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Thomassen BJM, Kimman ML, Somers AMJ, Ponds RWHM, Dekker JWT, van Leiden BL, Vink GR, de Groot JWB, Melenhorst J, Reynders KMMW, Gielen CMJ, Weerts THA, Lutke Holzik MF, van Kuijk SMJ, Breukink SO, Gidding-Slok AHM. The Assessment of Burden of ColoRectal Cancer (ABCRC)-tool; a validity and reliability study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108032. [PMID: 38489938 DOI: 10.1016/j.ejso.2024.108032] [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: 10/12/2023] [Revised: 01/12/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Follow-up care after treatment for colorectal cancer (CRC) is increasingly focused on health-related quality of life (HRQoL) and functional outcomes. The Assessment of Burden of ColoRectal Cancer (ABCRC)-tool is developed to measure these outcomes and support patient-oriented care. The tool comprises items assessing burden of disease and lifestyle parameters. It consists of a generic module combined with one of the three CRC specific modules. The objective of this study is to assess the construct validity and reliability of the items of the ABCRC-tool. METHODS Patients who were receiving follow-up care after surgical CRC treatment were invited to complete the ABCRC-tool together with other validated patient-reported outcome measures (PROMs). Construct validity was assessed by testing expected correlations between items of the ABCRC-tool and domains of other PROMs and by examining predefined hypotheses regarding differences in subgroups of patients. Patients completed the ABCRC-tool twice, with 8 days apart, to evaluate its reliability. RESULTS In total, 177 patients participated (64% male) with a mean age of 67 years (range 33-88). The colon, rectum and stoma module were completed by subsequently 89, 53 and 35 patients. Most items correlated as expected with anticipated domains of the EORTC QLQ-C30 or EORTC QLQ-CR29 (all p-values <0.05). Furthermore, the ABCRC-tool could discriminate between subgroups of patients. The intraclass correlation coefficient (ICC) was good (>0.70) for most items, indicating good reliability. CONCLUSION The ABCRC-tool is a valid and reliable instrument that is ready for use in a clinical setting to support personalized follow-up care after CRC treatment.
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Affiliation(s)
- Britt J M Thomassen
- Department of Surgery, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Anne M J Somers
- Department of Internal Medicine, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands
| | - Rudolf W H M Ponds
- Department of Medical Psychology, Amsterdam University Medical Center, Location VU, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier de Graaf Group, P.O. Box 5011, 2600 GA, Delft, the Netherlands
| | - Barbara L van Leiden
- National Association of Dutch Health Insurers, P.O. Box 520, 3700 AM, Zeist, the Netherlands
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, the Netherlands
| | - Jan Willem B de Groot
- Department of Medical Oncology, Isala Oncology Center, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands; School for Oncology and Developmental Biology (GROW) Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Kim M M W Reynders
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Christel M J Gielen
- Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Tom H A Weerts
- Department of Gastroenterology, Zuyderland Medical Center, P.O. Box 5500, 6130 MD, Sittard-Geleen, the Netherlands
| | - Martijn F Lutke Holzik
- Department of Surgery, Hospital Group Twente, P.O. Box 7600, 7600 SZ, Almelo, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands; School for Oncology and Developmental Biology (GROW) Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Annerika H M Gidding-Slok
- Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Department of Family Medicine, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
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Melhem SJ, Kayyali R. Multilayer framework for digital multicomponent platform design for colorectal survivors and carers: a qualitative study. Front Public Health 2023; 11:1272344. [PMID: 38115846 PMCID: PMC10728820 DOI: 10.3389/fpubh.2023.1272344] [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: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
Background The advent of eHealth services offers the potential to support colorectal cancer (CRC) survivors and their informal caregivers (ICs), yet research into user needs and design requirements remains scant. This exploratory qualitative study addresses this knowledge gap by focusing on the development of a Digital Multicomponent Platform (DMP) designed to provide comprehensive support to these populations. Aims The objective of this research is to use qualitative methodologies to identify key user needs and design requirements for eHealth services. It seeks to propose and apply a multi-tiered framework for creating a DMP that encapsulates the needs of CRC survivors and their ICs. Methods Skype-based focus groups (FGs) were utilized to gather qualitative data from CRC survivors and ICs. This approach served to elicit crucial themes integral to the design of the DMP. A multi-tiered framework was subsequently developed to integrate user-centered design (UCD) principles and requirements with predetermined outcomes, eHealth services, and IT infrastructure. Results The first stage of the analysis identified five crucial themes: (1) the importance of healthcare system interaction via eHealth, (2) interaction between healthcare providers and peers, (3) lifestyle and wellness considerations, (4) platform content and user interface requirements, (5) caregiver support. The second stage analysis applied the multi-tiered framework, to determine the DMP that was conceptualized from these themes, underscores the significance of personalized content, caregiver involvement, and integration with electronic health records (EHRs). Conclusion The study offers novel insights into the design and development of digital supportive care interventions for CRC survivors and their caregivers. The results highlight the utility of user-centered design principles, the significance of personalized content and caregiver involvement, and the need for a unified health data platform that promotes communication among patients, healthcare providers, and peers. This multi-tiered framework could serve as a prototype for future eHealth service designs.
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Affiliation(s)
- Samar J. Melhem
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey, United Kingdom
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Chan H, Savoie MB, Munir A, Moslehi J, Anwar M, Laffan A, Rowen T, Salmon R, Varma M, Van Loon K. Multi-Disciplinary Management in Rectal Cancer Survivorship: A Clinical Practice Review. J Gastrointest Cancer 2023; 54:1102-1115. [PMID: 36622517 PMCID: PMC10754749 DOI: 10.1007/s12029-022-00885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 01/10/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the USA and worldwide. In the USA, nearly one-third of CRC cases are anatomically classified as rectal cancer. Over the past few decades, continued refinement of multimodality treatment and the introduction of new therapeutic agents have enhanced curative treatment rates and quality of life outcomes. As treatments improve and the incidence of young onset rectal cancer rises, the number of rectal cancer survivors grows each year. This trend highlights the growing importance of rectal cancer survivorship. Multimodality therapy with systemic chemotherapy, chemoradiation, and surgery can result in chronic toxicities in multiple organ systems, requiring a multi-disciplinary care model with services ranging from appropriate cancer surveillance to management of long-term toxicities and optimization of modifiable risk factors. Here, we review the evidence on these long-term toxicities and provide management considerations from consensus guidelines. Specific topics include bowel dysfunction from radiation and surgery, oxaliplatin-induced neuropathy, accelerated bone degeneration, the impact of fluoropyrimidines on long-term cardiovascular health, urinary incontinence, sexual dysfunction, and psychosocial distress. Additionally, we review modifiable risk factors to inform providers and rectal cancer survivors of various lifestyle and behavioral changes that can be made to improve their long-term health outcomes.
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Affiliation(s)
- Hilary Chan
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco (UCSF), 550 16th Street, Floor 06, Room 6803, Box 3211, San Francisco, CA, 94158, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Marissa B Savoie
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Amir Munir
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Javid Moslehi
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Medicine, Division of Cardiology, UCSF, San Francisco, CA, USA
| | - Mekhail Anwar
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Radiation Oncology, UCSF, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Angela Laffan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Tami Rowen
- Department of Obstetrics and Gynecology, UCSF, San Francisco, CA, USA
| | - Rebeca Salmon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Madhulika Varma
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Section of Colorectal Surgery, Department of Surgery, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Katherine Van Loon
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco (UCSF), 550 16th Street, Floor 06, Room 6803, Box 3211, San Francisco, CA, 94158, USA.
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
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Golsteijn RHJ, Bolman C, Peels DA, Volders E, de Vries H, Lechner L. Long-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: A randomized controlled trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:690-704. [PMID: 37591482 PMCID: PMC10658345 DOI: 10.1016/j.jshs.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/18/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period. METHODS Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes. RESULTS At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups. CONCLUSION The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.
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Affiliation(s)
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
| | - Denise Astrid Peels
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
| | - Esmee Volders
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Lilian Lechner
- Department of Psychology, Open University of the Netherlands, Heerlen, 6401 DL, the Netherlands
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Ramezanzade Tabriz E, Ramezani M, Heydari A, Aledavood SA, Jamali J. Development and psychometric properties of Health-Promoting Lifestyle Scale in Colorectal Cancer Survivors (HPLS-CRCS): a mixed-method study. BMC Cancer 2023; 23:931. [PMID: 37789256 PMCID: PMC10546727 DOI: 10.1186/s12885-023-11436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Detecting a health-promoting lifestyle in colorectal cancer (CRC) survivors is of paramount importance to manage disease complications, prevent their recurrence, and enhance survival; however, no specialized tool has yet been provided to measure the lifestyle of these patients. Accordingly, this study aimed to develop and determine the psychometric properties of the Health-Promoting Lifestyle Scale in CRC Survivors (HPLS-CRCS). METHODS This study was a mixed study with an exploratory sequential design in two phases. Concept analysis was performed in the first phase according to Schwartz-Barcott and Kim's (2000) hybrid model to explain the concept, identify dimensions, and generate items. In the second phase, psychometrics including validity (face, content, and construct) and reliability (internal consistency and stability) were determined. Responsiveness, interpretability, ease of use, item weighting, and scale scoring were also determined. RESULTS After explaining the concept, an initial scale encompassing 211 items was developed, content and item analyses were conducted, and the items decreased to 89 items after the face validity assessment. For construct validity, confirmatory factor analysis (CFA) was conducted with a sample size of 500 survivors, and convergent validity was performed for the Persian version of the Health-Promoting Lifestyle Profile II (HPLP-II). Accordingly, 80 items were classified into six factors: activity and rest, spiritual growth, health responsibility, nutrition, interpersonal relationships, and psychological management, with RMSEA = 0.055, χ2/df = 2.484, and χ2 = 6816.516. The reliability of the scale was confirmed, Cronbach's alpha was between 0.865 and 0.928, and the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal important change (MIC), and the smallest detectable change (SDC) were 0.896, 3.36, 13.86, and 19.87, respectively. CONCLUSION The HPLS-CRCS consists of 80 items in six dimensions and is a valid and reliable scale for evaluating the health-promoting lifestyle in CRC survivors. Using this scale to evaluate the healthy lifestyle in these survivors can lead healthcare providers to detect deficiencies and plan the lifestyle of CRC survivors during the post-treatment period.
