vigorous exercise and activities were associated with lower CRF in the sample as a whole. However, there was no association between CRF and physical activity in men with bone metastasis. IMPLICATIONS FOR NURSING CRF is a common and burdensome symptom among individuals with cancer and survivors. Identification of demographic, symptom, and lifestyle factors associated with CRF can enhance understanding of this symptom and contribute to early risk assessment and intervention.
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14
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Using Exercise and Nutrition to Alter Fat and Lean Mass in Men with Prostate Cancer Receiving Androgen Deprivation Therapy: A Narrative Review. Nutrients 2021; 13:nu13051664. [PMID: 34068965 PMCID: PMC8156712 DOI: 10.3390/nu13051664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 01/12/2023] Open
Abstract
Fat mass (FM) gain and lean mass (LM) loss are common side effects for patients with prostate cancer receiving androgen deprivation therapy (ADT). Excess FM has been associated with an increased risk of developing obesity-related comorbidities, exacerbating prostate cancer progression, and all-cause and cancer-specific mortality. LM is the predominant contributor to resting metabolic rate, with any loss impacting long-term weight management as well as physical function. Therefore, reducing FM and preserving LM may improve patient-reported outcomes, risk of disease progression, and ameliorate comorbidity development. In ADT-treated patients, exercise and nutrition programs can lead to improvements in quality of life and physical function; however, effects on body composition have been variable. The aim of this review was to provide a descriptive overview and critical appraisal of exercise and nutrition-based interventions in prostate cancer patients on ADT and their effect on FM and LM. Our findings are that FM gain and LM loss are side effects of ADT that could be reduced, prevented, or even reversed with the implementation of a combined exercise and nutrition program. However, the most effective combination of specific exercise and nutrition prescriptions are yet to be determined, and thus should be a focus for future studies.
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15
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WILSON REBEKAHL, NEWTON ROBERTU, TAAFFE DENNISR, HART NICOLASH, LYONS-WALL PHILIPPA, GALVÃO DANIELA. Weight Loss for Obese Prostate Cancer Patients on Androgen Deprivation Therapy. Med Sci Sports Exerc 2021; 53:470-478. [PMID: 33009195 PMCID: PMC7886363 DOI: 10.1249/mss.0000000000002509] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Excess fat mass (FM) contributes to poor prostate cancer (PCa) prognosis and comorbidity. However, FM gain is a common side effect of androgen deprivation therapy (ADT). We examined the efficacy of a 12-wk weight loss intervention to reduce FM and maintain lean mass (LM) in ADT-treated obese PCa patients. METHODS Fourteen ADT-treated obese PCa patients (72 ± 9 yr, 39.7% ± 5.4% body fat) were recruited for a self-controlled prospective study, with 11 completing the 6-wk control period, followed by a 12-wk intervention comprising 300 min·wk-1 of exercise including supervised resistance training and home-based aerobic exercise, and dietitian consultations advising a daily energy deficit (2100-4200 kJ) and protein supplementation. Body composition was assessed by dual x-ray absorptiometry. Secondary outcomes included muscle strength (one-repetition maximum), cardiorespiratory fitness (maximal oxygen consumption), and blood biomarkers. RESULTS There were no significant changes during the control period. Patients attended 89% of supervised exercise sessions and 100% of dietitian consultations. No changes in physical activity or energy intake were observed. During the intervention, patients experienced significant reductions in weight (-2.8 ± 3.2 kg, P = 0.016), FM (-2.8 ± 2.6 kg, P < 0.001), and trunk FM (-1.8 ± 1.4 kg, P < 0.001), with LM preserved (-0.05 ± 1.6 kg, P = 0.805). Muscle strength (4.6%-24.7%, P < 0.010) and maximal oxygen consumption (3.5 ± 4.7 mL·min-1·kg-1, P = 0.041) significantly improved. Leptin significantly decreased (-2.2 (-2.7 to 0.5) ng·mL-1, P = 0.016) with no other changes in blood biomarkers such as testosterone and lipids (P = 0.051-0.765); however, C-reactive protein (rs = -0.670, P = 0.024) and triglycerides (r = -0.667, P = 0.025) were associated with individual changes in LM. CONCLUSIONS This study shows preliminary efficacy for an exercise and nutrition weight loss intervention to reduce FM, maintain LM, and improve muscle strength and cardiorespiratory fitness in ADT-treated obese PCa patients. The change in body composition may affect blood biomarkers associated with obesity and PCa progression; however, further research is required.
