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Donz R, Russia B, Barbaret C, Braybrook D, Perceau-Chambard E, Reverdy T, Economos G. What contributes to promote sexual health in cancer palliative care? A realist review. Sex Med Rev 2024; 12:334-345. [PMID: 38508856 DOI: 10.1093/sxmrev/qeae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored. OBJECTIVES In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care. METHODS A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations. RESULTS Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo. CONCLUSIONS The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.
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Affiliation(s)
- Roxane Donz
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
| | - Bruno Russia
- Hospitalisation à domicile, Centre Léon Bérard, Lyon 69008, France
| | - Cécile Barbaret
- Service de soins palliatifs, CHU de Grenoble, La Tronche 38700, France
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London SE5 9PJ, United-Kingdom
| | - Elise Perceau-Chambard
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Thibaut Reverdy
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
- Oncology Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Guillaume Economos
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
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Wennerberg C, Hellström A, Schildmeijer K, Ekstedt M. Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial. JMIR Cancer 2023; 9:e44320. [PMID: 37672332 PMCID: PMC10512115 DOI: 10.2196/44320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. OBJECTIVE This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. METHODS A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. RESULTS This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (β=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (β=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15). CONCLUSIONS ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. TRIAL REGISTRATION ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11625.
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Affiliation(s)
- Camilla Wennerberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Surgery, Region Kalmar County, Kalmar, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Management, Informatics and Ethics, Karolinska Institutet, Stockholm, Sweden
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Chung E, Rhee H. Impact of Physical Exercise Program Interventions on Erectile Function and Cardiovascular Health in Males with Prostate Cancer. World J Mens Health 2022; 40:361-367. [PMID: 34169682 PMCID: PMC9253808 DOI: 10.5534/wjmh.210032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022] Open
Abstract
Prostate cancer (PC) and its associated treatments can cause significant cardiovascular and sexual dysfunctions. While structured exercise interventions can induce positive outcomes in males with PC, there are limited data on its effects on cardiovascular health, erectile function, or the combination of these outcomes. It has been proposed that positive changes in biomarkers of cardiovascular health through physical exercise programs, can result in cardiovascular remodelling and improve penile haemodynamic and erectile function recovery in those with metabolic syndrome and/or cardiovascular diseases, although the data is accruing in males who are diagnosed and/or treated for PC. While the results of this review article support structured physical exercise interventions to effectively prevent and mitigate the development of both sexual and cardiovascular dysfunctions in males with PC, appropriate caution should be maintained and future clinical research should focus on the development of standardised and evidence-based exercise guidelines in the setting of PC survivorship.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD and Sydney, NSW, Australia
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
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4
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Reimer N, Zopf EM, Böwe R, Baumann FT. Effects of Exercise on Sexual Dysfunction in Patients With Prostate Cancer - A Systematic Review. J Sex Med 2021; 18:1899-1914. [PMID: 37057481 DOI: 10.1016/j.jsxm.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emerging evidence suggests that exercise interventions may improve sexual dysfunction, one of the most common and distressing long-term adverse effects of cancer treatment. AIM The aim of this systematic review is to provide an overview of the effects of exercise on sexual dysfunction in prostate cancer patients. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The systematic literature search was performed on 13th July 2021 using CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing sexual function in prostate cancer patients conducting an exercise intervention alone or in combination with other supportive interventions. The methodological quality was assessed using the Physiotherapy Education Database Score and Jadad scale. Outcomes were reported as between-group differences. Intragroup differences were also reported if significant. OUTCOMES Positive intervention effects on sexual function were primarily observed in patients following prostatectomy and undergoing anti-hormone treatment and for pelvic floor muscle exercises as well as aerobic and resistance exercise. RESULTS 22 RCTs (n = 1.752 patients) met the eligibility criteria, conducting either an exercise-only intervention (n = 10), a multimodal (exercise plus other supportive therapy) intervention (n = 4), or pelvic floor muscle exercises (n = 8). 6 RCTs assessed sexual dysfunction as a primary endpoint and 8 RCTs used dedicated assessment methods. 9 of the 22 RCTs found significant between-group differences in favor of the intervention group. CLINICAL IMPLICATIONS The multifaceted etiology of sexual dysfunction provides a strong rationale to further investigate the effects of exercise on sexual dysfunction in prostate cancer patients and also to consider a multidisciplinary approach. STRENGTHS AND LIMITATIONS A strength is the comprehensive literature search to identify RCTs involving different exercise interventions and a wide range of sexual function assessments. Further, this is the first systematic review on this topic. The main limitations include the difficulty to compare studies due to the heterogeneity of exercise interventions and low questionnaire completion rates in some studies. CONCLUSION Preliminary data from a small number of studies suggest that certain exercise interventions may improve sexual dysfunction in prostate cancer patients, however further trials involving sexual dyfunction as a primary outcome and more comprehensive assessment tools are needed to confirm the rehabilitative and preventive effects of exercise on sexual dysfunction in prostate cancer patients. Nadine Reimer, Eva Maria Zopf, Rebecca Böwe, et al. Effects of Exercise on Sexual Dysfunction in Patients With Prostate Cancer - A Systematic Review. J Sex Med 2021;18:1899-1914.