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Affiliation(s)
- Elahe Ramezanzade Tabriz
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monir Ramezani
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Ebne Sina St, PO Box 9137913199, Mashhad, Iran.
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhou XD, Wei HG, Ai FL. Biofeedback therapy combined with Baduanjin on quality of life and gastrointestinal hormone level in patients with colorectal cancer. World J Gastrointest Oncol 2022; 14:1187-1198. [PMID: 35949217 PMCID: PMC9244983 DOI: 10.4251/wjgo.v14.i6.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the change in people’s lifestyles, the incidence of colorectal cancer (CRC) is increasing. It is essential to study the efficacy of various treatment methods for CRC patients to prevent and treat CRC.
AIM To investigate the efficacy of biofeedback therapy combined with Baduanjin in improving the quality of life and gastrointestinal hormone levels of patients with CRC.
METHODS A total of 120 patients with CRC who were admitted to our hospital from June 2020 to June 2021 were included in the study. They were randomly divided into four groups (n = 30): the control group (group A), the biofeedback therapy intervention group (group B), the Baduanjin exercise intervention group (group C), and the combination group (group D). Patients in group A adopted the standard nursing mode and necessary health education. Patients in group B were treated with biofeedback therapy based on routine nursing care. Patients in group C were given Baduanjin intervention for 12 wk based on conventional drug treatment and care. Patients in group D were treated with biofeedback therapy and Baduanjin exercise. In this study, patients’ quality of life, gastrointestinal hormone levels, and clinical efficacy in the four groups were observed at baseline and 12 wk after intervention. Meanwhile, the correlation between gastrointestinal hormone levels and various functional areas of quality of life was analyzed. By comparing the observed indicators of patients in the four groups, the efficacy of biofeedback therapy combined with Baduanjin in improving the quality of life and gastrointestinal hormone levels of patients with CRC was explored.
RESULTS At baseline, there were no significant differences in quality of life, gastrointestinal hormone levels, or clinical efficacy among the four groups (P > 0.05). Twelve weeks after the intervention, the combination group’s quality of life, gastrointestinal hormone levels, and clinical effectiveness were better than those of the three other groups.
CONCLUSION On the basis of routine nursing care, patients with CRC combined with biofeedback therapy and Baduanjin exercise can improve the quality of life of patients with CRC and the efficacy of gastrointestinal hormone levels.
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Affiliation(s)
- Xiao-Ding Zhou
- Graduate Work Department, Shenyang Sport University, Shenyang 110102, Liaoning Province, China
| | - Hong-Gang Wei
- Wushu and Dance Academy, Shenyang Sport University, Shenyang 110115, Liaoning Province, China
| | - Fu-Lu Ai
- Department of General Surgery, Liaoning Tumor Hospital, Shenyang 110042, Liaoning Province, China
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Prutianu I, Alexa-Stratulat T, Cristea EO, Nicolau A, Moisuc DC, Covrig AA, Ivanov K, Croitoru AE, Miron MI, Dinu MI, Ivanov AV, Marinca MV, Radu I, Gafton B. Oxaliplatin-induced neuropathy and colo-rectal cancer patient’s quality of life: Practical lessons from a prospective cross-sectional, real-world study. World J Clin Cases 2022; 10:3101-3112. [PMID: 35647128 PMCID: PMC9082707 DOI: 10.12998/wjcc.v10.i10.3101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/27/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colon cancer is one the most common forms of cancer in both sexes. Due to important progress in the field of early detection and effective treatment, colon and rectal cancer survivors currently account for 10% of cancer survivors worldwide. However, the effects of anti-cancer treatments, especially oxaliplatin-based chemotherapy, on the quality of life (QoL) have been less evaluated. Although the incidence of severe chemotherapy-induced neuropathy (CIPN) in clinical studies is below 20%, data from real-world studies is scarce, and CIPN is probably under-reported due to patient selection and the patients’ fear that reporting side-effects might lead to treatment cessation.
AIM To determine the impact of CIPN on QoL in colorectal cancer patients with a recent history of oxaliplatin-based chemotherapy.
METHODS We performed a prospective cross-sectional study in two major Romanian oncology tertiary hospitals—the Regional Institute of Oncology Iași (Iasi, Romania) and the Fundeni Clinical Oncology Institute (Bucharest, Romania). All consecutive patients with colon or rectal cancer, undergoing Oxaliplatin-based chemotherapy that consented to enroll in the study, were assessed by means of two questionnaires—the EORTC QQ-CR29 (quality of life in colon and rectal cancer patients) and the QLQ-CIPN20 (assessment of neuropathy). Several demographical, social, clinical and treatment data were also collected. Statistical analysis was performed by means of SPSS v20. The student t test was used to assess the relationship between the QLQ-CIPN20 and QLQ-CR29 results. Kaplan Meyer-curves were used to report 3-year progression-free survival (PFS) in patients that discontinued chemotherapy vs those that completed the recommended course.
RESULTS Of the 267 patients that fulfilled the inclusion criteria in the pre-specified time frame, 101 (37.8%) agreed to participate in the clinical study. At the time of the enrolment in the study, over 50% of the patients had recently interrupted their oxaliplatin-based chemotherapy, most often due to neuropathy. Almost 85% of the responders reported having tingling or numbness in their fingers or hands, symptoms that were associated with pain in over 20% of the cases. When comparing the scores in the two questionnaires, a statistically significant relationship (P < 0.001) was found between the presence of neuropathic symptoms and a decreased quality of life. This correlation was consistent when the patients were stratified by sex, disease stage, comorbidities and the presence of stoma or treatment type, suggesting that neuropathy in itself may be a reason for a decreased quality of life. At the 3 year final assessment, median recurrence-free survival in stage III patients was 26.88 mo. When stratified by completion of chemotherapy, median recurrence free-survival of stage III patients that completed chemotherapy was 28.27 mo vs 24.33 mo in patients that discontinued chemotherapy due to toxicity, a difference that did not reach statistical significance.
CONCLUSION CIPN significantly impacts QoL in colorectal cancer patients. CIPN is also the most frequent reason for treatment discontinuation. Physicians should actively assess for CIPN in order to prevent chronic neuropathy.
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Affiliation(s)
- Iulian Prutianu
- Medical Oncology, SC MNT Healthcare Europe SRL, Iasi 700021, Romania
| | - Teodora Alexa-Stratulat
- Medical Oncology-Radiotherapy, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700483, Romania
| | | | - Andrei Nicolau
- Oral and Maxillo-facial Surgery, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700021, Romania
| | | | | | - Karina Ivanov
- Medical Oncology, Regional Oncology Institute Iasi, Iasi 700483, Romania
| | - Adina Emilia Croitoru
- Department of Medical Oncology, Fundeni Clinical Institute, Bucuresti 022328, Romania
| | - Monica Ionela Miron
- Department of Medical Oncology, Fundeni Clinical Institute, Bucuresti 022328, Romania
| | - Mihaela Ioana Dinu
- Department of Medical Oncology, Fundeni Clinical Institute, Bucuresti 022328, Romania
| | - Anca Viorica Ivanov
- Paediatrics, University of Medicine and Pharmacy “Grigore T Popa”, Iasi 700021, Romania
| | - Mihai Vasile Marinca
- Medical Oncology-Radiotherapy, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700483, Romania
| | - Iulian Radu
- Department of Surgery, Department of Surgical Oncology, University of Medicine and Pharmacy “Grigore T Popa”, Regional Institute of Oncology, Iasi 700021, Romania
| | - Bogdan Gafton
- Medical Oncology-Radiotherapy, University of Medicine and Pharmacy Grigore T Popa Iasi, Iasi 700483, Romania
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Tabriz ER, Ramezani M, Manzari ZS, Jamali J, Heydari A. Psychometric Properties of the Persian Version of the Short-Form Survivor Unmet Needs Survey (SF-SUNS) among Cancer Patients. Asia Pac J Oncol Nurs 2022; 9:100074. [PMID: 35669287 PMCID: PMC9166368 DOI: 10.1016/j.apjon.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Accurate identification of the unmet needs of patients with cancer and with a valid and reliable scale leads to the improvement of planning and implementation of nursing care. Thus, this study aims to translate the Short-Form Survivor Unmet Needs Survey (SF-SUNS) into Persian and to assess the psychometric properties of the Persian version among patients with cancer in Iran. Methods This study was conducted by methodological design. The translation of SF-SUNS was performed by translation protocol of the Quality of Life Assessment. Qualitative assessment of the face validity was conducted through cognitive interview and content validity was assessed through expert panel. This study used a convenience sampling method for 757 patients with cancer referring to Omid and Imam Reza hospitals in Mashhad, Iran. To determine the construct validity, confirmatory factor analysis and convergent validity were employed. Cronbach's alpha and intraclass correlation coefficient were calculated for reliability. Results Total score of unmet needs was 2.20 ± 0.73, which indicates the average level of unmet needs in patients with cancer. Content validity ratio and content validity index scores were 0.88 and 0.91, respectively, Cronbach's alpha coefficient was 0.89, and intraclass correlation coefficient was 0.91. Based on confirmatory factor analysis, goodness-of-fit indices confirmed the model fit (χ2/df = 4.43, GFI = 0.90, TLI/NNFI = 0.91, CFI = 0.90, RMSEA = 0.067). In the subscale of unmet work and financial needs, 4 items had a factor loading lower than 0.4, which were omitted from the Persian version. The results revealed a significant difference in the unmet needs and quality of life of patients with cancer (P < 0.001). Conclusions The Persian version of SF-SUNS has desirable psychometric properties. It can be used to design and assess interventions to improve the quality of caring, cancer management, and as well as interaction between patients and healthcare providers.