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Affiliation(s)
- REBEKAH L. WILSON
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, AUSTRALIA
| | - ROBERT U. NEWTON
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, AUSTRALIA
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, AUSTRALIA
| | - DENNIS R. TAAFFE
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, AUSTRALIA
| | - NICOLAS H. HART
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, AUSTRALIA
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, AUSTRALIA
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, AUSTRALIA
| | - PHILIPPA LYONS-WALL
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, AUSTRALIA
| | - DANIEL A. GALVÃO
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, AUSTRALIA
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16
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Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2021; 61:167-189.e14. [PMID: 32768552 DOI: 10.1016/j.jpainsymman.2020.07.037] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer. OBJECTIVES The objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer. METHODS The following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. RESULTS A total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45-53) with significant heterogeneity between studies (P < 0.000; τ2 = 0.0000; I2 = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue. CONCLUSION This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.
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Affiliation(s)
| | - Mohammed Al Sinani
- Reproductive and Developmental Biology Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zakariya Al Naamani
- School of Nursing and Midwifery, Queen's University Medical Biology Centre, Belfast, Northern Ireland
| | - Khalid Al Badi
- Al Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Mu'ath Ibrahim Tanash
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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17
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Edmunds K, Tuffaha H, Scuffham P, Galvão DA, Newton RU. The role of exercise in the management of adverse effects of androgen deprivation therapy for prostate cancer: a rapid review. Support Care Cancer 2020; 28:5661-5671. [PMID: 32699997 DOI: 10.1007/s00520-020-05637-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Prostate cancer (PCa) is the most commonly diagnosed cancer in Australia, accounting for one quarter of all new cancer diagnoses for males. Androgen deprivation therapy (ADT) is the standard first-line therapy for metastatic PCa but is also used across much of the spectrum of disease. Unfortunately, debilitating adverse effects are a significant and largely unavoidable feature of ADT. A recent systematic review of adverse effects of ADT identified 19 sub-groups classified according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. The potential for multiple simultaneous adverse effects, their associated management and the impact of adverse effects on cancer outcomes and quality of life are important considerations in the treatment and supportive care of men with PCa. Exercise is increasingly being recognized as an efficacious strategy in managing these adverse effects. METHODS A rapid review was undertaken to examine the role of exercise in the management of the most commonly reported ADT adverse effects classified according to the CTCAE sub-groups. A systematic search was conducted in Medline, PsycINFO, Google Scholar and Google for the years 2010 to September 2019 to identify the benefits of exercise in managing the adverse effects of ADT for PCa. RESULTS There is strong evidence for exercise as medicine in addressing several of the adverse effects of PCa such as loss of muscle mass and strength, fatigue and declining physical function. Moderate level evidence for PCa exists for exercise-induced improvements in depression and anxiety, bone loss, and sexual dysfunction. While evidence of the effectiveness of exercise is lacking for many adverse effects of ADT for PCa, evidence in the cancer population as a whole or other clinical populations is strong, and many clinical guidelines recommend exercise as a fundamental part of their clinical management. With the exception of gynaecomastia and breast pain, there is increasing evidence (PCa, cancer or other clinical populations) to suggest that exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa. CONCLUSION Exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa. The use of exercise for PCa management has the potential to translate into health and economic benefits in improved quality of life and fewer complications, resulting in savings to the health care system, enhanced productivity and reduced patient and carer burden. Exercise thus has the potential to improve quality of life for this population as well as generate significant cost savings.
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Affiliation(s)
- Kim Edmunds
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
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18
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Hanson ED, Betik AC, Timpani CA, Tarle J, Zhang X, Hayes A. Testosterone suppression does not exacerbate disuse atrophy and impairs muscle recovery that is not rescued by high protein. J Appl Physiol (1985) 2020; 129:5-16. [PMID: 32463734 DOI: 10.1152/japplphysiol.00752.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Androgen deprivation therapy (ADT) decreases muscle mass, force, and physical activity levels, but it is unclear whether disuse atrophy and testosterone suppression are additive. Additionally, conflicting reports exist on load-mediated hypertrophy during ADT and if protein supplementation offsets these deficits. This study sought to determine the role of testosterone suppression and a high-protein diet on 1) immobilization-induced atrophy and 2) muscle regrowth during reloading. Eight-week-old male Fischer 344 rats underwent sham surgery (Sham), castration surgery (ORX), or ORX and a high-casein diet supplemented with branched-chain amino acids (BCAA) (ORX+CAS/AA) followed by 10 days of unilateral immobilization (IMM) and 0, 6, or 14 days of reloading. With IMM, body mass gains were ~8% greater than ORX and ORX+CAS/AA that increased to 15% during reloading (both P < 0.01). IMM reduced muscle mass by 11-34% (all P < 0.01) and extensor digitorum longus and soleus (SOL) force by 21% and 49% (both P < 0.01), respectively, with no group differences. During reloading, castration reduced gastrocnemius mass (~12%) at 6 days and SOL mass (~20%) and SOL force recovery (~46%) at 14 days relative to Sham (all P < 0.05). Specific force reduced castration deficits, indicating that muscle atrophy was a key contributor. IMM decreased SOL cross-sectional area by 30.3% (P < 0.001), with a trend for reduced regrowth in ORX and ORX+CAS/AA following reloading (P = 0.083). Castration did not exacerbate disuse atrophy but may impair recovery of muscle function, with no benefit from a CAS/AA diet during reloading. Examining functional outcomes in addition to muscle mass during dietary interventions provides novel insights into muscle regrowth during ADT.NEW & NOTEWORTHY Low testosterone levels during skeletal muscle disuse did not worsen declines in muscle mass and function, although hypogonadism may attenuate recovery during subsequent reloading. Diets high in casein did not improve outcomes during immobilization or reloading. Practical strategies are needed that do not compromise caloric intake yet provide effective protein doses to augment these adverse effects.