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Affiliation(s)
- Nadine Reimer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany.
| | - Eva Maria Zopf
- Australian Catholic University, Mary MacKillop Institute for Health Research, Melbourne, Australia
| | - Rebecca Böwe
- Hochschule Fresenius, University of Applied Sciences, Faculty of Health & Social Work, Cologne, Duesseldorf, Germany
| | - Freerk Theeagnus Baumann
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
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Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc 2020; 51:2375-2390. [PMID: 31626055 DOI: 10.1249/mss.0000000000002116] [Citation(s) in RCA: 1307] [Impact Index Per Article: 326.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue. METHODS A second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes. RESULTS Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain. CONCLUSIONS The proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice.
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Affiliation(s)
- Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, CANADA
| | - Kerri M Winters-Stone
- School of Nursing and Knight Cancer Institute, Oregon Health Sciences University, Portland, OR
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Clinic, Heidelberg, GERMANY
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, AZ
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, CANADA
| | - David S Zucker
- Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, WA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | - Lynn H Gerber
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA.,Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA
| | | | - Alpa V Patel
- Epidemiology Research, American Cancer Society, Atlanta, GA
| | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Frank M Perna
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Behaviors Research Branch, National Cancer Institute, Rockville, MD
| | - Kathryn H Schmitz
- Public Health Science, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA
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Ekstedt M, Schildmeijer K, Wennerberg C, Nilsson L, Wannheden C, Hellström A. Enhanced Patient Activation in Cancer Care Transitions: Protocol for a Randomized Controlled Trial of a Tailored Electronic Health Intervention for Men With Prostate Cancer. JMIR Res Protoc 2019; 8:e11625. [PMID: 30900999 PMCID: PMC6450475 DOI: 10.2196/11625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Prostate cancer has increased in incidence worldwide and is the leading cause of cancer death in 24 countries. The most common treatment is radical prostatectomy. However, surgery is associated with postoperative complications such as urinary incontinence and sexual dysfunction, causing decreased quality of life. If survivors are encouraged to be more active in self-care management, the symptom burden may decrease and quality of life may improve. An electronic health (eHealth) intervention based on motivational behavioral theory has been developed for this purpose. Objective This study aimed to compare the effectiveness of standard care in combination with a tailored eHealth and mobile health self-management support system, electronic Patient Activation in Treatment at Home (ePATH), with standard care of adverse effects of prostate cancer treatment (urinary incontinence and sexual functioning) in men undergoing radical prostatectomy. The secondary aim was to test the effect on patient activation, motivation, overall well-being, and health literacy over time in and between groups. Methods A pragmatic multicenter, block-randomized controlled trial with 2 study arms, standard care (control) and eHealth-assisted standard care (intervention), for patients undergoing radical prostatectomy. For 80% power, a sample of 242 men will need to be recruited. Results Recruitment started in January 2018 and is expected to be completed by August 2019. Data collection will be completed in August 2020. The first cross-sectional results from this trial are anticipated to be published in January 2020. Conclusions With the increasing number of prostate cancer survivors, attention should be paid to rehabilitation, psychosocial care, and support for endurance of self-care to reduce suffering from adverse treatment effects, poor quality of life, and depression because of postoperative complications. This project may increase knowledge of how patients can be supported to feel involved in their care and returning to as normal a life as possible. The anticipated effects of ePATH could improve health outcomes for individuals and facilitate follow-up for health care professionals. Trial Registration International Standard Randomised Controlled Trial Number: 18055968; http://www.isrctn.com/ISRCTN18055968 (Archived by WebCite at http://www.isrctn.com/ISRCTN18055968). International Registered Report Identifier (IRRID) DERR1-10.2196/11625
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Affiliation(s)
- Mirjam Ekstedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Camilla Wennerberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Surgery, Kalmar County Council, Kalmar, Sweden
| | - Lina Nilsson
- eHealth Institute, Department of medicine and optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Department of Informatics, Faculty of Technology, Linnaeus University, Kalmar, Sweden
| | - Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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7
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Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJC, Rosario DJ, Thaha MA, Bourke L. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2018; 9:CD010192. [PMID: 30229557 PMCID: PMC6513653 DOI: 10.1002/14651858.cd010192.pub3] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in the Cochrane Library 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. OBJECTIVES To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? SEARCH METHODS We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. MAIN RESULTS We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week).Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). AUTHORS' CONCLUSIONS Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population.