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Ellis KR, Raji D, Olaniran M, Alick C, Nichols D, Allicock M. A systematic scoping review of post-treatment lifestyle interventions for adult cancer survivors and family members. J Cancer Surviv 2022; 16:233-256. [PMID: 33713302 PMCID: PMC8564800 DOI: 10.1007/s11764-021-01013-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Supporting the health of cancer survivors and their families from diagnosis through survivorship is a recognized priority. However, the extent to which health promotion efforts after the completion of acute treatment attend to the needs of adult survivors and families is unclear. This systematic scoping review summarizes the key characteristics of post-treatment lifestyle interventions aiming to improve diet, physical activity, and/or weight-related outcomes for adult cancer survivors and family members. METHODS We retrieved relevant studies from six databases using keywords. Studies were appraised for quality and limited to English-language, peer-reviewed journal articles published in or after 2005. RESULTS A total of 2,376 articles were obtained from the databases; 14 main articles (and 2 supplemental articles) representing 14 unique interventions were retained for our analysis. Most interventions were designed to modify aspects of participant diet and physical activity (in combination) or physical activity alone; cited social cognitive theory as a guiding or interpretative framework; included survivors of multiple cancer types; and were limited to one type of familial relationship (e.g., spouse/partner, sister). Where reported, intervention samples were predominantly White. CONCLUSIONS Few post-treatment interventions concurrently target cancer survivor and family members' positive lifestyle behaviors. Positive findings highlight the potential for expanding this area of intervention research and increasing understanding of individual and familial factors that contribute to successful post-treatment family interventions. IMPLICATIONS FOR CANCER SURVIVORS Promoting cancer survivors' healthy behaviors within the family context could capitalize on existing support networks and improve the health of family members in supportive roles.
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Affiliation(s)
- Katrina R. Ellis
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Dolapo Raji
- University of Michigan, School of Information, Ann Arbor, MI, USA
| | - Marianne Olaniran
- The University of Texas, Health Science Center at Houston School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
| | - Candice Alick
- North Carolina Central University, Department of Human Sciences, Durham, NC, USA
| | - Darlene Nichols
- University of Michigan Library, Hatcher Graduate Library, Ann Arbor, MI, USA
| | - Marlyn Allicock
- The University of Texas, Health Science Center at Houston School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
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Ayyoubzadeh SM, Shirkhoda M, R Niakan Kalhori S, Mohammadzadeh N, Zakerabasali S. A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis. JMIR Cancer 2022; 8:e18083. [PMID: 34989685 PMCID: PMC8771344 DOI: 10.2196/18083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/24/2020] [Accepted: 10/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. OBJECTIVE In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors' and clinical experts' views. METHODS A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won't have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. RESULTS The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (-0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors' perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. CONCLUSIONS The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients' and health care providers' communication and interaction.
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Affiliation(s)
- Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shirkhoda
- Department of Surgery, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.,Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Braunschweig, Germany
| | - Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayyeh Zakerabasali
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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KENKHUIS MARLOUFLOOR, VAN ROEKEL ELINEH, BREEDVELD-PETERS JOSÉJL, BREUKINK STÉPHANIEO, JANSSEN-HEIJNEN MARYSKALG, KEULEN ERICTP, VAN DUIJNHOVEN FRÄNZELJB, MOLS FLOORTJE, WEIJENBERG MATTYP, BOURS MARTIJNJL. Longitudinal Associations of Sedentary Behavior and Physical Activity with Quality of Life in Colorectal Cancer Survivors. Med Sci Sports Exerc 2021; 53:2298-2308. [PMID: 34033619 PMCID: PMC8542069 DOI: 10.1249/mss.0000000000002703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Given the growing population of colorectal cancer (CRC) survivors, identifying ways to enhance health-related quality of life (HRQoL) and alleviate complaints of fatigue and chemotherapy-induced peripheral neuropathy (CIPN) is essential. PURPOSE We aimed to assess longitudinal associations of sedentary behavior (SB) and moderate to vigorous physical activity (MVPA) independently, as well as their joint association, with HRQoL, fatigue, and CIPN in CRC survivors. METHODS In a prospective cohort among stage I-stage III CRC survivors (n = 396), five repeated home visits from diagnosis up to 24 months posttreatment were executed. SB was measured using triaxial accelerometers, and MVPA, HRQoL, fatigue, and CIPN were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 months posttreatment. RESULTS Average time in prolonged SB (accumulated in bouts of duration ≥30 min) was 5.3 ± 2.7 h·d-1, and approximately 82% of survivors were classified as sufficiently active (≥150 min·wk-1 of MVPA) at 6 wk posttreatment. Decreases in SB and increases in MVPA were independently associated with better HRQoL and less fatigue over time. No associations were found for CIPN complaints. A synergistic interaction was observed between prolonged SB and MVPA in affecting functioning scales. Relative to CRC survivors with low prolonged SB and high MVPA, survivors with high prolonged SB and low MVPA reported a stronger decrease in physical functioning and role functioning over time than expected based on the independent associations of prolonged SB and MVPA. CONCLUSION Our longitudinal results show that less SB and more MVPA are beneficial for CRC survivors' HRQoL and fatigue levels. Our findings regarding interaction underscore that joint recommendations to avoid prolonged sitting and accumulate MVPA are important.
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Affiliation(s)
- MARLOU FLOOR KENKHUIS
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - ELINE H. VAN ROEKEL
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - JOSÉ J. L. BREEDVELD-PETERS
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - STÉPHANIE O. BREUKINK
- Department of Surgery, GROW School for Oncology and Developmental Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - MARYSKA L. G. JANSSEN-HEIJNEN
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
- Department of Clinical Epidemiology, Viecuri Medical Center, Venlo, THE NETHERLANDS
| | - ERIC T. P. KEULEN
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, THE NETHERLANDS
| | | | - FLOORTJE MOLS
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, THE NETHERLANDS
| | - MATTY P. WEIJENBERG
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - MARTIJN J. L. BOURS
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
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12
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Mulder FECM, van Roekel EH, Bours MJL, Weijenberg MP, Evers SMAA. The burden of colorectal cancer survivors in the Netherlands: costs, utilities, and associated patient characteristics. J Cancer Surviv 2021; 16:1055-1064. [PMID: 34510364 PMCID: PMC9489543 DOI: 10.1007/s11764-021-01096-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Purpose The aim of this study is to assess the societal burden of colorectal cancer (CRC) survivorship 2–10 years post-diagnosis in terms of (1) societal costs, and (2) quality of life/utilities, and to analyze associated patient characteristics. Methods This is a cross-sectional, bottom-up prevalence-based burden of disease study, conducted from a societal perspective in the Netherlands. In total, 155 CRC survivors were included. Utilities were measured by the EQ-5D-5L, using the Dutch tariffs. A cost questionnaire was developed to obtain cost information. Subgroup analyses were performed, based on patient characteristics and sensitivity analyses. Results Of all CRC survivors, 81(54%) reported no problems for mobility, 133(88%) for self-care, 98(65%) for daily activities, 59(39%) for pain/discomfort, and 112(74%) for anxiety/depression on the EQ-5D-5L. The average EQ-5D-5L utility score was 0.82 (SD = 0.2) on a scale from 0 (death) to 1 (perfect health). Significant differences in utility score were found for gender, tumor stage, number of comorbidities, and lifestyle score. The average societal costs per CRC survivor per 6 months were estimated at €971 (min = €0, max = €32,425). Significant differences in costs were found for the number of comorbidities. Conclusions This study shows a considerable burden of CRC survivors 2–10 years after diagnosis, in comparison with survivors sooner after diagnosis and with healthy individuals in the Netherlands. Implications for Cancer Survivors Long-term care of CRC survivors should focus on improving the societal burden by identifying modifiable factors, as summarized in the WCRF/AICR lifestyle score, including body composition, physical activity, and diet.
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Affiliation(s)
- Frederike E C M Mulder
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. .,Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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13
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Odikpo LC, Chiejina EN. Assessment of Practice and Outcome of Exercise on Quality of Life of Women with Breast Cancer in Delta State. Asian Pac J Cancer Prev 2021; 22:2377-2383. [PMID: 34452549 PMCID: PMC8629475 DOI: 10.31557/apjcp.2021.22.8.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study evaluated the effect of exercise on the quality of life of women with breast cancer. It determined the pre and post-intervention functional, symptoms, and global quality of life of women with breast cancer in the control and intervention groups. METHODS The quasi-experimental design study adopted a purposive sampling technique in selecting the women with breast cancer in the intervention (47) and control (47) groups. Data on QOL was measured using standardized instruments, namely the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-version 3 (EORTC QLQ-C30. RESULTS The results show the pre-intervention overall functional quality of life domain score was 59.2±21.98 for the intervention and 67.0± 20.13 for the control, an overall score for the symptom domain was 31.8±10.89 for the intervention and 29.8±10.24 for the control. The post-intervention overall generic functional domain score was 89.0±11.1 for the intervention and 51.2±17.8 for the control and for symptoms domain; their overall score was 16.4±10.2 for the intervention and 35.4±12.4 for the control. A significant difference existed in all post-intervention functional domain scores of the generic function and symptoms quality of life as the functional domains (p < 0.001) and global health status (p < 0.001). CONCLUSION As the numbers of women who survive breast cancer continue to increase, there is a need for lifestyle modification like exercise to improve and maintain their overall QOL to live a fulfilled life devoid of post-treatment complications.
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Affiliation(s)
- Linda C Odikpo
- Department of Nursing Science, Nnamdi Azikiwe University Awka, Nnewi Campus, Nigeria.
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14
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Kline RM, Temple LKF, Nekhlyudov L. Implementing Quality Colon Cancer Survivorship Care: A Practical Proposal for a Path Forward. JCO Oncol Pract 2020; 17:77-84. [PMID: 32822258 DOI: 10.1200/op.20.00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There are currently close to 17 million survivors of cancer in the United States. This number is expected to grow as both an aging population and improved treatment increase the number of survivors. Consequently, the importance of quality survivorship care has been recognized, but implementing, measuring, and paying for this care in a highly fragmented health care system, across a broad spectrum of diseases, is difficult. Quality measurement tied to payment is one approach that has commonly been used to improve the quality of care in the US health care system, but the complexity of applying quality measurement metrics across the spectrum of cancer survivorship care had led to stalemate. In this article, we draw on prior work to develop a quality cancer survivorship framework and propose a practical path forward with a focus on the provision of colon cancer survivorship care within integrated health care delivery networks. With this narrowly defined approach, we hope that we can promote a practical solution that can be extended to other diseases and payment systems over time.