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Affiliation(s)
- Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Andrew C Betik
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Cara A Timpani
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,Institute for Musculoskeletal Science (AIMSS), Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tarle
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Xinmei Zhang
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,Institute for Musculoskeletal Science (AIMSS), Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Baguley BJ, Skinner TL, Jenkins DG, Wright ORL. Mediterranean-style dietary pattern improves cancer-related fatigue and quality of life in men with prostate cancer treated with androgen deprivation therapy: A pilot randomised control trial. Clin Nutr 2020; 40:245-254. [PMID: 32534948 DOI: 10.1016/j.clnu.2020.05.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Cancer-related fatigue (CRF) is a prevalent and persistent symptom from androgen deprivation therapy (ADT) in prostate cancer. The Mediterranean-style dietary pattern (MED-diet) offers a plausible mechanism to mitigate CRF through reducing inflammation and improving body composition. This study aimed to evaluate the effects of a 12-week MED-diet, compared to usual care, on CRF and quality of life in men with prostate cancer treated with ADT. METHODS Twenty-three men (65.9 ± 7.8 years; body mass index: 29.6 ± 2.7 kg/m2; ADT duration: 33.8 ± 35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 12-weeks of usual care or the MED-diet involving six individualised nutrition consults. Primary outcomes included CRF [Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale (FACIT-F) and quality of life [FACIT-General (FACIT-G)], secondary outcomes included body mass/composition and interleukin (IL)-6 and IL-8 concentrations measured at baseline, 8-weeks and 12 weeks. Intervention feasibility was measured by intervention safety, study completion rate, consult attendance, and adherence to the MED-diet through the Mediterranean-diet adherence screener (MEDAS). Intention to treat linear mixed models were used to determine changes in outcomes between the MED-diet and usual care at baseline, 8-weeks and 12-weeks. RESULTS The MED-diet improved CRF (FACIT-F) at 8-weeks [+4.8 (0.0, 9.8); P = 0.05] and 12-weeks [+7.2 (2.2, 12.0); P = 0.005], quality of life (FACIT-G) at 12-weeks [+9.2 (2.7, 15.8); P = 0.006], reduced total body mass at 8-weeks [-2.51 kg (-4.25, -0.78); P = 0.005] and 12-weeks [-2.97 kg (-4.71, -1.25); P = 0.001], lean mass at 8-weeks [-1.50 kg (-2.91, -0.10); P = 0.036], and IL-8 at 8-weeks [-0.18 ng/ml (-0.34, -0.02); P = 0.029] compared to usual care. The MED-diet demonstrated zero adverse events, 91% study completion, 100% attendance, and 81% adherence to the MEDAS. CONCLUSION The MED-diet is safe and feasible, and has the potential to improve CRF and quality of life in overweight men treated with ADT compared to usual care. Further exploration of the MED-diet is warranted in a larger powered sample size to consolidate these findings.
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Affiliation(s)
- Brenton J Baguley
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - David G Jenkins
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia; Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
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20
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Sanchez A, Kissel S, Coletta A, Scott J, Furberg H. Impact of body size and body composition on bladder cancer outcomes: Risk stratification and opportunity for novel interventions. Urol Oncol 2020; 38:713-718. [PMID: 32312642 DOI: 10.1016/j.urolonc.2020.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 01/06/2023]
Abstract
Body size is emerging as a novel and clinically-relevant patient factor in bladder cancer research. Historically, a patient's body mass index (BMI) has been used as a proxy for obesity but it shows inconsistent associations with risk of developing the disease as well as with most clinical outcomes. More specific body composition features can be derived for patients using a variety of methods. To date, skeletal muscle measurements derived from preoperative computed tomography scans have shown the most consistent associations with clinical outcomes. Importantly, skeletal muscle can potentially be modified through resistance training and/or nutritional interventions. Large scale studies that evaluate the prognostic impact of not only body composition features at baseline but also describe changes in body composition post-treatment are needed to move the field forward to ultimately improve clinical outcomes for bladder cancer patients.