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Affiliation(s)
- Rebecca R Turner
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Liz Steed
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public HealthBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Helen Quirk
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - Rosa U Greasley
- Sheffield Hallam UniversityCentre for Sport and Exercise ScienceA124 Collegiate Hall, Collegiate CrescentSheffieldSouth YorkshireUKS10 2BP
| | - John M Saxton
- Northumbria UniversityDepartment of Sport, Exercise, and RehabilitationNewcastle‐upon‐TyneUKNE1 8ST
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
| | - Derek J Rosario
- University of SheffieldDepartment of OncologyBeech Hill RoadRoyal Hallamshire HospitalSheffieldUKS010 2RX
| | - Mohamed A Thaha
- Barts & The London School of Medicine & Dentistry, Queen Mary University LondonAcademic Surgical Unit, National Centre for Bowel Research & Surgical Innovation, Centre for Digestive Diseases, Blizard Institute1st Floor, Abernethy Building, 2 Newark StreetThe Royal London Hospital, WhitechapelLondonEnglandUKE1 2AT
| | - Liam Bourke
- Sheffield Hallam UniversityHealth and Wellbeing Research InstituteSheffieldUKS10 2BP
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Grondhuis Palacios LA, Krouwel EM, den Oudsten BL, den Ouden MEM, Kloens GJ, van Duijn G, Putter H, Pelger RCM, Elzevier HW. Suitable sexual health care according to men with prostate cancer and their partners. Support Care Cancer 2018; 26:4169-4176. [PMID: 29876833 PMCID: PMC6209012 DOI: 10.1007/s00520-018-4290-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/23/2018] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine which health care provider and what timing is considered most suitable to discuss sexual and relational changes after prostate cancer treatment according to the point of view of men and their partners. METHODS A cross-sectional survey was conducted among men diagnosed with prostate cancer or treated after active surveillance, who received laparoscopic radical prostatectomy, brachytherapy, intensity-modulated radiotherapy, and/or hormonal therapy. If applicable, partners were included as well. RESULTS In this survey, 253 men and 174 partners participated. Mean age of participating men was 69.3 years (SD 6.9, range 45-89). The majority (77.8%) was married and average length of relationship was 40.3 years (SD 14.1, range 2-64). Out of 250 men, 80.5% suffered from moderate to severe erectile dysfunction. Half of them (50.2%, n = 101) was treated for erectile dysfunction and great part was partially (30.7%, n = 31) up to not satisfied (25.7%, n = 26). Half of the partners (50.6%, n = 81) found it difficult to cope with sexual changes. A standard consultation with a urologist-sexologist to discuss altered sexuality is considered preferable by 74.7% (n = 183). Three months after treatment was the most suitable timing according to 47.6% (n = 49). CONCLUSIONS During follow-up consultations, little attention is paid to the impact of treatment-induced sexual dysfunction on the relationship of men with prostate cancer and their partners. A standard consultation with a urologist-sexologist 3 months after treatment to discuss sexual and relational issues is considered as most preferable.
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Affiliation(s)
| | - Esmée M Krouwel
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Marjolein E M den Ouden
- Research Center of Nursing, Saxion University of Applied Sciences, PO Box 70000, 7500 KB, Enschede, The Netherlands
| | - Gert Jan Kloens
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Grethe van Duijn
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
| | - Henk W Elzevier
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 WB, Leiden, The Netherlands
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Perceptions of masculinity and body image in men with prostate cancer: the role of exercise. Support Care Cancer 2018; 26:3379-3388. [DOI: 10.1007/s00520-018-4178-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
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Mundell NL, Daly RM, Macpherson H, Fraser SF. Cognitive decline in prostate cancer patients undergoing ADT: a potential role for exercise training. Endocr Relat Cancer 2017; 24:R145-R155. [PMID: 28209634 DOI: 10.1530/erc-16-0493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
Androgen deprivation therapy (ADT) is an effective and widely prescribed treatment for prostate cancer (PCa), but it is associated with multiple treatment-induced adverse effects that impact on various musculoskeletal and cardiometabolic health outcomes. Emerging research has shown that ADT is also associated with cognitive impairment, which has been linked to a loss of independence, increased falls and fracture risk and greater use of medical services. The aim of this review is to outline the evidence related to the effect of ADT use on cognitive function, and propose a role for exercise training as part of usual care to prevent and/or manage cognitive impairments for PCa survivors on ADT. The following results have been obtained from this study. ADT has been shown to adversely affect specific cognitive domains, particularly verbal memory, visuomotor function, attention and executive function. However, current clinical guidelines do not recommend routine assessment of cognitive function in these men. No studies have examined whether exercise training can preserve or improve cognitive function in these men, but in healthy adults', multimodal exercise training incorporating aerobic training, progressive resistance training (PRT) and challenging motor control exercises have the potential to attenuate cognitive decline. In conclusion, as treatment with ADT for men with PCa has been associated with a decline in cognition, it is recommended that cognitive function be routinely monitored in these men and that regular exercise training be prescribed to preserve (or improve) cognitive function. Assessment of cognition and individualised exercise training should be considered in the usual treatment plan of PCa patients receiving ADT.