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Affiliation(s)
- Ronald M Kline
- Healthcare and Insurance Program Office, US Office of Personnel Management, Washington, DC
| | - Larissa K F Temple
- Division of Colorectal Surgery, University of Rochester School of Medicine, Rochester, NY
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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15
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McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database Syst Rev 2020; 5:CD012864. [PMID: 32361988 PMCID: PMC7196359 DOI: 10.1002/14651858.cd012864.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colorectal cancer is the third most commonly diagnosed cancer worldwide. A diagnosis of colorectal cancer and subsequent treatment can adversely affect an individuals physical and mental health. Benefits of physical activity interventions in alleviating treatment side effects have been demonstrated in other cancer populations. Given that regular physical activity can decrease the risk of colorectal cancer, and cardiovascular fitness is a strong predictor of all-cause and cancer mortality risk, physical activity interventions may have a role to play in the colorectal cancer control continuum. Evidence of the efficacy of physical activity interventions in this population remains unclear. OBJECTIVES To assess the effectiveness and safety of physical activity interventions on the disease-related physical and mental health of individuals diagnosed with non-advanced colorectal cancer, staged as T1-4 N0-2 M0, treated surgically or with neoadjuvant or adjuvant therapy (i.e. chemotherapy, radiotherapy or chemoradiotherapy), or both. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 6), along with OVID MEDLINE, six other databases and four trial registries with no language or date restrictions. We screened reference lists of relevant publications and handsearched meeting abstracts and conference proceedings of relevant organisations for additional relevant studies. All searches were completed between 6 June and 14 June 2019. SELECTION CRITERIA We included randomised control trials (RCTs) and cluster-RCTs comparing physical activity interventions, to usual care or no physical activity intervention in adults with non-advanced colorectal cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, performed the data extraction, assessed the risk of bias and rated the quality of the studies using GRADE criteria. We pooled data for meta-analyses by length of follow-up, reported as mean differences (MDs) or standardised mean differences (SMDs) using random-effects wherever possible, or the fixed-effect model, where appropriate. If a meta-analysis was not possible, we synthesised studies narratively. MAIN RESULTS We identified 16 RCTs, involving 992 participants; 524 were allocated to a physical activity intervention group and 468 to a usual care control group. The mean age of participants ranged between 51 and 69 years. Ten studies included participants who had finished active treatment, two studies included participants who were receiving active treatment, two studies included both those receiving and finished active treatment. It was unclear whether participants were receiving or finished treatment in two studies. Type, setting and duration of physical activity intervention varied between trials. Three studies opted for supervised interventions, five for home-based self-directed interventions and seven studies opted for a combination of supervised and self-directed programmes. One study did not report the intervention setting. The most common intervention duration was 12 weeks (7 studies). Type of physical activity included walking, cycling, resistance exercise, yoga and core stabilisation exercise. Most of the uncertainty in judging study bias came from a lack of clarity around allocation concealment and blinding of outcome assessors. Blinding of participants and personnel was not possible. The quality of the evidence ranged from very low to moderate overall. We did not pool physical function results at immediate-term follow-up due to considerable variation in results and inconsistency of direction of effect. We are uncertain whether physical activity interventions improve physical function compared with usual care. We found no evidence of effect of physical activity interventions compared to usual care on disease-related mental health (anxiety: SMD -0.11, 95% confidence interval (CI) -0.40 to 0.18; 4 studies, 198 participants; I2 = 0%; and depression: SMD -0.21, 95% CI -0.50 to 0.08; 4 studies, 198 participants; I2 = 0%; moderate-quality evidence) at short- or medium-term follow-up. Seven studies reported on adverse events. We did not pool adverse events due to inconsistency in reporting and measurement. We found no evidence of serious adverse events in the intervention or usual care groups. Minor adverse events, such as neck, back and muscle pain were most commonly reported. No studies reported on overall survival or recurrence-free survival and no studies assessed outcomes at long-term follow-up We found evidence of positive effects of physical activity interventions on the aerobic fitness component of physical fitness (SMD 0.82, 95% CI 0.34 to 1.29; 7 studies, 295; I2 = 68%; low-quality evidence), cancer-related fatigue (MD 2.16, 95% CI 0.18 to 4.15; 6 studies, 230 participants; I2 = 18%; low-quality evidence) and health-related quality of life (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence) at immediate-term follow-up. These positive effects were also observed at short-term follow-up but not medium-term follow-up. Only three studies reported medium-term follow-up for cancer-related fatigue and health-related quality of life. AUTHORS' CONCLUSIONS The findings of this review should be interpreted with caution due to the low number of studies included and the quality of the evidence. We are uncertain whether physical activity interventions improve physical function. Physical activity interventions may have no effect on disease-related mental health. Physical activity interventions may be beneficial for aerobic fitness, cancer-related fatigue and health-related quality of life up to six months follow-up. Where reported, adverse events were generally minor. Adequately powered RCTs of high methodological quality with longer-term follow-up are required to assess the effect of physical activity interventions on the disease-related physical and mental health and on survival of people with non-advanced colorectal cancer. Adverse events should be adequately reported.
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Affiliation(s)
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Marie M Cantwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
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Ayyoubzadeh SM, R. Niakan Kalhori S, Shirkhoda M, Mohammadzadeh N, Esmaeili M. Supporting colorectal cancer survivors using eHealth: a systematic review and framework suggestion. Support Care Cancer 2020; 28:3543-3555. [DOI: 10.1007/s00520-020-05372-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/20/2020] [Indexed: 01/01/2023]
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17
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Tiranda Y, Siripul P, Sangchart B, Septiwi C. Perspectives of adult survivors of colorectal cancer with an ostomy on their needs: synthesis of qualitative research studies. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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18
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Melo L, Hagar A. How to train a mouse-methodological issues in pre-clinical exercise oncology. Am J Cancer Res 2019; 9:1246-1253. [PMID: 31285956 PMCID: PMC6610064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 06/09/2023] Open
Abstract
We point at several challenges that current exercise oncology rodent models face, which call their human-relevance into question: the vast majority of pre-clinical studies in exercise oncology treat "physical exercise" as a primitive concept without further analysis or qualification, and their results are based on dosages that no human can endure. The lack of analysis and qualification together with the dosage mismatch conceal the fact that rodents do not run like humans. Consequently, while these pre-clinical studies may yield insights into potential biological mechanisms underlying the systemic effects of physical exercise on cancer, the applicability of this knowledge to preventive interventions in healthy humans and the ability to translate it to practical therapies in the critically ill remain limited. We propose an alternative exercise rodent model that has better chances of meeting these challenges.
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Affiliation(s)
- Luma Melo
- Department of Environmental Health, School of Public Health, Indiana UniversityBloomington, IN 47405, USA
- Department of History & Philosophy of Science & Medicine, Indiana UniversityBloomington, IN, USA
| | - Amit Hagar
- Department of Environmental Health, School of Public Health, Indiana UniversityBloomington, IN 47405, USA
- Department of Intelligent Systems Engineering, Indiana UniversityBloomington, IN, USA
- Department of History & Philosophy of Science & Medicine, Indiana UniversityBloomington, IN, USA
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Oruç Z, Kaplan MA. Effect of exercise on colorectal cancer prevention and treatment. World J Gastrointest Oncol 2019; 11:348-366. [PMID: 31139306 PMCID: PMC6522766 DOI: 10.4251/wjgo.v11.i5.348] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023] Open
Abstract
In recent years, because of improved cancer screening, detection and treatment modalities, a rapid increase in the population of colorectal and other cancer survivors has been observed. The increasing population has justified the requirement of preventive strategies such as lifestyle modifications with regard to obesity, physical activity, diet and smoking. Physical activity may prevent approximately 15% of the colon cancers. Furthermore, several observational studies have demonstrated the efficacy and dose-dependent and anti-cancer effects of exercise on decreasing the mortality and risk of recurrence before and after the colorectal cancer (CRC) diagnosis. However, the required exercise dose, type and intensity are yet unclear. The results of randomised prospective studies are expected to determine the optimal amount, type and intensity of exercise and formulate the most appropriate exercise plan and guidelines, according to the requirements and comorbidities of the patients. In addition, recent studies have focused on the molecular and genetic mechanisms underlying the effect of physical activity on disease outcomes and recurrence rates. This review aimed to investigate the effects of physical activity and the biological basis of these effects in preventing the risk and recurrence of CRC and decreasing the hazards of cancer and cancer treatment.
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Affiliation(s)
- Zeynep Oruç
- Department of Medical Oncology, Mersin City Hospital, Mersin 33000, Turkey
| | - Muhammed Ali Kaplan
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır 21280, Turkey
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20
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Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women's Health Initiative. Eur J Nutr 2019; 59:965-977. [PMID: 30955051 DOI: 10.1007/s00394-019-01956-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/24/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Dietary factors may influence colorectal cancer (CRC) survival through effects on inflammation. We examined the association between post-CRC diagnosis inflammatory potential of diet and all-cause and cancer-specific mortality in the Women's Health Initiative. METHODS The study included 463 postmenopausal women who developed CRC during follow-up and completed a food frequency questionnaire (FFQ), on average 1.7 years after diagnosis. Women were followed from CRC diagnosis until death, censoring, or the end of follow-up in October 2014. Energy-adjusted dietary inflammatory index (E-DII)® scores were calculated from the FFQ and dietary supplement inventory. Cox proportional hazards models were fitted to estimate multivariable-adjusted HRs and 95% confidence intervals (CIs) for all-cause, total cancer, and CRC-specific mortality with the most pro-inflammatory E-DII scores (tertile 3) as referent. RESULTS After a median 11.6 years of follow-up, 162 deaths occurred, including 77 from CRC. Lowest tertile (i.e., most anti-inflammatory) E-DII scores from diet plus supplements were associated with significantly lower all-cause mortality (HRT1vsT3 = 0.49; 95% CI 0.31-0.79) compared to the most pro-inflammatory E-DII tertile. Modest associations with total cancer mortality or CRC-specific mortality were observed, though 95% CIs included 1. CONCLUSIONS Consuming a dietary pattern and supplements with more anti-inflammatory potential after CRC diagnosis may improve overall survival among postmenopausal women.