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Affiliation(s)
- Alejandro Sanchez
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Suzanne Kissel
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT
| | - Adriana Coletta
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT; Department of Health, Kinesiology, and Recreation, The University of Utah, Salt Lake City, UT
| | - Jessica Scott
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
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21
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Roberts AL, Potts HWW, Stevens C, Lally P, Smith L, Fisher A. Cancer specialist nurses' perspectives of physical activity promotion and the potential role of physical activity apps in cancer care. J Cancer Surviv 2019; 13:815-828. [PMID: 31475306 PMCID: PMC6828618 DOI: 10.1007/s11764-019-00801-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/17/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to understand breast, prostate and colorectal cancer clinical nurse specialists' (CNSs) perspectives on physical activity (PA) promotion and the role of smartphone apps to support PA promotion in cancer care. METHODS CNSs working in breast, prostate or colorectal cancer were recruited via advertisements distributed by professional organizations. In-depth semi-structured telephone interviews were conducted and analysed using thematic analysis. RESULTS Nineteen CNSs participated. The analysis resulted in 4 themes regarding CNSs' perspectives of PA promotion within cancer care: (i) policy changes in survivorship care have influenced CNSs' promotion of PA; (ii) CNSs recognize their role in supporting PA but sit within a wider system necessary for effective PA promotion; (iii) CNSs use several techniques to promote PA within their consultations; (iv) remaining challenges in PA promotion. The analysis resulted in 3 themes regarding CNSs' perspectives on the use of apps to promote PA within cancer care: (i) the influence of apps on access to PA support; (ii) the role of apps in self-directed PA; (iii) implementing apps in cancer care. CONCLUSIONS The results of this study provide valuable insight into the CNS role and provide a number of important considerations for the development and implementation of PA interventions within cancer care, with a specific focus on smartphone-based interventions. IMPLICATIONS FOR CANCER SURVIVORS CNSs play an important role in PA promotion in cancer care and this research can inform the development of PA interventions delivered via smartphone app for people affected by cancer.
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Affiliation(s)
- Anna L Roberts
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Claire Stevens
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa Lally
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Abigail Fisher
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK
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22
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Fairman CM, Kendall KL, Newton RU, Hart NH, Taaffe DR, Chee R, Tang CI, Galvão DA. Examining the effects of creatine supplementation in augmenting adaptations to resistance training in patients with prostate cancer undergoing androgen deprivation therapy: a randomised, double-blind, placebo-controlled trial. BMJ Open 2019; 9:e030080. [PMID: 31542747 PMCID: PMC6756416 DOI: 10.1136/bmjopen-2019-030080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Creatine supplementation has consistently been demonstrated to augment adaptations in body composition, muscle strength and physical function in a variety of apparently healthy older adults and clinical populations. The effects of creatine supplementation and resistance training in individuals with cancer have yet to be investigated. This study aims to examine the effects of creatine supplementation in conjunction with resistance training on body composition, muscle strength and physical function in prostate cancer patients undergoing androgen deprivation therapy. METHODS AND ANALYSIS This is a randomised, double-blind, placebo-controlled trial designed to examine the effects of creatine supplementation in addition to resistance training in patients with prostate cancer receiving androgen deprivation therapy. Both supplement and placebo groups will receive a 12-week supervised exercise programme comprising resistance training undertaken three times per week. The primary endpoint (fat-free mass) and secondary endpoints (fat mass, per cent body fat, physical fitness, quality of life and blood biomarkers) will be assessed at baseline and immediately following the intervention. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Edith Cowan University approved this study (ID: 22243 FAIRMAN). If the results of this trial demonstrate that creatine supplementation can augment beneficial adaptations of body composition, physical function and/or psychosocial outcomes to resistance training, this study will provide effect sizes that will inform the design of subsequent definitive randomised controlled trials. The results of this study will be published in peer-reviewed journals and presented at various national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12619000099123.
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Affiliation(s)
- Ciaran M Fairman
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Krissy L Kendall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Raphael Chee
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Radiation Oncology, Genesis Care, Perth, Western Australia, Australia
| | - Colin I Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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