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Affiliation(s)
- Niamh L Mundell
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Helen Macpherson
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Steve F Fraser
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Zhou ES, Bober SL, Nekhlyudov L, Hu JC, Kantoff PW, Recklitis CJ. Physical and emotional health information needs and preferences of long-term prostate cancer survivors. PATIENT EDUCATION AND COUNSELING 2016; 99:2049-2054. [PMID: 27439668 PMCID: PMC5675563 DOI: 10.1016/j.pec.2016.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/22/2016] [Accepted: 07/12/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effects of treatment. Their interest/preferences for receiving information about addressing common sequelae is not well understood. We examined long-term PC survivors' level of interest, whether this differed based upon symptomatology, and their preferred coping information source. METHODS N=615 PC survivors (3-8 years post-diagnosis) completed a survey on physical and psychological health and their information interests and preferences related to late effects of cancer treatment. RESULTS Over half of PC survivors reported interest in information about late effects of treatment or sexual health, while approximately a quarter were interested in emotional health information. Survivors preferred to receive information about late effects of treatment from their oncologists, sexual health information from their primary care providers (PCP), oncologist, or written/online resources, and emotional health information from their PCP. Information needs were more commonly reported among men with poorer domain-specific health functioning. CONCLUSION Long-term PC survivors report significant interest in receiving information about their physical, sexual, and emotional health. PRACTICE IMPLICATIONS Medical providers caring for these men should inquire about survivors' information needs and future intervention efforts should consider who delivers the information, dependent upon the type of dysfunction reported.
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Affiliation(s)
- Eric S Zhou
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
| | - Sharon L Bober
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
| | - Larissa Nekhlyudov
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical Center, 1300 York Avenue, New York, NY, USA.
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 600 Third Avenue, New York, NY, USA.
| | - Christopher J Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
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Maintaining intimacy for prostate cancer patients on androgen deprivation therapy. Curr Opin Support Palliat Care 2016; 10:55-65. [PMID: 26761788 DOI: 10.1097/spc.0000000000000190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Androgen deprivation therapy (ADT) causes erectile dysfunction and increases patients' emotionality while diminishing their sexual interest. ADT has been linked to erosion of spousal bonds; however, this is not an invariant outcome. Understanding the factors that lead to these various outcomes may help couples deal with ADT. RECENT FINDINGS A subset of couples report that they became closer as a result of the patients going on ADT. Recent data suggest that what helps couples most is preemptive awareness of ADT's side-effects and congruence in how patients and their partners understand and accept the psychosexual impact of ADT. Sex therapy for prostate cancer patients divides along gendered lines, with distinctly 'male' (recovery of erections) and 'female' (promoting sexual practices that are not erection dependent) approaches. Unfortunately, neither is very effective for couples when the patient is on ADT. Options beyond the standard gendered framework, such as use of an external penile prosthesis, may be worth offering to ADT patients trying to find a 'new normal' that is sexually rewarding for them. SUMMARY Intimacy is sharing something with someone that one shares with no one else. Exploring novel sexual practices can help couples stay intimate, even when the patient is on ADT.
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Østergren PB, Kistorp C, Bennedbæk FN, Faber J, Sønksen J, Fode M. The use of exercise interventions to overcome adverse effects of androgen deprivation therapy. Nat Rev Urol 2016; 13:353-64. [DOI: 10.1038/nrurol.2016.67] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, Albertsen PC, Tombal B, Payne HA, Rosario DJ. Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol 2016; 69:693-703. [DOI: 10.1016/j.eururo.2015.10.047] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/23/2015] [Indexed: 12/21/2022]
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Sexuality and exercise in men undergoing androgen deprivation therapy for prostate cancer. Support Care Cancer 2014; 23:133-42. [DOI: 10.1007/s00520-014-2327-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
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