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Short-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: a randomized controlled trial. Int J Behav Nutr Phys Act 2018; 15:106. [PMID: 30376857 PMCID: PMC6208119 DOI: 10.1186/s12966-018-0734-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/09/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer and cancer treatment, but adherence to PA guidelines is low. Computer-tailored PA interventions can reach large populations with little resources. They match with patients' preference for home-based, unsupervised PA programs and are thus promising for the growing population of cancer survivors. The current study assessed the efficacy of a computer-tailored PA intervention in (four subgroups of) prostate and colorectal cancer survivors. METHODS Prostate and colorectal cancer patients and survivors were randomized to the OncoActive intervention group (N = 249), or a usual-care waiting-list control group (N = 229). OncoActive participants received a pedometer and computer-tailored PA advice, both Web-based via an interactive website and with printed materials. Minutes moderate-to-vigorous PA (MVPA) and days ≥30 min PA were assessed with an accelerometer (ActiGraph) at baseline and 6 months. Further, questionnaires were used to assess self-reported PA, fatigue, distress, and quality of life at baseline, 3 and 6 months. Differences between both groups were assessed using linear regression analyses (complete cases and intention-to-treat). In addition, efficacy in relation to age, gender, education, type of cancer, and time since treatment was examined. RESULTS Three months after baseline OncoActive participants significantly increased their self-reported PA (PA days: d = 0.46; MVPA: d = 0.23). Physical functioning (d = 0.23) and fatigue (d = - 0.21) also improved significantly after three months. Six months after baseline, self-reported PA (PA days: d = 0.51; MVPA: d = 0.37) and ActiGraph MVPA (d = 0.27) increased significantly, and ActiGraph days (d = 0.16) increased borderline significantly (p = .05; d = 0.16). Furthermore, OncoActive participants reported significantly improvements in physical functioning (d = 0.14), fatigue (d = - 0.23) and depression (d = - 0.32). Similar results were found for intention-to-treat analyses. Higher increases in PA were found for colorectal cancer participants at 3 months, and for medium and highly educated participants' PA at 6 months. Health outcomes at 6 months were more prominent in colorectal cancer participants and in women. CONCLUSIONS The OncoActive intervention was effective at increasing PA in prostate and colorectal cancer patients and survivors. Health-related effects were especially apparent in colorectal cancer participants. The intervention provides opportunities to accelerate cancer recovery. Long-term follow-up should examine further sustainability of these effects. TRIAL REGISTRATION The study was registered in the Dutch Trial Register ( NTR4296 ) on October 17 2018.
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Abstract
Mortality from colorectal cancer has been declining over the past 20 years due to improvements in screening and treatment. Physical activity improves patient quality of life, slows functional decline, and reduces all-cause mortality. Although some patients may have difficulty participating in physical activity, clinicians should always try to incorporate exercise into a management plan for patients who have survived colorectal cancer.
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Eyl RE, Koch-Gallenkamp L, Jansen L, Walter V, Carr P, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Potential determinants of physical inactivity among long-term colorectal cancer survivors. J Cancer Surviv 2018; 12:679-690. [PMID: 30097853 DOI: 10.1007/s11764-018-0705-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Since physical activity (PA) has been shown to be associated with better prognosis and quality of life (QOL) in colorectal cancer (CRC) patients, this study focuses on the barriers of PA among CRC survivors. METHODS This study is based on a population-based study from Germany of 1343 women and men, diagnosed with CRC between 2003 and 2008 and being alive five years later. Multivariable logistic regression was used to explore associations between baseline as well as five-year follow-up (5YFU) characteristics and physical inactivity (PIA) at 5YFU. Quartiles were calculated based on metabolic equivalent hours per week of PA at baseline and at 5YFU. Participants in quartile 1 were defined as physically inactive, and patients in quartile 2 to quartile 4 were defined as physically active. RESULTS Cancer-specific factors such as having a stoma (odds ratio (OR) = 1.51, 95% confidence interval (CI) = 1.12-2.04), demographic factors such as living in a small town or city (OR = 1.46, 95% CI = 1.05-2.02; OR = 1.42, 95% CI = 1.01-2.02), older age (OR = 1.44, 95% CI = 0.80-2.58), or being divorced (OR = 1.72, 95% CI = 0.96-3.07), as well as lifestyle factors such as being a current smoker (OR = 1.54, 95% CI = 1.04-2.29) or being obese (OR = 1.43, 95% CI = 0.96-2.13) were associated with PIA at 5YFU. Subgroup analyses showed that the association between body mass index and PIA was stronger in women than in men. Baseline PA was identified as a strong predictor of PIA at 5YFU. CONCLUSIONS Findings suggest that predominately patients with a stoma, patients living in a more populated area, being older, divorced, a current smoker, or obese were more likely to be physically inactive and therefore could be targeted to be more physically active. IMPLICATIONS FOR CANCER SURVIVORS Addressing barriers for PA might help to develop specific, individually tailored PA interventions to overcome PIA and improve the long-term outcome of CRC survivors.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Prudence Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Abstract
Physical Activity and Cancer Abstract. This article aims to summarize the literature on the role of physical activity in cancer patients and to propose exercise programs based on studies and recommendations. Medical advances with improved early diagnosis and treatment have increased the number of cancer survivors. At the same time, the quality of life of these patients must also be improved. In the different stages of the disease physical activity has an important role to play with its beneficial effects on fatigue, physical condition, mood etc. Collaboration between health system actors and patient education are the key to success in this multi-disciplinary care.
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Affiliation(s)
| | | | - Pierre Molnar
- 1 Hôpital du Jura, Centre de Rééducation, Porrentruy
| | - Serdar Koçer
- 1 Hôpital du Jura, Centre de Rééducation, Porrentruy
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Soares-Miranda L, Abreu S, Ruiz-Casado A, Lucia A. Physical activity and nutritional interventions and health-related quality of life in colorectal cancer survivors: a review. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1503538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Luisa Soares-Miranda
- University of Porto, Research Center in Physical Activity Health and Leisure, Faculty of Sport, Porto, Portugal
| | - Sandra Abreu
- University of Porto, Research Center in Physical Activity Health and Leisure, Faculty of Sport, Porto, Portugal
- Faculty of Psychology, Education and Sport, Lusófona University of Porto, Porto, Portugal
| | - Ana Ruiz-Casado
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Alejandro Lucia
- Research Institute of Hospital 12 de Octubre (‘i+12ʹ), Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Eyl RE, Xie K, Koch-Gallenkamp L, Brenner H, Arndt V. Quality of life and physical activity in long-term (≥5 years post-diagnosis) colorectal cancer survivors - systematic review. Health Qual Life Outcomes 2018; 16:112. [PMID: 29859108 PMCID: PMC5984808 DOI: 10.1186/s12955-018-0934-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 05/15/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Due to the increasing number of long-term (≥5 years post diagnosis) colorectal cancer survivors, long-term quality of life of these patients is highly relevant. Several studies have reported a positive association between physical activity and quality of life in colorectal cancer survivors, however, so far no systematic review has been published which focuses on long-term colorectal cancer survivors. MATERIAL AND METHODS A systematic review was conducted using the databases PubMed, Web of Science, PsychINFO, and CINAHL. Studies which investigated associations between physical activity and quality of life in long-term colorectal cancer survivors were included. RESULTS AND CONCLUSION Ten articles based on seven studies were identified. Long-term colorectal cancer survivors who were physically active reported better quality of life than long-term survivors who were not physically active. Both, moderate to vigorous physical activity and lower levels like light physical activity were associated with higher quality of life. Most studies assessed the association between physical activity and quality of life cross-sectionally but one prospective study which measured physical activity and quality of life at three different points in time also found associations between physical activity and quality of life. The association between physical activity and quality of life seemed to be stronger among women than among men. The findings of this systematic review support an association between physical activity and quality of life in long-term colorectal cancer survivors. However, the evidence is limited as most studies were based on cross-sectional and observational design.
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Affiliation(s)
- Ruth Elisa Eyl
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,University of Heidelberg, Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Kun Xie
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,University of Heidelberg, Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Hermann Brenner
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Division of Preventive Oncology, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- German Cancer Research Center (DKFZ), Divison of Clinical Epidemiology and Aging Research, Unit of Cancer Survivorship, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Eng L, Pringle D, Su J, Shen X, Mahler M, Niu C, Charow R, Tiessen K, Lam C, Halytskyy O, Naik H, Hon H, Irwin M, Pat V, Gonos C, Chan C, Villeneuve J, Harland L, Shani RM, Brown MC, Selby P, Howell D, Xu W, Liu G, Alibhai SMH, Jones JM. Patterns, perceptions, and perceived barriers to physical activity in adult cancer survivors. Support Care Cancer 2018; 26:3755-3763. [DOI: 10.1007/s00520-018-4239-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
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Igwebuike LT, Zhang X, Brown JC, Schmitz KH. Applying pre-participation exercise screening to breast cancer survivors: a cross-sectional study. Support Care Cancer 2017; 26:1825-1831. [PMID: 29260391 DOI: 10.1007/s00520-017-4020-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Clinical guidelines recommend that breast cancer (BrCa) survivors be prescribed exercise. However, clinicians often do not prescribe exercise citing the presence of multiple health issues found among cancer survivors. No study has examined the proportion of BrCa survivors that can be prescribed a community/home-based unsupervised exercise program safely and independently, without further medical investigations or supervision. METHODS Participants included BrCa survivors who received treatment at a university healthcare system between 2009 and 2014. We applied previously identified published guidelines for health conditions that may impede BrCa survivors from completing a community/home-based exercise program. Logistic regression models were used to quantify the magnitude of the association between demographic and clinical characteristics and the ability to perform community/home-based exercise. RESULTS Among 667 BrCa survivors, 65 to 75% was classified as able to complete community/home-based exercise as recommended by the clinical guidelines. Older age, black race, treatment with chemotherapy, and treatment with radiation were associated with the potential need for further medical evaluation prior to starting exercise. CONCLUSIONS A large proportion of BrCa survivors can be prescribed community/home-based exercise program safely and independently, without further medical investigations or supervision. Future research will be needed to determine how to identify the subset of BrCa survivors that may benefit from medical evaluation prior to starting exercise in a manner that does not interrupt clinical oncology workflow. Approximately 35% of BrCa survivors may benefit from medical evaluation prior to starting community/home-based exercise.
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Affiliation(s)
| | - Xiaochen Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Justin C Brown
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kathryn H Schmitz
- Public Health Science, Penn State College of Medicine, Penn State Cancer Institute, Room T3427, 500 University Drive, Mail code CH69, Hershey, PA, 17033, USA.
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Lawrence LM, Stone MR, Rainham DG, Keats MR. Environments Associated with Moderate-to-Vigorous Physical Activity and Sedentary Behavior of Colorectal Cancer Survivors. Int J Behav Med 2017; 24:120-126. [PMID: 27364123 DOI: 10.1007/s12529-016-9575-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Physical activity (PA) is an effective intervention for improving the quality of life of colorectal cancer survivors (CRC) and may reduce the risk of cancer recurrence and cancer specific and all-cause mortality. However, most CRC survivors are not sufficiently active to receive these benefits. Sedentary behavior (SB) has also been linked to morbidity and mortality risk independent of activity level, thereby presenting an additional opportunity to improve health outcomes of CRC survivors. The built environment is known to influence PA and SB; however, little is known about where CRC survivors engage in PA and SB. The objective of this exploratory study was to objectively identify locations where CRC survivors engage in PA and SB in order to inform health promoting interventions. METHOD Activity and location of CRC survivors (n = 31) was monitored for 1 week between January 2014 and April 2015 in Nova Scotia, Canada. Bouts of PA and SB were time-matched with GPS data to attribute bouts to specific geographic locations. RESULTS Participants' home environment was the main location for both time spent in PA bouts (73.7 %) and time spent in SB bouts (90.5 %). CONCLUSION This study is the first to objectively identify environments where CRC survivors are active and sedentary. These findings highlight the importance of considering the home environment when developing intervention strategies to increase PA and reduce SB in CRC survivors.
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Affiliation(s)
- Logan M Lawrence
- School of Health and Human Performance, Dalhousie University, PO Box 15000, B3H 4R2, Halifax, NS, Canada.
| | - Michelle R Stone
- School of Health and Human Performance, Dalhousie University, PO Box 15000, B3H 4R2, Halifax, NS, Canada
| | - Daniel G Rainham
- Environmental Science, Dalhousie University, Halifax, NS, Canada
| | - Melanie R Keats
- School of Health and Human Performance, Dalhousie University, PO Box 15000, B3H 4R2, Halifax, NS, Canada
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Golsteijn RHJ, Bolman C, Peels DA, Volders E, de Vries H, Lechner L. A Web-Based and Print-Based Computer-Tailored Physical Activity Intervention for Prostate and Colorectal Cancer Survivors: A Comparison of User Characteristics and Intervention Use. J Med Internet Res 2017; 19:e298. [PMID: 28835353 PMCID: PMC5587888 DOI: 10.2196/jmir.7838] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 12/31/2022] Open
Abstract
Background Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer. The rapidly increasing number of cancer survivors, resulting from aging and improved cancer care, emphasizes the importance to develop and provide low cost, easy accessible PA programs. Such programs could be provided through the Internet, but that could result in the exclusion of cancer survivors not familiar with the Internet. Therefore, we developed a computer-tailored PA intervention for prostate and colorectal cancer survivors in which both Web-based and print materials are provided, and participants can choose their own preferred delivery mode. Objective The aim of this study was to assess participants’ characteristics related to delivery mode and use of intervention materials. Methods We studied characteristics of participants using Web-based and printed intervention materials in a randomized controlled trial (RCT). Prostate and colorectal cancer survivors recruited from hospitals were randomized to OncoActive (computer-tailored PA intervention) or a usual-care control group. OncoActive participants received both Web-based and printed materials. Participants were classified into initial print- or Web-based participants based on their preferred mode of completion of the first questionnaire, which was needed for the computer-tailored PA advice. Intervention material use during the remainder of the intervention was compared for initial print- or Web-based participants. Additionally, participants were classified into those using only print materials and those using Web-based materials. Differences in participant characteristics and intervention material use were studied through analysis of variance (ANOVAs), chi-square tests, and logistic regressions. Results The majority of the participants in the intervention group were classified as initial Web-based participants (170/249, 68.3%), and 84.9% (191/249) used Web-based intervention materials. Dropout was low (15/249, 6.0%) and differed between initial Web-based (4/170, 2.4%) and print-based (11/79, 14%) participants. Participants were less likely to start Web-based with higher age (odds ratio [OR]=0.93), longer time since last treatment (OR=0.87), and higher fatigue (OR=0.96), and more likely with higher education (OR=4.08) and having completed treatments (OR=5.58). Those who were older (OR=0.93) and post treatment for a longer time (OR=0.86) were less likely to use Web-based intervention materials. Initial print-based participants predominantly used print-based materials, whereas initial Web-based participants used both print- and Web-based materials. Conclusions To our knowledge, this is one of the first studies that assessed participant characteristics related to delivery mode in an intervention in which participants had a free choice of delivery modes. Use of print-based materials among the initial Web-based participants was substantial, indicating the importance of print-based materials. According to our findings, it may be important to offer Web- and print-based materials alongside each other. Providing Web-based materials only may exclude older, less educated, more fatigued, or currently treated participants; these groups are especially more vulnerable and could benefit most from PA interventions.
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Affiliation(s)
| | - Catherine Bolman
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
| | - Denise Astrid Peels
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
| | - Esmee Volders
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Lilian Lechner
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, Netherlands
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Physical activity, bowel function, and quality of life among rectal cancer survivors. Qual Life Res 2017; 26:3131-3142. [PMID: 28677077 DOI: 10.1007/s11136-017-1641-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Physical activity (PA) is positively associated with numerous health benefits among cancer survivors. This study examined insufficiently investigated relationships among PA, health-related quality of life (HRQOL), and bowel function (BF) in rectal cancer survivors. METHODS RC survivors (n = 1063) ≥5 years from diagnosis in two Kaiser permanente regions were mailed a multidimensional survey to assess HRQOL and BF. PA was assessed by a modified Godin Leisure-Time Exercise Questionnaire. PA minutes were categorized into weighted categories based on guidelines: (1) not active (zero PA minutes); (2) insufficiently active (1-149 PA minutes); (3) meeting guidelines (150-299 PA minutes); and (4) above guidelines (≥300 PA minutes). Relationships of PA with HRQOL and BF were evaluated using multiple linear regression, stratified by sex and ostomy status for BF. Types of PA identified as helpful for BF and symptoms addressed were summarized. RESULTS Response rate was 60.5%. Of 557 participants, 40% met or exceeded PA guidelines, 34% were not active, and 26% were insufficiently active. Aerobic activities, specifically walking and cycling, were most commonly reported to help BF. Higher PA was associated with better psychological wellbeing and multiple SF12 scales, worse BF scores in men with ostomies, and better BF scores in women. CONCLUSIONS Meeting or exceeding PA guidelines was associated with higher HRQOL. Although the BF findings are exploratory, they suggest women may benefit from increased PA, whereas men with ostomies may face challenges that require more study. Identifying PA strategies that will lead to improved patient compliance and benefit are needed.
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Golsteijn RHJ, Bolman C, Volders E, Peels DA, de Vries H, Lechner L. Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer 2017. [PMID: 28651586 PMCID: PMC5485671 DOI: 10.1186/s12885-017-3397-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems. Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands Methods The OncoActive intervention was developed through systematic adaptation of a proven effective, evidence-based, computer-tailored PA intervention for adults over fifty, called Active Plus. The Intervention Mapping (IM) protocol was used to guide the systematic adaptation. A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed. Change objectives, theoretical methods and applications and the actual program content were adapted to address the specific needs, beliefs and cancer-related issues of prostate and colorectal CPS. Intervention participants received tailored PA advice three times, on internet and with printed materials, and a pedometer to set goals to improve PA. Pre- and pilot tests showed that the intervention was highly appreciated (target group) and regarded safe and feasible (healthcare professionals). The effectiveness of the intervention is being evaluated in a randomized controlled trial (RCT) (n = 428), consisting of an intervention group and a usual care waiting-list control group, with follow-up measurements at three, six and twelve months. Participants are recruited from seventeen hospitals and with posters, flyers and calls in several media. Discussion Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored. Trial registration The study is registered in the Dutch Trial Register (NTR4296) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4296.
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Affiliation(s)
- R H J Golsteijn
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands.
| | - C Bolman
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - E Volders
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - D A Peels
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - H de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - L Lechner
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
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Bauml J, Kim J, Zhang X, Aggarwal C, Cohen RB, Schmitz K. Unsupervised exercise in survivors of human papillomavirus related head and neck cancer: how many can go it alone? J Cancer Surviv 2017; 11:462-468. [PMID: 28194641 DOI: 10.1007/s11764-017-0604-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 02/02/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Patients with human papillomavirus (HPV)-related head and neck cancer (HNC) have a better prognosis relative to other types of HNC, making survivorship an emerging and critical issue. Exercise is a core component of survivorship care, but little is known about how many survivors of HPV-related HNC can safely be advised to start exercising on their own, as opposed to needing further evaluation or supervised exercise. METHODS We utilized guidelines to identify health issues that would indicate value of further evaluation prior to being safely prescribed unsupervised exercise. We performed a retrospective chart review of 150 patients with HPV-related HNC to assess health issues 6 months after completing definitive therapy. Patients with at least one health issue were deemed appropriate to receive further evaluation prior to prescription for unsupervised exercise. We utilized logistic regression to identify clinical and demographic factors associated with the need for further evaluation, likely performed by outpatient rehabilitation clinicians. RESULTS In this cohort of patients, 39.3% could safely be prescribed unsupervised exercise 6 months after completing definitive therapy. On multivariable regression, older age, BMI >30, and receipt of radiation were associated with an increased likelihood for requiring further evaluation or supervised exercise. CONCLUSIONS Over half of patients with HPV-related HNC would benefit from referral to physical therapy or an exercise professional for further evaluation to determine the most appropriate level of exercise supervision, based upon current guidelines. IMPLICATIONS FOR CANCER SURVIVORS Development of such referral systems will be essential to enhance survivorship outcomes for patients who have completed treatment.
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Affiliation(s)
- Joshua Bauml
- Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Jiyoung Kim
- Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | | | - Charu Aggarwal
- Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Roger B Cohen
- Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, South Pavilion, Floor 10, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Surgical Prehabilitation in Patients with Cancer. Phys Med Rehabil Clin N Am 2017; 28:49-64. [DOI: 10.1016/j.pmr.2016.09.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ellis KR, Janevic MR, Kershaw T, Caldwell CH, Janz NK, Northouse L. Engagement in health-promoting behaviors and patient-caregiver interdependence in dyads facing advanced cancer: an exploratory study. J Behav Med 2017; 40:506-519. [PMID: 28078502 DOI: 10.1007/s10865-016-9819-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/26/2016] [Indexed: 11/25/2022]
Abstract
Diet and exercise are important for the wellbeing of people with cancer and their family caregivers. Unfortunately, little is known about their behaviors over time or factors that may influence their engagement in these behaviors. This exploratory study examined the influence of chronic conditions, symptom distress, and perceived social support on exercise and diet behaviors of patients with advanced cancer and their caregivers using the actor-partner interdependence mediation model (APIMeM) and interdependence theory as guiding frameworks. This secondary analysis uses self-report data from a large RCT (N = 484 patient-caregiver dyads) at three time points: baseline data was collected within three months of the diagnosis, at 3 months post-baseline, and 6 months post-baseline. A number of actor effects were observed: patient and caregiver prior exercise and diet were significant predictors of their own future exercise and diet behaviors; more patient-reported social support was associated with less patient exercise; more patient symptom distress was associated with poorer patient diet; and, more caregiver-reported social support was associated with more caregiver exercise and better caregiver diet. Partner effects were also observed: more patient exercise was positively associated with more caregiver exercise; more patient comorbidities were associated with better caregiver diet; more caregiver-reported social support was associated with better patient diet; and, more patient-reported social support was associated with better caregiver diet. Despite the challenges of advanced cancer and caregiving, past exercise and diet behavior remained a significant predictor of future behavior. Other health problems and perceptions of social support within the dyad may exert a positive or negative influence on patient/caregiver diet and exercise.
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Affiliation(s)
- Katrina R Ellis
- Gillings School of Global Public Health, University of North Carolina, 302C Rosenau Hall, CB 7440, Chapel Hill, NC, 27559, USA.
| | - Mary R Janevic
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Nancy K Janz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Annexin A2 Coordinates STAT3 to Regulate the Invasion and Migration of Colorectal Cancer Cells In Vitro. Gastroenterol Res Pract 2016; 2016:3521453. [PMID: 27274723 PMCID: PMC4870365 DOI: 10.1155/2016/3521453] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/11/2016] [Accepted: 03/24/2016] [Indexed: 01/01/2023] Open
Abstract
The present study aimed to reveal the expression of STAT3 and Anxa 2 in CRC specimens and to investigate the effects of STAT3 and Anxa 2 signaling on the proliferation, invasion, and migration in CRC Caco-2 cells. Results demonstrated that both Anxa 2 and STAT3 were highly expressed in CRC specimens in both mRNA and protein levels, with or without phosphorylation (Tyrosine 23 in Anxa 2 and Tyrosine 705 in STAT3). And the upregulated Anxa 2 promoted the phosphorylation of STAT3 (Tyrosine 705) in CRC Caco-2 cells. The upregulated Anxa 2 promoted the proliferation, migration, and invasion of Caco-2 cells in vitro. Moreover, the STAT3 knockdown also repressed the proliferation, migration, and invasion of Caco-2 cells. In conclusion, the overexpressed Annexin A2 regulated the proliferation, invasion, and migration in CRC cells in an association with STAT3.
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Abstract
BACKGROUND Performing regular exercise of at least 150 minutes weekly has benefits for colorectal cancer survivors. However, barriers inhibit these survivors from performing regular exercise. OBJECTIVES The aim of this study was to explore exercise behaviors and significant factors influencing weekly exercise time of more than 150 minutes in colorectal cancer survivors. METHODS A cross-sectional study design was used to recruit participants in Taiwan. Guided by the ecological model of health behavior, exercise barriers were assessed including intrapersonal, interpersonal, and environment-related barriers. A multiple logistic regression was used to explore the factors associated with the amount of weekly exercise. RESULTS Among 321 survivors, 57.0% of them had weekly exercise times of more than 150 minutes. The results identified multiple levels of significant factors related to weekly exercise times including intrapersonal factors (occupational status, functional status, pain, interest in exercise, and beliefs about the importance of exercise) and exercise barriers related to environmental factors (lack of time and bad weather). No interpersonal factors were found to be significant. CONCLUSIONS Colorectal cancer survivors experienced low levels of physical and psychological distress. Multiple levels of significant factors related to exercise time including intrapersonal factors as well as exercise barriers related to environmental factors should be considered. IMPLICATIONS FOR PRACTICE Healthcare providers should discuss with their patients how to perform exercise programs; the discussion should address multiple levels of the ecological model such as any pain problems, functional status, employment status, and time limitations, as well as community environment.
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Backman M, Browall M, Sundberg CJ, Wengström Y. Experiencing health – Physical activity during adjuvant chemotherapy treatment for women with breast cancer. Eur J Oncol Nurs 2016; 21:160-7. [DOI: 10.1016/j.ejon.2015.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/29/2015] [Accepted: 09/22/2015] [Indexed: 01/23/2023]
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Boereboom C, Doleman B, Lund JN, Williams JP. Systematic review of pre-operative exercise in colorectal cancer patients. Tech Coloproctol 2015; 20:81-9. [PMID: 26614304 DOI: 10.1007/s10151-015-1407-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/14/2015] [Indexed: 12/13/2022]
Abstract
The aim of this systematic review was to evaluate the evidence for exercise interventions prior to surgery for colorectal cancer resection. The evidence for use of exercise to improve physical fitness and surgical outcomes is as yet unknown. A systematic search was performed of MEDLINE, EMBASE, CINAHL, AMED and BNI databases for studies involving pre-operative exercise in colorectal cancer patients. Eight studies were included in the review. There is evidence that pre-operative exercise improves functional fitness, and to a lesser extent objectively measurable cardio-respiratory fitness prior to colorectal cancer resection. There is no clear evidence at present that this improvement in fitness translates into reduced peri-operative risk or improved post-operative outcomes. Current studies are limited by risk of bias. This review highlights the common difficulty in transferring promising results in a research setting, into significant improvements in the clinical arena. Future research should focus on which type of exercise is most likely to maximise patient adherence and improvements in cardio-respiratory fitness. Ultimately, adequately powered, randomised controlled trials are needed to investigate whether pre-operative exercise improves post-operative morbidity and mortality.
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Affiliation(s)
- C Boereboom
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - B Doleman
- University of Nottingham, Royal Derby Hospital, Derby, UK.
| | - J N Lund
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - J P Williams
- University of Nottingham, Royal Derby Hospital, Derby, UK
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van Putten M, Husson O, Mols F, Luyer MDP, van de Poll-Franse LV, Ezendam NPM. Correlates of physical activity among colorectal cancer survivors: results from the longitudinal population-based profiles registry. Support Care Cancer 2015; 24:573-583. [PMID: 26173977 PMCID: PMC4689770 DOI: 10.1007/s00520-015-2816-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/25/2015] [Indexed: 02/01/2023]
Abstract
Purpose Physical activity can improve health of cancer survivors. To increase physical activity levels among colorectal cancer (CRC) survivors, we need to understand which factors affect physical activity. Therefore, this study examined the longitudinal relationship between symptom-related, functioning-related, and psychological barriers and socio-demographic and clinical factors with physical activity among CRC survivors. Methods CRC survivors identified from the population-based Eindhoven Cancer Registry (ECR) diagnosed between 2000 and 2009 were included. Survivors completed validated questionnaires measuring moderate-to-vigorous physical activity (MVPA) and barriers in 2010(T1), 2011(T2), and 2012(T3). Linear-mixed models and linear regression techniques were used. Results Response rates were 74 % (N = 2451, T1); 47 % (N = 1547, T2); and 41 % (N = 1375, T3). Several factors were negatively associated with MVPA: symptom-related barriers (e.g., fatigue, dyspnea, chemotherapy side effects, pain, appetite loss, and weight loss); psychological barriers (i.e., depressive symptoms and anxiety); functioning-related barriers (e.g., low physical or role functioning, unfavorable future perspective); socio-demographic (i.e., older age, female, no partner); and clinical factors (i.e., obesity). However, no within-subject effects were significantly associated with MVPA. Groups of functioning-related barriers, socio-demographic factors, symptom-related barriers, psychological barriers, and clinical factors explained 11, 3.9, 3.8, 2.4, and 2.2 % of the variance in MVPA at T1, respectively. Conclusions Several functioning-related and symptom-related barriers and few socio-demographic factors were associated with physical activity among CRC survivors. Future interventions to promote physical activity among CRC survivors could benefit by taking into account functioning aspects and symptoms of cancer and its treatment, and assess the causal direction of these associations.
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Affiliation(s)
- Margreet van Putten
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands
| | - Olga Husson
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Floortje Mols
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Misha D P Luyer
- Department of Gastrointestinal and Oncological Surgeon, Catharina Hospital, Eindhoven, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Nicole P M Ezendam
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
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McCahon D, Daley AJ, Jones J, Haslop R, Shajpal A, Taylor A, Wilson S, Dowswell G. Enhancing adherence in trials promoting change in diet and physical activity in individuals with a diagnosis of colorectal adenoma; a systematic review of behavioural intervention approaches. BMC Cancer 2015; 15:505. [PMID: 26148790 PMCID: PMC4494153 DOI: 10.1186/s12885-015-1502-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/19/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Little is known about colorectal adenoma patients' ability to adhere to behavioural interventions promoting a change in diet and physical activity. This review aimed to examine health behaviour intervention programmes promoting change in diet and/or physical activity in adenoma patients and characterise interventions to which this patient group are most likely to adhere. METHODS Searches of eight databases were restricted to English language publications 2000-2014. Reference lists of relevant articles were also reviewed. All randomised controlled trials (RCTs) of diet and physical activity interventions in colorectal adenoma patients were included. Eligibility and quality were assessed and data were extracted by two reviewers. Data extraction comprised type, intensity, provider, mode and location of delivery of the intervention and data to enable calculation of four adherence outcomes. Data were subject to narrative analysis. RESULTS Five RCTs with a total of 1932 participants met the inclusion criteria. Adherence to the goals of the intervention ranged from 18 to 86 % for diet and 13 to 47 % for physical activity. Diet interventions achieving ≥ 50 % adherence to the goals of the intervention were clinic based, grounded in cognitive theory, delivered one to one and encouraged social support. CONCLUSIONS The findings of this review indicate that behavioural interventions can encourage colorectal adenoma patients to improve their diet. This review was not however able to clearly characterise effective interventions promoting increased physical activity in this patient group. Further research is required to establish effective interventions to promote adherence to physical activity in this population.
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Affiliation(s)
- Deborah McCahon
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Amanda J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Janet Jones
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard Haslop
- Critical Care and Perioperative Medical Research Group, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Arjun Shajpal
- School of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Aliki Taylor
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sue Wilson
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - George Dowswell
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Laine J, D'Souza A, Siddiqui S, Sayko O, Brazauskas R, Eickmeyer SM. Rehabilitation referrals and outcomes in the early period after hematopoietic cell transplantation. Bone Marrow Transplant 2015; 50:1352-7. [PMID: 26146804 DOI: 10.1038/bmt.2015.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/14/2015] [Accepted: 05/12/2015] [Indexed: 11/09/2022]
Abstract
In a cohort of inpatient hematopoietic cell transplantation (HCT) recipients, we assessed patterns of referral to rehabilitation treatment, functional performance and short-term outcomes in patients who received post-transplant rehabilitation in comparison with those who did not. Among 201 first-time HCT recipients, 53 (26%) were referred to an inpatient rehabilitation provider, had an assessment of functional performance using the Functional Independence Measure scale and underwent rehabilitation treatments to address functional needs. Patients who received rehabilitation therapy were more likely to be females (P=0.02), older than 60 years of age (P=0.0146), employed (P=0.01), have hypertension (P=0.02), peripheral vascular disease (P=0.01) and pre-transplant Karnofsky Performance Score (KPS) <90 (P=0.02). Mean functional performance scores for transfers and ambulation increased significantly in the group with rehabilitation interventions (P=0.0022 and P<0.0001, respectively). There was no difference between the groups that did and did not receive rehabilitation treatments in 30-day re-admission rates. Patients who are 60 years of age or older, with pre-transplant KPS<90, and pre-transplant hypertension were more likely to be referred for rehabilitation treatments in the early period after HCT. Future studies should be designed to determine the optimal timing and cost effectiveness of functional assessment and rehabilitation treatments in this high-risk population.
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Affiliation(s)
- J Laine
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - A D'Souza
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Siddiqui
- Wheaton Franciscan-St Joseph Campus, Milwaukee, WI, USA
| | - O Sayko
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S M Eickmeyer
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS, USA
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Williams GR, Nyrop KA, Deal AM, Muss HB, Sanoff HK. Self-directed physical activity intervention in older adults undergoing adjuvant chemotherapy for colorectal cancer: Design of a randomized controlled trial. Contemp Clin Trials 2015; 42:90-7. [DOI: 10.1016/j.cct.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 02/08/2023]
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Lee J, Lee M, Hong S, Kim JY, Park H, Oh M, Yang HI, Kang DW, Park J, Kim DI, Chu S, Lee J, Hur H, Kim NK, Jeon JY. Association between physical fitness, quality of life, and depression in stage II-III colorectal cancer survivors. Support Care Cancer 2015; 23:2569-77. [PMID: 25688034 DOI: 10.1007/s00520-015-2615-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The impact of cancer on quality of life and depression is an important issue. The purpose of this study was to identify the impact of physical fitness on quality of life and depression in stage II-III colorectal cancer survivors. METHODS Participants in the current study included 122 stage II-III colorectal cancer survivors (57 females; 56.67 ± 9.16 years of age and 55 males; 54.69 ± 9.78 years of age). Fitness was assessed using the 6-min walk test, chair stand test, and push-up test. Quality of life and depression were measured using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale and a 9-item patient health questionnaire interview, respectively. RESULTS There was a significant association between physical fitness and quality of life and depression in colorectal cancer survivors. The 6-min walk test results were associated with FACT-C total (r = 0.298, p < 0.05), physical well-being (r = 0.230, p < 0.05), functional well-being (r = 0.234, p < 0.05), colorectal cancer concern (r = 0.229, p < 0.05), and depression (r = -0.228, p < 0.05), and the chair stand test results were associated with functional well-being (r = 0.231, p < 0.05), colorectal cancer concern (r = 0.242, p < 0.05), and depression (r = -0.227, p < 0.05) even after controlling for all potentially confounding variables. A multiple regression analysis indicated that the 6-min walk was a significant predictor of health-related quality of life, and participants in the lowest tertile of the 6-min walk test results had lower quality of life and greater depression than those in the highest tertile. CONCLUSION Improving and maintaining physical fitness are important for quality of life and depression in stage II-III colorectal cancer survivors.
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Affiliation(s)
- Junga Lee
- Department of Sport and Leisure Studies, Yonsei University, 134 Seodaemun-Gu, Shinchon-Dong, Seoul, Korea, 120-749
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Husson O, Mols F, Ezendam NPM, Schep G, van de Poll-Franse LV. Health-related quality of life is associated with physical activity levels among colorectal cancer survivors: a longitudinal, 3-year study of the PROFILES registry. J Cancer Surviv 2015; 9:472-80. [DOI: 10.1007/s11764-014-0423-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 12/17/2014] [Indexed: 12/26/2022]
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Abstract
PURPOSE Clinical guidelines recommend that oncologists prescribe exercise to their patients with colorectal cancer (CRC). However, 84% of oncologists do not prescribe exercise, citing concerns of safety and feasibility. Data are inadequate regarding the proportion of CRC survivors that could be safely prescribed with the dose of exercise recommended by the American College of Sports Medicine (ACSM), American Cancer Society (ACS), or National Comprehensive Cancer Network (NCCN) in an unsupervised setting. METHODS We reviewed published guidelines for exercise prescription among cancer survivors and extracted health factors that may necessitate referral to trained personnel (physical therapist or exercise professional) for an individualized exercise program or supervision of exercise as recommended by the ACSM/ACS/NCCN. We applied these health factors to a cohort of nonmetastatic CRC survivors 6 months after completing curative care. The primary outcome was the proportion of CRC survivors to whom oncologists could prescribe unsupervised exercise at the dose recommended by the ACSM/ACS/NCCN. RESULTS Among 351 CRC survivors, 6 months after curative care, 21%-42% of patients could be prescribed with the dose of exercise recommended by the ACSM/ACS/NCCN. Estimates varied as a function of the inclusion or exclusion of several prevalent comorbid health conditions including hypertension, diabetes, arthritis, obesity, and hyperlipidemia. CONCLUSIONS Our data are consistent with the clinical observation that a large proportion of CRC survivors may be unable to participate in unsupervised exercise 6 months after curative care. These data underscore the need for continued research to clarify the safety and feasibility of prescribing exercise to CRC survivors.
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Affiliation(s)
- Justin C Brown
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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Abstract
UNLABELLED There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management. METHODS This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors. RESULTS The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort. CONCLUSIONS Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.
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Affiliation(s)
- David O Garcia
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
| | - Cynthia A Thomson
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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Sax AT, Jenkins DG, Devin JL, Hughes GI, Bolam KA, Skinner TL. The insulin-like growth factor axis: A biological mechanism linking physical activity to colorectal cancer survival. Cancer Epidemiol 2014; 38:455-9. [PMID: 24968815 DOI: 10.1016/j.canep.2014.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 12/17/2022]
Abstract
Physical activity (PA) is related to colorectal cancer (CRC) mortality, with approximately 15% of CRC deaths worldwide attributable to physical inactivity. Moreover, higher levels of PA in CRC survivors have been associated with a reduced risk of the disease recurring. Despite the recognised nexus between PA and the risk of CRC, the physiological mechanisms underlying the inverse relationship between PA and mortality following CRC diagnosis are less apparent, with evidence primarily drawn from epidemiological studies. The insulin-like growth factor (IGF) axis plays a central role in cellular growth, proliferation regulation, differentiation and apoptosis. Specifically, high levels of insulin-like growth factor 1 (IGF-1) have been consistently linked to the severity of CRC tumours. Further, insulin-like growth factor binding protein 3 (IGFBP-3) regulates the bioavailability of IGF-I and therefore plays a central role in CRC prognosis. Decreasing levels of IGF-1 and increasing levels of IGFBP-3 may thus be a plausible mechanism underlying the inverse association between PA and CRC survival.
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Affiliation(s)
- Andrew T Sax
- School of Human Movement Studies, The University of Queensland, Australia.
| | - David G Jenkins
- School of Human Movement Studies, The University of Queensland, Australia
| | - James L Devin
- School of Human Movement Studies, The University of Queensland, Australia
| | - Gareth I Hughes
- School of Human Movement Studies, The University of Queensland, Australia
| | - Kate A Bolam
- School of Human Movement Studies, The University of Queensland, Australia
| | - Tina L Skinner
- School of Human Movement Studies, The University of Queensland, Australia
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